Despite Eisenberg's 1995 declaration that Psychiatry is all biological and all social,1,p 1571 the prevailing attitude in the North American psychiatric literature continues to be that psychotic disorders arise principally from biological factors; social causes of psychosis remain neglected. Advances in genetics, neuroscience, and psychopharmacology continue to capture the imagination of psychiatrists and the general public by offering hope that the molecular basis of psychosis will be unravelled, that psychotic disorders will be firmly established in the pantheon of medical diseases, and that long-awaited cures for severe mental illnesses such as schizophrenia and bipolar disorder will be discovered.2 The search to uncover the genetic and molecular secrets of the brain has not solved the riddle of psychosis, nor has it eradicated its disabling symptoms. What this search has perpetuated is the hegemony of reductionist biological determinism.1, p 1563 For decades, this paradigm has reigned supreme in North American psychiatry and has encouraged the investment of resources to develop biological theories and treatments-to the exclusion of other approaches-despite only modest improvements in patient outcomes.3-6 Perhaps the time has come for a fresh theoretical approach that is unaffected by commercial interests7-9 and not limited to the narrow biological framework of disease etiology. Perhaps the time has come for the field of psychiatry to reassess the role of social factors in the etiology of psychosis. In this issue's In Review section, Dr Cantor-Graae10 reviews the literature on this topic, mostly from western Europe. She explains that important lines of research on migrants, social adversity, and neighbourhood and urban effects link social factors to the development of schizophrenia. She also proposes a mechanism whereby social factors may precipitate psychosis in those with an underlying predisposition: the stress of social defeat leads to alterations in central nervous system dopamine sensitivity and the regulation of dopaminergic systems. The second paper11 in this In Review Review section reports that discussions of social causes of psychosis, such as migration, poverty, and racial discrimination, have all but disappeared from the North American psychiatric literature. The paper suggests that, in the United States, investigation into the role of society in the onset of psychosis has focused exclusively on the clinician-patient interaction. In the prevailing ethos, social factors are not considered to cause psychotic disorders per se but, rather, to influence predominantly white clinicians to overdiagnose psychosis in African Americans. In other words, social factors are only considered important insofar as they contribute to clinician bias and misdiagnosis. The papers in this section advocate reinstating social factors in the discussion of the etiology of psychosis. The lack of North American psychiatric literature on this topic is startling. An extensive MEDLINE search going back to 1966 and using dozens of key words and combinations of key words yielded only 10 relevant articles originating in the United States. Most of these were written before 1980. A similar search of the Canadian literature found no articles at all. Reasons for such a pervasive neglect of social factors in the etiology of psychosis must of necessity derive from values and traditions that are deeply rooted in North American psychiatry. The history and culture of me profession may act to encourage scientific inquiry in some domains while limiting work in other areas. With respect to psychosis, there has not yet been a comprehensive analysis of the history of psychiatric knowledge in the United States and Canada. Such work would detail the ebbs and flows of psychiatric fashion over time and would suggest why some productive lines of research lie fallow while others flourish for political or economic reasons. …