Alienist in the 21st century

Until about the 19th century, doctors working with patients with mental illness were called ‘alienists’ and patients were called ‘aliens’. Patients were to be differentiated from vagabonds and vagrants. Alienists provided largely containment. With changes in attitudes and knowledge, patients were liberated from their chains. In the 20th century with new treatments, especially pharmacological interventions becoming available, the role of the institutions and doctors changed dramatically. With increasing improvements and changes in public attitudes and expectations, gradually psychiatric asylums were closed and patients and clinical services moved to the community. Now, as the first decade of the 21st century draws to a close, challenges facing psychiatrists are of a different kind. With the expansion of the knowledge base among patients and ease of access to information, the traditional equation of doctor–patient relationship is changing and becoming more equal. Also, an emphasis on quality of services has become ever so important. In addition, the profession needs to deal with stigma and the advent of psychopharmacogenomics. However, in spite of some skepticism, patients will always need psychiatrists, even though their roles may change. In this paper we highlight some of these issues and suggest some ways to move forward.