Need to integrate mental and brain activities

Following my previous post, Ed Pinkney @mwproject sent a tweet asking me to elaborate on what I meant by the "need to integrate mental and brain activities" and I said I would. Psychiatry functions within the mind-brain philosophical problem. Psychiatrists don't need to be philosophers but they do need to realise there's an issue in this respect.

Nineteenth century medicine developed on the basis of the anatomoclinical method, which recognised disease as having a bodily pathological origin. Psychiatry didn't quite fit with this, although it was recognised that dementia paralytica was a late consequence of syphilis, senile dementia had a physical cause such as Alzheimer's disease, that there could be focal abnormalities in the brain and that learning disability could also have physical causes (eg. see my book chapter). However, most psychiatric illnesses are functional, in the sense that there are no structural abnormalities in the brain.

As this is the case, how should psychiatry be practiced? All medicine should be patient-centred. The danger is that if doctors focus on disease, they may be distracted from dealing with the ill person. There may actually be some self-protective element in this, considering the emotional consequences of dealing with the suffering of patients, but ultimately medical training is about learning to focus on the ill person. This situation is even more prominent in psychiatry, as the symptoms and signs that patients have are part of them as people rather than due to a structural abnormality in the brain. Don't misunderstand me! Of course, the thoughts, feelings and behaviour of people who are not mentally ill are due to their brain. We have an integrated understanding of their mental and brain activities. In the same way, we should have an integrated understanding of the mental and brain activities of people who are mentally ill.