Has there ever been a medical specialty as beleaguered as psychiatry? Since the profession’s founding in 1844, the doctors of the soul have had to contend with suspicions that they do not know what mental illness is, what type their patients might have, or what they should do about it—in other words, that they are doctors who do not practice real medicine. Some of the worry comes from the psychiatrists themselves, such as Pliny Earle, who in 1886 complained that “in the present state of our knowledge, no classification of insanity can be erected upon a pathological basis.” In 1917, psychiatrist