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Thomas Reilly's avatar

Fascinating discussion. My only quibble is with ‘the most important breakthrough in psychiatry in my lifetime has been cognitive behavior therapy’.

I can think of various psychiatric treatments from 70s onward which seem more transformational than CBT - clozapine for treatment resistant schizophrenia and lithium for bipolar disorder spring to mind.

If anything, recent research seems to challenge the superiority of CBT over other modalities of psychotherapy!

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Eric Turkheimer's avatar

On a quick look, Clozapine was first developed in 1958 (I was 4) and Lithium long before i was born. On a fair reading of lifetime to mean, "my professional career" we are talking about developments since the 80s.

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Thomas Reilly's avatar

Apologies for inadvertently discussing your age!

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Awais Aftab's avatar

Ha! I had a quibble with that too, and Eric and I had a little discussion off the books about it. I think the development of second-generation antipsychotics and antidepressants and elaboration of the associated molecular pharmacology shaped psychiatric practice as much as CBT shaped clinical psychology. The limitations of both are also painfully evident now.

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Awais Aftab's avatar

What would be on your list?

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Thomas Reilly's avatar

Other than clozapine and lithium, I agree with you!

Maybe you could make an argument for CBT having the potential to help more people with common mental disorders (mild-moderate depression / anxiety), but I don’t think it has greatly influenced the treatment of major mental illnesses (bipolar disorder, schizophrenia)

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Steve Pittelli, MD's avatar

There is nothing “gloomy” about the prospect of leveling a century and a half of genetic determinism, which has led to so much harm and misery. It’s a chance to have real discussions about the human mind without the usual suspects pigeon-holing it. Good riddance to the fantasy that is behavioral genetics.

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