Psychiatry is a medical specialty. It has changed or perhaps, better, been changed a great deal in the last 40 years. There are competing claims on its future. Much of hospital medicine has moved in the direction of being applied science and improved patient outcomes. We face a series of uncertainties. Can psychiatry aspire to be applied neuroscience? We have not improved patient outcomes in psychiatry in the same way as other specialties – is this a reason to double down or give up on neuroscience? Psychiatry is viewed in a different way from the rest of medicine and by the rest of medicine. Are current directions of the profession likely to make that better or worse? Indeed, does it matter? Are we waving or are we drowning? Without posing the questions we are unlikely to find the answers.