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This article focuses on the ways of integrating psychiatry and medicine. The notion of a psychiatrist with such broad-ranging biopsychosocial knowledge is becoming increasingly plausible, given recent developments in the field of psychosomatic medicine. The term psychosomatic was first used by the German physician Johann Christian Heinroth in 1818, when discussing causes of insomnia, and the term psychosomatic medicine is thought to have been introduced by Felix Deutsch, Maryland, around 1922. The 1920s also saw the emergence of general hospital psychiatric units in the U.S., such as the one at Henry Ford Hospital in Detroit. INSET: Acknowledgement..

This article presents clinical reflections on cosmetic psychiatry. It is the mission of psychiatrists to render assistance to any who seek relief from emotional illness. This noble mission, however, does not currently apply to people who seek only subjective perfection. People seeking subjective perfection are discouraged by physicians wielding the persuasive powers of diagnostic definition, no diagnosis or label, no prescription, no pills. It is the use and not the abuse of psychotropic medication that forms the framework of cosmetic psychiatry.

The author reflects on the future of the profession of medicine particularly psychiatry. He says physicians should be reminded of the definition of a profession to better judge what actions and attitudes threaten and support the concept. He adds that more than any other branch of medicine, the profession of psychiatry is unable to coexist with business because the suffering of mentally ill persons is deeper and darker than any other form of human anguish.

The article examines studies on the validation of clinical algorithms in psychiatry. Among the initial studies that deal with clinical algorithm are the stepped collaborative care intervention, Texas Medication Algorithm Project and the German Algorithm Project phase 2. It is suggested in several studies that patients with a major depressive or bipolar disorder who are treated according to an accepted clinical algorithm have more successful outcomes that those treated as usual.

The article is an appreciation of an insightful article by Cynthia M.A. Geppert, about Part II of the American Board of Psychiatry and Neurology (ABPN) certification examination. As the author writes, she says that she is staring at the certificates for which she sweated blood in general psychiatry in 1993 and in child psychiatry in 1994.