We opened this book with some very firm and unambiguous statements about the state of modern psychiatry. In Chapter 1 we said: ‘There is more cause for therapeutic optimism now than at any other time in the history of psychiatry’, ‘looking back over our lengthy careers in psychiatry what is really striking is a dramatic improvement in the quality of mental health services.’ Attentive readers will have noticed that in subsequent chapters, we have condemned or moaned about a wide range of prominent features of modern mental health services, from government policy to the overuse of counselling. If there is any merit in the arguments that we have made, how can we sustain an upbeat expectation of the future of psychiatry as a therapeutic endeavour?

There have been many ignoble episodes in the history of psychiatry. From time to time it has allowed itself to be misused. Its practitioners have sometimes embraced practices that are objectively harmful to people with mental illness. However, we believe that it is possible to identify a legitimate historical mission that psychiatry has followed from its inception in the nineteenth century until today.

Psychiatry came into existence as a consequence of the formation of the asylums. This was a project that aimed to provide humane and rational care for people suffering from mental illness, rescuing them from the abuses of the private madhouses.