Neuropsychiatry

To the Editor: The editorial by Stuart C. Yudofsky, M.D., and Robert E. Hales, M.D. (1), was thoughtful and addressed a large conceptual issue in psychiatry. However, I am less sanguine about the rapprochement between neurology and psychiatry and their subsequent unification in neuropsychiatry. Psychiatry is the only medical specialty that concerns itself with the patient’s subjective world and labors at the uncomfortable interface between mind and brain, attempting to straddle both. As frustrating as the results of the effort sometimes become, it is at the core of our professional identity.

Jaspers put it well when he outlined the coexisting scientific and subjective roles of the psychiatrist (2). I am concerned that our interest in the emotional lives of our patients and the meaning that they assign to their existence may be lost with a neuropsychiatric perspective, which in my experience tends to focus on more narrow data. Of course, if a new neuropsychiatry enlarges its purview, then we may be able to preserve the uniqueness of psychiatry and the unfolding of neuroscience. I am actually of the opinion that psychotherapy may be susceptible to reconceptualization in neurobiological terms, which would move toward synthesis and congruence with the scientific zeitgeist of the day.