Looking back as a psychiatrist and historian today, I find that these hopes feel quaint. They remind me of other misplaced visions of technological futures from the twentieth century: flying cars, pills for a whole day’s nutrition. The reality of psychiatric practice is far less glamorous than the visions of its future that I grew up with. Thirty years later we still have no biological tests for psychiatric disorders, and none is in the pipeline. Instead our diagnoses are based on criteria in a book, the Diagnostic and Statistical Manual of Mental Disorders (often called, derisively, the “bible” of American psychiatry). It has gone through five editions in the last 70 years, and while the latest edition is almost 100 pages longer than the last, there is no evidence that it is any better than the version it replaced. None of the diagnoses is defined in terms of the brain.