In the early 1980s, American psychiatry declared a biological revolution. The Freudian ideas, that had dominated understanding and treatment since at least World War II, were denounced as unscientific and retrograde. Drugs, brain science and genes were declared the future of mental health care. More than thirty years later, there are clear signs that this so-called revolution is running into the sand. Far from flocking to psychiatry, many pharmaceutical companies have been fleeing it. The diagnostic manual on which profession has rested so much of its biological authority has come under sharp attack, not just by cranky outsiders but by informed insiders committed to the mission.

To understand why this has happened, we need to rethink our understanding of the events of the 1980s and beyond. A revolution was declared, but the period was not marked by any revolutionary new scientific understandings. The call to “revolution” was instead a way of rhetorically summoning a new vision of psychiatry’s identity and destiny into existence. The challenge is to understand why it was summoned, and all the ways in which it became a critically important belief system under which all sorts of stakeholders carried out—and still carry out—their business. Only once we understand that can we understand why it left behind such an unsatisfactory legacy.