The masters of time Those who predict successfully are the real masters of time. But what is predicted correctly is often the stuff of depression; excitement lies in uncertainty tinged with anxiety. I would like to think the British Journal of Psychiatry occupies the latter slot in readers' minds: we are struggling down in the foothills of successful prediction, but the doubt we acknowledge makes it a more interesting area than the tiny stony summit of certainty with its fixed perspectives. This has always been a worry behind the genetic advances in psychiatry, as the fear that your genes might predestine your future mental state can provoke real alarm. Newson (pp. 189-190) reassures us that this bleak world of genetic determinism is a long way off, but there are still ethical concerns even with our current predictive ability. We have been seduced by the idea that the earlier we can predict a mental disorder the better we can treat it successfully, so that at present we have diligent researchers determined to identify those 'at risk' of disorders such as schizophrenia and depression by neuroimaging approaches or sophisticated psychological tests in the hope that early intervention can minister to a mind already slightly diseased. To do this we have to be certain our diagnoses are right and our continued debate about the overlap between psychosis, bipolar disorder and schizophrenia exhorts us to find better assessments such as magnetic resonance imaging studies (Arnone et al, pp. 194-201, Koutsouleris et al, pp. 218-226), or in-depth testing of those with an adolescent onset of psychosis (Janssen et al, pp. 227-233). The presence of even minor abnormalities of mental state earlier in life seems to predict more major disturbance later (Johnson et al, pp. 264-265) and reinforces the quest for early identification.
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