In her review of my book Mind Fixers, Alison Abbott chides me for being “pessimistic” about biological psychiatry’s prospects and failing to call attention to “new insights about brain circuitry as a potential target for treatment” (Nature 568, 314–315, 2019). Her criticism misses my historical point.

The research to which Abbott refers might or might not have a transformative effect on the care of the mentally ill. Either way, we have other work to do. The ‘old’ biological psychiatry launched in the 1980s — the one under which so many of us have conducted our business for the past 40 years — is running into the sands. The confusion and distrust it has engendered is entrenched in the public sphere.

We are at an inflection point. Either we can double down or we can call for a stocktaking. What do we want — and what do patients want — from a future biological psychiatry? We need to know how to engage constructively with the distrust, and how to balance the relationship between immediate patient needs and long-term scientific insights.

I am not pessimistic at all. I am energized: crises are times of opportunity. I am hoping that Mind Fixers will encourage more people to discuss the choices and challenges.