Psychiatric Annals

Editorial Free

Psychiatry and Medicine in Transition

Jan Fawcett, MD

This issue of Psychiatric Annals, guest edited and written by Devdutt Nayak, MD, and his collaborators, focuses on the placebo response. Dr. Nayak and his co-authors have crafted an elegant series of reviews of the placebo response that speak in a much broader sense to our potential for therapeutic effects in the clinical treatment of our patients. He covers the mechanisms of self-healing we have the potential to encourage in our patients, including social, psychological, and neuronal or biological mechanisms, from many perspectives.

It is particularly important that we remind ourselves of this potential at a point where psychiatry and medicine is in transition from the 19th-century Oslerian model of symptom categories to a model of systems biology leading to personalized medicine. As Dr. Nayak discusses, many of our medications directed at symptoms we categorize as disorders, such as anxiety, depression, and psychosis, have very limited effects when one separates out placebo effects, and many of our psycho-therapeutic treatments seem to recruit psychological forces for healing that are non-specific to the theories underlying the treatment.

We are realizing the limitations of a categorical model based on symptoms inherent in the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases systems of diagnosis — which are not very efficient at leading to effective treatment — and realizing the need for more specific knowledge of the underlying biology to create more specific and effective treatment interventions. At the same time, an understanding of the general therapeutic mechanisms underlying the effectiveness of our treatment allows us to get the most positive effects we can for our patients; this is important to be conscious of while we gain knowledge of systems biology approaches to specific mechanisms underlying various disorders or disease manifestations and can be more directly effective in our efforts to heal.

A further development and synthesis of known mechanisms of non-specific healing combined with more specific approaches to treatment as we learn about them will enhance both our ability to diagnose and more effectively treat conditions that undermine the human experience.

Thank you, Dr. Nayak and colleagues, for reminding us of this area of knowledge that can enhance our ability to help our patients weather their storms.


Jan Fawcett, MD, is a Professor with the Department of Psychiatry at the University of New Mexico School of Medicine. He was chairperson of the DSM-5 Mood Disorders Task Force.

Contact Dr. Fawcett via email:


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