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The neurology-psychiatry divide: a thought experiment

  • Thomas J. Reilly (a1)
Summary

Diseases of the brain are generally classified as either neurological or psychiatric. However, these two groups of illnesses cannot be readily separated on the basis of pathophysiology or symptomatology. It is difficult to rationally explain to someone with no prior frame of reference why we have the split between neurological and psychiatric illness. This demonstrates that the division is untenable, which has implications for training in both psychiatry and neurology.

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Copyright
This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to Thomas J. Reilly (t.reilly@nhs.net)
Footnotes
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See pp. 105–7, this issue.

Declaration of interest

None.

Footnotes
References
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1 Reynolds, EH, Trimble, MR. Epilepsy, psychiatry, and neurology. Epilepsia 2009; 50 (suppl 3): 50–5.
2 Fusar-Poli, P, Radua, J, McGuire, P, Borgwardt, S. Neuroanatomical maps of psychosis onset: voxel-wise meta-analysis of antipsychotic-naive VBM studies. Schizophr Bull 2012; 38: 1297–307.
3 Kanaan, R, Armstrong, D, Barnes, P, Wessely, S. In the psychiatrist's chair: how neurologists understand conversion disorder. Brain 2009; 132: 2889–96.
4 Barry, H, Hardiman, O, Healy, DG, Keogan, M, Moroney, J, Molnar, PP, et al. Anti-NMDA receptor encephalitis: an important differential diagnosis in psychosis. Br J Psychiatry 2011; 199: 508–9.
5 Williams, DR, Lees, AJ. Visual hallucinations in the diagnosis of idiopathic Parkinson's disease: a retrospective autopsy study. Lancet Neurol 2005; 4: 605–10.
6 Feinstein, A. Multiple sclerosis and depression. Mult Scler 2011; 17: 1276–81.
7 Engel, GL. The clinical application of the biopsychosocial model. Am J Psychiatry 1980; 34: 535–44.
8 Oakley, C, Malik, A. Psychiatric training in Europe. Psychiatrist 2010; 34: 447–50.
9 Oakley, C, Jenkinson, J, Oyebode, F. Psychiatric training for the next generation. Psychiatrist 2013; 37: 25–9.
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BJPsych Bulletin
  • ISSN: 2056-4694
  • EISSN: 2056-4708
  • URL: /core/journals/bjpsych-bulletin
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The neurology-psychiatry divide: a thought experiment

  • Thomas J. Reilly (a1)
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eLetters

Fully inform the Martian

Richard Braithwaite, Consultant Psychiatrist, Isle of Wight NHS Trust
09 June 2015

At first glance, Reilly's thesis appears reasoned and structured (1). But his argument is flawed, such that he misses the most important reason for the distinction between psychiatry and neurology, with which a Martian would surely concur.

Reilly states that "most organs (such as lungs, kidneys, hearts and eyes) are treated by a single medical specialty". Not so. A cardiac surgeon operates on the heart, determines which patients would benefit from surgery, and manages pre- and postoperative care. A cardiologist's talents lie elsewhere.

Similarly, the division between psychiatry and neurology is defined by knowledge and skill. This is no artificial distinction imposed by a quirk of history, but reflects a difference in the very nature of the knowledge and skill base developed by doctors as they specialise. One cannot expect every trainee neurologist to additionally become expert in, say, holistic and developmental assessment, psychological formulation and complex diagnostic classifications of a nature unknown outside psychiatry. These are for trainee psychiatrists to focus on.

Doctors do not practice in isolation, but as members of multidisciplinary teams. Nurses and others develop similarly specialist knowledge and skills to work with patients with broadly different presentations.

Of course, there are small areas of overlap, but Reilly falsely dichotomises these to fuel his argument: I had no idea conversion disorder was the preserve of neurologists. At best, he puts forward a case for closer working and more shared care of patients between the two specialties. But two specialties they most assuredly are.

Reference:

1. Reilly TJ. The neurology-psychiatry divide: a thought experiment. BJPsych Bull 2015; 39: 134-5. doi: 10.1192/pb.bp.113.045740
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