Do we do what we know works, and if not why not?

There have always been a range of treatments for mental illness. Evidence exists of ancient trepanning, and through the ages other techniques have been used such as blood letting, exorcism, confinement, dietary interventions, environmental interventions, talking therapies of various modalities, industrial therapies, insulin comas, and ice baths among many others. In the past the view was held that physicians were people of such sober judgement and fine knowledge that ‘all remedies whatever are at the disposal of practitioners to reject or employ them under the sole guidance of their own judgment’. But in more recent times, for reasons of efficacy and economics, there has been greater concern with using treatments for which there is the best evidence of a positive outcome.