Significant changes in the mental health field over the past 20 years include the shift from psychoanalytic thinking to brain-based psychiatry, the rise of managed care, and the growth of mental health consumer groups. These changes have greatly influenced patients, families, mental health professionals, psychiatric institutions, and society. They have also significantly altered the role of mental health administrators. A major change has been the increased understanding of brain neurochemistry. While beneficial, this has led to some negative side effects. For example, it has encouraged a reductionistic, mechanistic approach in psychiatry, especially among young residents trained in brain biology. These psychiatrists often understand diagnoses and medications but lack knowledge of patients' psychological states, life experiences, and how to communicate therapeutically with them. This reductionistic view may lead to a neglect of psychotherapy, which is seen as less important, and may result in psychiatrists focusing mainly on prescribing medications. This one-sided view of mental illness separates mind and brain, moving away from the integration of both. This separation has two significant consequences: it undermines the role of psychotherapy and allows cost-conscious payors to seek therapy from other professions. As a result, psychiatrists may focus mainly on prescribing medications, making the specialty less attractive. To prevent this, psychiatric training programs should maintain a balance between brain-based and psychodynamic perspectives. Some programs already do this, but many do not. Programs led by psychiatrists with broad perspectives recognize the need for both approaches in contemporary practice.Significant changes in the mental health field over the past 20 years include the shift from psychoanalytic thinking to brain-based psychiatry, the rise of managed care, and the growth of mental health consumer groups. These changes have greatly influenced patients, families, mental health professionals, psychiatric institutions, and society. They have also significantly altered the role of mental health administrators. A major change has been the increased understanding of brain neurochemistry. While beneficial, this has led to some negative side effects. For example, it has encouraged a reductionistic, mechanistic approach in psychiatry, especially among young residents trained in brain biology. These psychiatrists often understand diagnoses and medications but lack knowledge of patients' psychological states, life experiences, and how to communicate therapeutically with them. This reductionistic view may lead to a neglect of psychotherapy, which is seen as less important, and may result in psychiatrists focusing mainly on prescribing medications. This one-sided view of mental illness separates mind and brain, moving away from the integration of both. This separation has two significant consequences: it undermines the role of psychotherapy and allows cost-conscious payors to seek therapy from other professions. As a result, psychiatrists may focus mainly on prescribing medications, making the specialty less attractive. To prevent this, psychiatric training programs should maintain a balance between brain-based and psychodynamic perspectives. Some programs already do this, but many do not. Programs led by psychiatrists with broad perspectives recognize the need for both approaches in contemporary practice.