Pharmacotherapies that are at least partially specific and research that delineates diagnostic subgroups instill a new purpose into careful diagnosis and treatment monitoring. Today's psychiatrist must not only perfect psychotherapeutic skills, but also must exercise vigilance in differential diagnosis and be able to use not one or two but several therapies.
From the mid-1930s to its peak in the mid-1950s, the trend in American psychiatry, except for a few centers, was to overlook the diagnosis of manic-depressive disease and to overdiagnose schizophrenia; the diagnosis of schizophrenia was made eightfold more here than in Great Britain.1 Historical, cross-national, and contemporary research predict that admissions for rigorously and reliably diagnosed schizophrenia and affective disorders should be close to a 1:1 ratio. Even now there may be 100,000 people classified as chronic schizophrenics who, with systematic and rigorous rediagnosis, would be reclassified as having affective disorders. Perhaps an overdiagnosis of