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Are neurological and psychiatric disorders different?

  • Anthony S. David (a1) and Timothy Nicholson (a1)

Summary

There have been recent calls to abandon the distinction between neurological and psychiatric disorders on philosophical and moral grounds. Crossley and colleagues, in this issue, meta-analyse published structural brain imaging data and prove that they are different after all – or do they?

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Copyright

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.

Corresponding author

Anthony S. David, Institute of Psychiatry, Psychology and Neuroscience, King's College London, DeCrespigny Park, London SE5 8AF, UK. Email: anthony.david@kcl.ac.uk

Footnotes

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See pp. 429–434, this issue.

Declaration of interest

None.

Footnotes

References

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1 Crossley, NA, Scott, J, Ellison-Wright, I, Mechelli, A. Neuroimaging distinction between neurological and psychiatric disorders. Br J Psychiatry 2015; 207: 429–34.
2 White, PD, Rickards, H, Zeman, AZ. Time to end the distinction between mental and neurological illnesses. BMJ 2012; 344: e3454.
3 Wright, IC, Rabe-Hesketh, S, Woodruff, PW, David, AS, Murray, RM, Bullmore, ET. Meta-analysis of regional brain volumes in schizophrenia. Am J Psychiatry 2000; 157: 1625.
4 David, AS, Bedford, N, Wiffen, B, Gilleen, J. Failures of metacognition and lack of insight in neuropsychiatric disorders. Philos Trans R Soc Lond B Biol Sci 2012; 367: 1379–90.
5 Whitfield-Gabrieli, S, Ford, JM. Default mode network activity and connectivity in psychopathology. Annu Rev Clin Psychol 2012; 8: 4976.
6 Goodkind, M, Eickhoff, SB, Oathes, DJ, Jiang, Y, Chang, A, Jones-Hagata, LB, et al. Identification of a common neurobiological substrate for mental illness. JAMA Psychiatry 2015; 72: 305–15.
7 Craig, AD. How do you feel–now? The anterior insula and human awareness. Nat Rev Neurosci 2009; 10: 5970.
8 Fusar-Poli, P, Smieskova, R, Kempton, MJ, Ho, BC, Andreasen, NC, Borgwardt, S. Progressive brain changes in schizophrenia related to antipsychotic treatment? A meta-analysis of longitudinal MRI studies. Neurosci Biobehav Rev 2013; 37: 1680–91.
9 Keshavan, MS, Bagwell, WW, Haas, GL, Sweeney, JA, Schooler, NR, Pettegrew, JW. Changes in caudate volume with neuroleptic treatment. Lancet 1994; 344: 1434.
10 Filippi, M, van den Heuvel, MP, Fornito, A, He, Y, Hulshoff Pol, HE, Agosta, F, et al. Assessment of system dysfunction in the brain through MRI-based connectomics. Lancet Neurol 2013; 12: 1189–99.
11 McHugh, PR, Slavney, PR. The Perspectives of Psychiatry. Johns Hopkins University Press, 1983.

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Are neurological and psychiatric disorders different?

  • Anthony S. David (a1) and Timothy Nicholson (a1)
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eLetters

Neurological and psychiatric disorders are different

Saad F Ghalib, consultant old age psychiatrist, behavioral sciences pavilion, SKMC,Abu Dhabi, UAE
12 November 2015



This is certainly a thought provoking article. However, I am unsure if the authors’ conclusions can be justified by the editorial main argument! Their premise is that based on radio imaging studies, psychiatric disorders are distinct from neurological disorders as they both involve functionally different parts of the brain in a subtle way. Put differently, both psychiatric and neurological disorders can after all be reduced to impairments of specific brain areas, albeit different ones based on some quantitative statistical threshold. However, the latter statement, although does not explicitly abolish the distinction between psychiatric and neurological disorders , it certainly implies it, contrary to what the authors set out to prove in the first place!

To most scientists, although reductionism has proven its worth in elucidating some of the great laws of nature, however, when unnecessarily applied, it can easily lead to confusion and may well end up being counterproductive. A case in example was an attempt by some to ascribe some sort of free will to subatomic particles considering their inherent unpredictability when subjected to an act of measurement. One can easily see the absurdity of the latter position when the concept of undetermined (statistical) experimental outcome is conflated with that of free will. Obviously, a sensible approach would be to question as to what is meant by free will, if such a thing really exists! In keeping with the same argument we are compelled to ask if some statistical aberration on radio-imaging, possibly caused by medication, can sufficiently encompass the complexity of psychiatric disorders without some reference to an individual psychosocial narrative. I think most well informed psychiatrists are well inclined to give a resounding no answer to the latter question.

It is probably reasonable to assume that to most psychiatrists, a thorough understanding of mental disorders would inevitably have take into account certain biological factors, from genetic vulnerability to brain chemical imbalance. However, the problem lies in the naïve way whereby inconclusive statistical finding in some biological measure is somehow magically transformed into a biological explanation of a complex psychiatric disorder; the serotonin theory of depression is one such example.

There still remains a significant explanatory gap between our operational diagnostic labels and their biological underpinnings. Unfortunately, advancements in psychopharmacology have not helped to narrow that gap considering that most medicines are not disorder specific and that their mechanism of action is so broad spectrum , therefore, prohibits verification of specific biological theories stipulated for the disorders they intended to treat in the first place.

Psychiatric disorders will very likely remain different to neurological disorders, not just because the former affects different parts of the brain to the latter, but the fact that narratives of psychiatric disorders are far more complex to those of neurology as they include meaning, introspective feelings, social milieu, language, political pressures, financial hardships deprivation, the list goes on. To their credit and towards the end, the authors did acknowledge that groups of minds and social context will always be part of what constitute a psychiatric disorder.

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Conflict of interest: None Declared

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