Predicting the future is a thankless task

‘Never think of the future, it comes soon enough’, said Albert Einstein. ¹ Predicting the future is a thankless task, so Dr Shabbir Amanullah is admirably brave to share his thoughts about the future of medical and psychiatric treatment. ²

Undoubtedly somewhat tongue-in-cheek, Dr Amanullah’s future is one where surgeons have been reduced to machine operators and physicians replaced by machines programmed in the recognition of symptom clusters. Accident and emergency departments are thus without ‘emotional tension’. Psychiatry is spared, however, and indeed prospers with the need for the treatments of ‘robot phobia’ and ‘reminiscence therapy’ for our now unemployed medical colleagues.

Even in jest, I suspect some of our fellow doctors would find Dr Amanullah’s characterisation of their roles, and therefore future, rather objectionable. Are psychiatrists really so immune? We have in the past been at pains to argue how similar we are to other doctors in both our practice and the diseases we treat. It is therefore curious that in thinking about our future Dr Amanullah chooses to see us as invulnerable to the same pressures as those of other branches of medical practice.

If, as seems probable, our future holds impressive technological advances then it is unlikely that our understanding of and ability to manipulate human mental states will remain static. In an optimistic scenario, psychopharmacology will become so advanced that any psychiatric disorder will be banished by appropriate and side-effect-free medication. Psychological therapies could see equal upheaval. Indeed, cognitive–behavioural therapy has already been delivered via a computer with promising results. ³ Although some future patients may lament the days when their disorders were treated by ‘real doctors’, others may find a computer’s infinite patience and constant availability preferable. That is, of course, assuming it is programmed that way. The potential irony of having ‘robot phobia’ treated by a computer is duly noted.

Thinking more broadly and with even more optimism, one could hope that our future human societies – or ‘society’, should globalisation reach its natural conclusion – will be so harmonious, and their people so self-actualised that many of the societal factors we identify today as predisposing towards psychiatric disorders will be banished. A dystopian alternative, sadly illustrated by many places in today’s world, is one where our society has deteriorated to the extent that concern about individuals’ mental health is eclipsed by more basic survival needs. In either of these scenarios the future role of psychiatrists is unclear. Science fiction’s predictions have been pessimistic. In Aldous Huxley’s Brave New World, ⁴ ‘Soma’, a mind-altering drug, is widely used as a method of control through pleasure, while Philip K. Dick’s protagonist in Do Androids Dream of Electric Sheep? ⁵ grows distant from his wife because of her penchant for an electronic device which allows her to choose her moods (including depression).

These quibbles aside, Dr Amanullah has an important message for those of us working in healthcare today. Change is not just possible, but certain. It is likely that the job of today’s newly qualified consultants will, at the conclusion of their careers, be radically different to that of the present day. In order to prosper in such an environment, we must all attempt to prepare for a future that is difficult to foresee.