Managed Care and the Future of Psychiatry

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Abstract
IN 1987,1one of us (T.D.) issued 3 predictions about the future of psychiatry, all of which have come true: (1) The promiscuous use of psychiatry to address a world of problems that are not biomedical and are unrelated to individual patients or their families has diluted the specialty's focus and made it what it should not be—a proposed solution to social ills. (2) The routinization of complex clinical tasks has inevitably resulted in downward decentralization, en-abling lower-level professionals to take over responsibilities that were once the purview of physi-$ cians. (3) New knowledge about the brain and the mind have made it mandatory for psychiatry and neurology to mate for life to assure the future of both. These comments may have been considered gratuitous baiting of colleagues until managed care entered our lives, accelerating a process that would have occurred anyway but at a slower pace.