OBJECTIVE: The authors evaluate the forces that are changing psychiatric practice and propose options for redefining the clinical and educational goals of psychiatry within medicine. METHOD: An overview of current external and internal forces shaping psychiatry is provided. These forces are both social, political, and economic (external) and scientific and technological (internal). RESULTS: The convergence of these forces leads to recommendations for redefining psychiatric practice and education. If psychiatry fails to redefine itself on the basis of its scientific foundations, political and economic forces may lead to an untenable redefinition that could threaten the field. CONCLUSIONS: The redefinition process may lead to altered roles and somewhat different knowledge bases for psychiatry. The profession must choose whether to be reactive or proactive given this challenge.
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