Neuropsychiatry is a branch of medicine that deals with psychiatry as it relates to neurology, in an effort to understand and attribute behavior to the interaction of neurobiology and social psychological factors. Within neuropsychiatry, the mind is considered "as an emergent property of the brain", whereas other behavioral and neurological specialties might consider the two as separate entities. Those disciplines are typically practiced separately. Neuropsychiatry has become a growing subspecialty of neurology as it closely relates the fields of neuropsychology and behavioral neurology, and attempts to utilize this understanding to better understand psychological trauma, autism, attention deficit hyperactivity disorder (ADHD), and Tourette syndrome, among others.
The case for the rapprochement of neurology and psychiatry Given the considerable overlap between behavioral neurology and neuropsychiatry, there has been a resurgence of interest and debate relating to neuropsychiatry in academia since the early 2000s. Most of this work argues for a rapprochement of neurology and psychiatry, forming a specialty above and beyond a subspecialty of psychiatry. For example, Professor Joseph B. Martin, former Dean of Harvard Medical School and a neurologist by training, has summarized the argument for reunion: "the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway." These points and some of the other major arguments are detailed below.
Mind/brain monism Neurologists have focused objectively on organic nervous system pathology, especially of the brain, whereas psychiatrists have laid claim to illnesses of the mind. This antipodal distinction between brain and mind as two different entities has characterized many of the differences between the two specialties. However, it has been argued that this division is fictional; evidence from the last century of research has shown that our mental life has its roots in the brain. Brain and mind have been argued not to be discrete entities but just different ways of looking at the same system. It has been argued that embracing this mind/brain monism may be useful for several reasons. First, rejecting dualism implies that all mentation is biological, which provides a common research framework in which understanding and treatment of mental disorders can be advanced. Second, it mitigates widespread confusion about the legitimacy of mental illness by suggesting that all disorders should have a footprint in the brain. In sum, a reason for the division between psychiatry and neurology was the distinction between mind or first-person experience and the brain. That this difference is taken to be artificial by proponents of mind/brain monism supports a merge between these specialties. These specialities are different but rely on each other.
Causal pluralism One of the reasons for the divide is that neurology traditionally looks at the causes of disorders from an "inside-the-skin" perspective (neuropathology, genetics) whereas psychiatry looks at "outside-the-skin" causation (personal, interpersonal, cultural). This dichotomy is argued not to be instructive and authors have argued that it is better conceptualized as two ends of a causal continuum. The benefits of this position are: firstly, understanding of etiology will be enriched, in particular between brain and environment. One example is eating disorders, which have been found to have some neuropathology but also show increased incidence in rural Fijian school girls after exposure to television. Another example is schizophrenia, the risk for which may be considerably reduced in a healthy family environment. It is also argued that this augmented understanding of etiology will lead to better remediation and rehabilitation strategies through an understanding of the different levels in the causal process where one can intervene. It may be that non-organic interventions, like cognitive behavioral therapy (CBT), better attenuate disorders alone or in conjunction with drugs. Linden's demonstration of how psychotherapy has neurobiological commonalities with pharmacotherapy is a pertinent example of this and is encouraging from a patient perspective as the potentiality for pernicious side effects is decreased while self-efficacy is increased. In sum, the argument is that an understanding of the mental disorders must not only have a specific knowledge of brain constituents and genetics (inside-the-skin) but also the context (outside-the-skin) in which these parts operate. Only by joining neurology and psychiatry, it is argued, can this nexus be used to reduce human suffering. Combining these subjects would help improve patient care and reduce stigma.
Organic basis To further sketch psychiatry's history shows a departure from structural neuropathology, relying more upon ideology. One example of this is Tourette syndrome, which Sándor Ferenczi, although never having seen a patient with Tourette syndrome, suggested was the symbolic expression of masturbation caused by sexual repression. However, starting with the efficacy of neuroleptic drugs in attenuating symptoms the syndrome has gained pathophysiological support and is hypothesized to have a genetic basis too, based on its high inheritability. This trend can be seen for many hitherto traditionally psychiatric disorders (see table) and is argued to support reuniting neurology and psychiatry because both are dealing with disorders of the same system.
Improved patient care Further, it is argued that this nexus will allow a more refined nosology of mental illness to emerge thus helping to improve remediation and rehabilitation strategies beyond current ones that lump together ranges of symptoms. However, it cuts both ways: traditionally neurological disorders, like Parkinson's disease, are being recognized for their high incidence of traditionally psychiatric symptoms, like psychosis and depression. These symptoms, which are largely ignored in neurology, can be addressed by neuropsychiatry and lead to improved patient care. In sum, it is argued that patients from both traditional psychiatry and neurology departments will see their care improved following a reuniting of the specialties.
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