Academic Medical Leaders Call for Changes in the Teaching and Practice of Neurology, Psychiatry

January 10, 2000 -- Belmont, MA -- Clinical and scientific leaders in the fields of neurology and psychiatry at McLean Hospital, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS) have authored an article calling for fundamental changes in the training and practice of both medical disciplines.

Scheduled for publication in the Jan. 11 issue of Neurology, the article "Neurology and Psychiatry: Closing the Great Divide" traces the divergent--and ambivalent--relationship between neurology and psychiatry, and recommends efforts to close the gap between the two specialties. The authors are Bruce H. Price, MD, chairman of the Department of Neurology at McLean Hospital; Raymond D. Adams, MD, emeritus neurologist at MGH; and Joseph T. Coyle, MD, chairman of HMS’s Consolidated Department of Psychiatry.

According to the authors, neither discipline can continue to be effective alone without sacrificing future advances in patient care and research.

"Developments in neuroscience have produced a common ground for us to sit down at the same table, without the chains of traditional boundaries, to address complex problems of the brain. This multidisciplinary approach is the approach that will offer fundamental relief, if not ultimately cures, for many neurologic and psychiatric diseases," said Price, the article’s lead author.

Traditionally, neurology has focused on nervous system disorders of the brain, while psychiatry has concentrated on functional disorders of the "mind." However, according to the paper’s authors, increased understanding of the mind and brain’s inseparability and the brain’s plasticity have shown scientists that "nature vs. nurture" is no longer a useful distinction.

The article calls for a redesign of the education of neurologists and psychiatrists in training to emphasize reciprocal aspects of both disciplines. It also calls for the commitment of leaders of both disciplines to ensure this redesign takes place. Neurologists in training should receive rich clinical exposure to patients suffering from major mental and neuropsychiatric diseases, while psychiatrists in training should receive more exposure to patients with neurologic conditions, particularly those diseases that are accompanied by psychiatric symptoms.

"It may take a generation to completely overcome the present turf battles, but the authors of this article have made a compelling case that it is time to consider whether radical changes should be taken to place neurology and psychiatry in direct juxtaposition," said Joseph B. Martin, MD, PhD, dean of Harvard Medical School.

According to the authors, improved collaboration between neurology and psychiatry would help researchers answer significant questions about how biological and environmental factors influence the brain: How do biological processes give rise to mental events? How do environmental factors influence the brain’s biological structure? How can these two forces be harnessed to promote mental health and recovery from brain injury? Answers to these questions ultimately may improve the quality of life for people who suffer from psychiatric and/or neurologic conditions.

Along with changes in education, the authors recommend that the practice of psychiatry maintain its focus on the diagnosis and study of mental illness and the connections between brain and behavior. They recommend neurology increase its research on behavioral disorders of neuropsychiatric diseases, such as Alzheimer’s and Parkinson’s diseases.

The authors write that modern imaging technology such as CAT, MRI and PET scans, has revealed that diseases like schizophrenia, depression and obsessive/compulsive disorder have visible functional abnormalities in the brain. Recent advances and increased understanding of the mind and brain have shown that the brain and its behavior are continually shaped by the complex interplay between genetic and environmental forces. Other advances, including redefining major mental illnesses as biologically based diseases, and the dawning of the era of molecular biology, have further broken down the barriers between neurology and psychiatry.