Brave New Millennium - Part II

The following article is based on a series of pieces that recently appeared in my Depression and Bipolar Weekly:

At the end of the 21st century, according to an article by Steven Sharfstein MD appearing in the Dec issue of the Archives of General Psychology, one third of the gross domestic product in the US will be spent on health care. High-tech gene health centers - the hospitals of an earlier age - will provide gene therapy, biomedical engineering, and organ replacements to all those in need, but many of the basic services will take place at home or work.

The horrors of managed care will be a thing of the past, to be replaced by the free market and the government working together in a form of enlightened partnership. All physicians will be the employees of one of several gigantic health care corporations, which will compete for patients enrolled through the government.

Many of you reading this will be around to see these predictions come true, according to the article, for Americans will live to an average age of 105 years, and people celebrating their 130th and 140th birthdays will not be uncommon.

Mind you, we will be blowing out the birthday candles with the aid of genetically-engineered replacement lungs, not to mention almost all our other organs

Only our brains will be irreplaceable. Hence the continued need for psychiatrists, whose certifications will be in neuroscience, medical psychiatry, psychotherapy, and social psychiatry. The neuroscientist/psychiatrist with a combined MD and PhD will be the most highly specialized (and highly paid), an expert on the human genome, brain imaging and mapping, the differential use of neurochemicals, and the application of high technology.

Supercomputers programmed with the entire sequence of the human genome and different functions of the parts of the brain will perform much of the diagnostic chores, with sophisticated guidelines for biological and nonbiological interventions. Psychiatric hospitals will be a thing of the past, many medications will be available over the counter, and prescription drugs will be introduced via high-tech delivery systems into the brain.

That is, assuming there will be any patients left to practice on. In another article in the same issue, Robert Michels MD predicts that thanks to genetic embryo screening, "DSM-IV classics" will be rare. Rather than focusing on treatments for mental illness, psychiatry will be organized to help us fulfill our human potential.

However the future shapes up, both authors appear to view the present in terms of the bad old days. According to Michels: "Psychiatry treat[s] psychological disasters, but offer[s] little to improve the lives of the

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