During the past twenty years, psychiatry in Europe and North America has undergone the most extraordinary paradigm shift of this century. Journal publications, research dollars, and treatment orientations all reflect a shift in dominance from psychoanalytic discourse to biological, from a focus on psychological processes to classification of symptoms, from a primary interest in affect and its economy to cognition, and from investments in community psychiatry to biological research and pharmacological treatment. This change poses a serious challenge for the anthropologist interested in the role of culture in psychopathology, raising questions about what directions anthropological research should take in the coming decade. It also raises the specter of declining interest in the social and cultural dimensions of mental illness in the psychiatric profession and public policy. One might have anticipated that these changes in psychiatry would have provoked, among anthropologists, both a sharp critique of the reification of medicalized disease categories and a sense of despair, as funding agencies such as the US National Institutes of Mental Health (NIMH) increasingly reorient their mission and review committees to focus on the molecular biology and genetics of disease entities. What is most striking in reviewing the anthropological literature, however, is that there has been almost no anthropological response. With rare exceptions, our journals provide little evidence that anthropologists are even aware that the world of psychiatry has changed in the past two decades. Many in our field are aware, of course.