> when it comes to physical ailments, medicine of all kinds has been worked on and improved for many hundreds of years, but serious effort to treat mental illness in a scientific way has only been going on for a relatively short time.

Um... I'm not sure that that is correct... Hippocrates coined the term 'hysteria' and wrote on 'melencholia' as well... Edward Shorter (a historian) places the birth of psychiatry near the end of the 1700's which is around the time that medical specialisation became all the rage. Prior to then there weren't many specialities (aside from surgery).

Shorter also talks about two different 'biological revolutions' in Psychiatry. We are in the middle of the second biological revolution right now.

There is much more controversy in psychiatry than there is in any other medical specialisation (I'm sure it is fair to say that). While most medical conditions are fairly well understood (in the sense that we know where to look for the relevant mechanisms) we still haven't sorted that one out for a single psychiatric conditions. For example, any given mental disorder could be:

1) Genetic
2) Neurological
3) Cognitive
4) Phenomenological
5) Behavioural
6) Environmental (I'll put sociological in here too)

And there are competing accounts of the nature and much controversy over which of the above are essential to mental disorder.

Part of the problem is that we don't have a good understanding of how these levels of explanation relate to each other. It is one thing to say 'they ALL are relevant' and quite another to show precisely how each level relates to each other level.

There is also much controversy over where we should look (with respect to the above levels) in order to intervene or treat mental disorders. One popular notion (that is simply false) is that whichever level is right for nature is right for treatment and / or vice versa. So if, for example, we find some medication works to treat depression then it follows that depression is neurological and it also follows that the best treatment for it is going to be neurological. That doesn't follow at all, however.

If you want to teach someone to cook then you have to change their neurology. There is no other way they can learn something new. I'll still put my money on the best 'intervention' being teaching them how (so environmental or social) rather than neurological (medication or psychosurgery), however.

Psychiatry is held up by extra-scientific concerns (where politics and issues of treatment reimbursement and the financial investment of drug companies is more of a driving force than the scientific concerns). Psychiatry is also held up by conceptual confusions (such as the couple that I've outlined above).

There are a proliferation of theories... Many of them are not obviously consistent with each other and you have geneticists, neurologists, neuroscientists, cognitive theorists, cognitive neuropsychologists, behaviour theorists, sociologists, anthropologists, phenomenologists, not to mention: psychologists, psychiatrists, councellors, who all have an investment in the verdict. and that is to say nothing of the drug companies, the different brands of therapy, the people making money off the self help books, and so on and so forth. then you have the suffering masses who are prepared to pay...

and its a big monster it surely surely is.

> I have frequently found myself bemoaning the lack of ability to accurately diagnose and treat us...

Accurate diagnosis is thrown off considerably by the fact that the current diagnostic manual is constructed around extra-scientific concerns (that are political) rather than scientific concerns of carving nature at its joints.

Treatments are similarly driven by the extra-scientific concerns. Funds for drug companies and health insurance reimbursement for addicts and the like...

i think there is hope but i guess i don't think that hope will ever come in the form of a pill. it will help sedate you for a bit of a break... but i don't expect that the best way to alter the neurology is (or ever will be) in the form of a medication.