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January 2000

Peeking Through the Door to the 21st Century

Author Affiliations

From the Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pa.

Arch Gen Psychiatry. 2000;57(1):83-85. doi:10.1001/archpsyc.57.1.83

As we stand at the door to the 21st century, psychiatry, supported by the incredibly rapid pace of discovery in the neurosciences, seems poised to address questions that could not even have been imagined just 50 or 100 years ago. We outline 6 such questions. These questions have particular appeal to us because they draw concurrently on evolving science in the neurobiological and psychosocial arenas and because they seem especially ripe for exploration at the present time.

We have substantial evidence from genetic pedigree studies and from family studies1 of monozygotic twins that not everyone carrying the genetic vulnerability to a disorder necessarily expresses that disorder. We also have substantial evidence that stressful life events and ongoing long-term difficulties are critical in the timing of onset of first and subsequent episodes of even the most "genetic" of psychiatric disorders.24 A key question then becomes what is the process by which life experience, particularly life experience of a negative variety, alters genetic expression and allows the disorder to be manifest?

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