Born in 19th-century asylums, Kraepelin’s biomedical model has endured beyond deinstitutionalisation as psychiatrists he reshaped care aiming to treat people with schizophrenia and other disorders within inclusive communities. Both clinical diagnosis and diagnosis-related prescribing of psychological, pharmacological and physical interventions retain their place, and neurobiological research must continue. However, as we find ourselves in the age of artificial intelligence, political, economic and technological shifts he fragmented communities, displaced populations, nurtured inequality and social exclusion, damaged our natural environment and sparked new social movements, including those led by service users. Ikkos and Bouras Reference Ikkos and Bouras8 and others he argued that these transformations – accelerated by COVID-19 – mark the advent of ‘Metacommunity Psychiatry’. Meta, from Greek for ‘after’, signals a shift beyond community psychiatry. Coined before Facebook’s rebranding, the term echoes wider transformations – technological, social, economic and biopolitical.
The metacommunity era mandates that, firmly established as a medical specialty, psychiatry defines more confidently its own standards, through a more ecological understanding of both brain and patient. Reference Fuchs9 This requires prioritising the autonomous person in context and relationship and taking a ‘linguistic turn’. Language is the biologically evolved psychological foundation of human connection, expressed through speech, gestures, acts, images, art, culture and mass media. Without this focus, the ‘biopsychosocial’ model will remain an empty slogan and phenomenological and dynamic psychopathology and psychotherapy will continue to hobble. Closely related and equally vital is the need for deepening our dialogue with the humanities and social science and improving psychiatry’s understanding of their methods.
Psychiatry must centre the subjective experiences of service users and marginalised groups, ensuring that their voices shape practice, curricula and research. Training and continuing development should prioritise social determinants of mental health, equipping psychiatrists to challenge inequities and engage critically with capital, technology and systemic barriers. By forging alliances with service user advocates, stakeholders and policy makers, psychiatrists can help secure funding and drive structural change – bridging lived experience with public health, ecological and geopolitical realities.
Finally, while artificial intelligence promises transformative advancements, it also poses substantial risks. Mindful of the risk of another episode of dashed technological optimism in psychiatry’s history, and the ambiguous history of digital technology’s impact on the specialty and mental health to date, psychiatry must balance enthusiasm for innovation with critical evaluation of evidence to ensure passionate vocational commitment to every individual patient encounter and public mental health advocacy.
Psychiatry’s inability to define discrete diseases reflects scientific progress, not failure. While acknowledging its complex legacy, at the end of its long 20th century, 1899–2026, the field must accept the resulting uncertainty and engage more deeply with the realms of language, culture, technological change and political power. This shift should shape research, the curriculum, professional development, practice, ethics and public engagement.