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Why Does Neurology Get More Respect than Psychiatry?
A friend of mine suffers from seizures and thus, he sees a neurologist. His neurologist manages and tracks his condition over time. The neurologist is responsible for ensuring the seizures are minimized and this includes prescribing medication (the very same medication that’s prescribed in bipolar disorder, by the way).
This is exactly what psychiatrists do for their patients as well—they manage diseases of the brain—and yet not once have I heard of an anti-neurology lobby. Not once have I heard of anyone suggesting that my friend’s seizures are indicative of a moral failing on his part. Not once have I heard anyone say that he could think his way out of his disorder if he really wanted to. Not once have I heard someone suggest that it’s wrong of him to take medication to control his disorder.
No, because he sees a neurologist for his disorder people respect it and believe in its existence whereas because I see a psychiatrist for mine, it is suspect.
The Split between Neurology and Psychiatry
Neurology and psychiatry actually coexisted quite happily as the same specialty until about the 1950s. Before that time, doctors were known as neuropsychiatrists and had a unified board exam through the American Board of Psychiatry and Neurology. Neuropsychiatrists treated people with all manner of brain disorders including stroke, epilepsy, depression, anxiety, and so on. It was recognized at the time that all these disorders were disorders of the brain. And while medicine’s view on the brain and the split between the brain and mind has shifted over the years, we are now back to a place where we know this is right; so-called “mental” illnesses are, indeed, illnesses of the brain.
The Mind Complicates the Brain
One of the reasons for the split in the 1950s was Freudian theory and psychoanalysis. Luckily for all of us, those theories have largely been debunked, but there was a recognition that disorders that were rooted in thought and could be affected by psychological therapies.
And this, of course, remains true. The mind is extremely powerful and it can do things beyond what most of us consider logical in many circumstances and it can be affected in such a way that it changes the brain. In short, taking into account what the mind does complicates illnesses of the brain. (This is not to suggest that the mind can simply make the brain do its bidding, however. The brain is an organ and like the heart or the lungs it functions largely without our will having a thing to do with it.)
And so why then, when psychiatrists are trying to take into account this extreme complexity are they less respected? They are dealing with tough stuff and doesn’t that garner them some respect?
Psychiatry is Marred by History
I, certainly, would be the first one to admit that psychiatry, in the past, has been quite barbaric. How the mentally ill were treated 100 years ago should shock the consciousness of every medical professional alive. However, we were doing the best we could with our limited available knowledge. And the question remains, if other patients (such as those with seizures) were also treated wildly inhumanely (and they were) then why aren’t other branches of medicine like neurology also marred by this history? Why is it that only psychiatry bears the brunt of this past when medicine did things like perform surgery on patients without anaesthesia? If other parts of medicine have, rightly, moved beyond their history then why can’t psychiatry too?
A Return to Neuropsychiatry
In the editorial Let’s tear down the silos and reunify psychiatry and neurology! author Dr. Henry A. Nasrallah argues for a return to neuropsychiatry and I think this is not such a bad idea. It would put the “neuro” back into “psych,” which it seems to really need and deserve. While it would be ideal to simply change the way people think about psychiatry, that change might be best facilitated by a return to what medicine now has a fresh understanding of: psychiatric illnesses are illnesses of the brain and should be treated as such and with the same respect and care.