In this 'Pieter Baan Lecture', presented at the Annual Meeting of the Nederlandse Vereniging voor Psychiatrie, Lunteren, Holland, 1978, the author illustrates his (optimistic) viewpoint that as the medicine of the future is forged out of the contradictions of the present: what psychiatry has represented at its best will be incorporated into the mainstream of medical care. He emphasizes that this will require structural changes in the organization of medical care: incentives for caring for the patient rather than for the performance of procedures; assumption of responsibility for health maintenance for a defined population, not just the treatment of illness episodes; and the provision of the full range of mental health services in the context of general medical care rather than in isolated hospitals and clinics.
It will also require that psychiatrists reassume their medical roles and a concomitant broadening of the biomedical model of disease to include the social and psychological determinants of health and illness.