Neurology, Psychiatry, or Just Brain Medicine?

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Neurology and psychiatry both assess and treat disorders of the brain, yet they are separate specialties. Why?

"Psychiatric" diseases can now be treated with brain-based technology like transcranial magnetic stimulation.

The brain is perhaps the only organ in the body where there are two completely different medical specialties that treat patients with dysfunction in the organ. Those specialties are, of course, neurology and psychiatry. We are perhaps so used to having these two separate specialties that we don’t often step back and think how unusual this is. If we have a lung problem, the appropriate specialty is pulmonology. If there is a need for a specialist in the heart, we go to a cardiologist. If there is a problem with our kidneys, we go to a nephrologist.

On the other side, we are realizing that traditional neurological diseases often have significant mood, behavioral, and cognitive elements . In epilepsy, for example, mood problems can be more determinant of quality of life than seizure frequency. Multiple sclerosis can lead to significant mood, fatigue, and cognitive problems.So, what do we do? Luckily, the pendulum may be swinging away from the formulation of the 1800s to a more modern viewpoint.

There is a long way to go, but we may have at least started on the path to undo the schism of neurology from psychiatry. This path can lead to one specialty for the organ of the brain, just like there is one specialty for the organ of the lungs, or the heart, or the kidneys—in other words, like the rest of medicine.As the lines between real and fake blur, Americans increasingly chase the idea of authenticity.

 

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