The mind is indivisible from the brain

Peter White et al in an article in the BMJ propose that classifications of neurological and psychiatric disorders should be merged together into a single category of disorders of the nervous system. They justify this because of what they call the “revolution in the clinical science of the mind, as the techniques of basic neuroscience are successfully applied in mental health”.

This success is apparently demonstrated in brain scans that they say show structural brain abnormalities in various mental health disorders. However, they then don't say what these abnormalities are; nor do they note the dynamic nature of the appearance of the brain on scans; or discuss whether findings are specific. They also make a lot of the results of functional brain imaging showing brain activation but don’t say how it’s helped our understanding of brain function. For example, we already knew before brain scans that the limbic system is involved in supporting a variety of functions such as emotion. 

Of course the mind is indivisible from the brain, as they say. As such, a statement of this sort is tautologous, but White et al are saying more than this. Essentially, they believe that a sharp distinction between organic and functional disorders is unhelpful (an issue I’ve commented on in a previous post). In fact, they don’t seem to realise that DSM-IV has already tried to get rid of this distinction.

The arguments they use about the advantages of a more medicalised psychiatry do not really stand up. They suggest it helps stigma but as I have pointed out previously (see post), it could in fact increase stigma, as people do not really feel understood. Similarly, they think it might help recruitment to psychiatry but as I’ve again pointed out previously (eg see post), it may put people off.

I’m not against psychiatrists getting training in neurology and vice versa, but I do think it’s important that psychiatrists are well trained and they may well get the wrong idea if White et al’s proposal is taken up. Psychiatry, unlike neurology, is not based on treating a physical lesion.