Bullet points noted down in the airport waiting lounge, en route home from the American Psychiatric Association’s annual meeting.

• In its public face, psychiatry has become humble.

The large-scale sessions at this year’s convention involved acknowledgement that our clinical tools have limitations. It’s been years since scientists have introduced a truly novel medication or psychotherapy for the mentally ill. Our treatments are reasonably effective, and we know how to combine them when necessary. But we’ve had that expertise for some time. Meanwhile, psychiatry knows it has an image problem built around the apprehension that the leadership is in bed with Pharma.

In part, that last problem accounts for the low-key presentations. The APA’s new rules require that the slides for all industry-sponsored presentations be vettted in advance by members without drug-company affiliations. Speakers who stray from the script and make unsubstantiated claims can be (and some have been) barred from participation in future meetings. The one Pharma-sponsored lecture I attended was sober, as regards our ability to treat bipolar disorder — although it seemed to me that one overly favorable table, about the benefits of a drug still in development, had slipped through the screen.

• Privately, the field is excited by the promise of neuroscience.

Researchers are moving past old models of mind and brain, the ones that focused on serotonin, norepinephrine, and dopamine. In part, this means considering other neurotransmitters, like glutamate. But it also means looking in more detailed fashion at receptors on neurons and then peeking inside the cell, tracking reactions that lead to cell growth and new cell connections, down to the level of the gene.

• Within neuroscience, the hot topic is gene regulation.

The most striking presentations that I attended involved epigenetics. I’ll explain that term in a future posting. In brief, epigenetics refers to changes that don’t affect the sequence of genes but do determine which genes get expressed and which lie dormant.

• Neuroscience is telling this story: Gene expression is shaped by the environment, including life events, like neglect in childhood.

It works that way for rodents. Raise them in a harsh environment, and for the whole of their lives, they will behave as if resources are scarce. The new science shows what psychological deprivation looks like at the level of the altered gene.

Increasingly, the biological model is a psychological model. Who we are, in our brain cells, is a function of who we have been in our lives.

• Psychotherapy is beginning to speak the new language of neuroscience.

Much of this talk is metaphorical. Psychotherapists want to reshape gene expression, or to help patients circumvent fixed limitations, though new learning that modifies the “fate neurosis” embedded in the altered chromosomes. Combining medication and talk makes special sense, in particular in the treatment of patients whose early lives were difficult. The drugs allow for new connections; the therapeutic relationship shapes them. (I sketch out this model in Against Depression.)