Where Psychiatry Meets Neurology and the Mind Meets the Brain: Neuropsychiatry Perspectives on Clinical, Training, and Historical Paradigms
"A brain scan may reveal the neural signs of anxiety, but a Kokoschka painting, or a Schiele self-portrait, reveals what an anxiety state really feels like. Both perspectives are necessary if we are to fully grasp the nature of the mind, yet they are rarely brought together."
Every behavior has an anatomy."
It is with honor and pride that we introduce this special neuropsychiatry theme in the Residents’ Journal. Each generation of psychiatrists before us has played its part both individually and as a field to apply theoretical concepts, whether physiological or psychological, to the patient who suffers from ailments of thinking, feeling, and behaving. This is no simple task, and our explorations have been previously limited by a lack of tools and technology. The neuroscience of behavior, a notion conceptualized over time from the likes of Freud and Kraepelin to Kandel and Solms, has seen various iterations and definitions.
In an era of vastly expanding knowledge of the brain’s most elusive territories and circuits, the onus again falls on us, as individuals and as a field, to continue exploring new ways of approaching patient care with each individualized human experience. We must do so without losing sight of how our predecessors taught us to empathize and align with patients.
Biological psychiatry remains challenged to produce a clear mechanistic understanding of mental illness. Therefore, it is fascinating and potentially elucidating to consider cases in which a known, quantifiable neurologic or systemic dysfunction resulted in a psychiatric presentation. As psychiatrists we learn to live in the world of diagnoses of phenomenology, syndromes of behavior, and constellations of subjectivities, but as physicians we are drawn to cases in which a somatic pathophysiology might be discovered and possibly measured and treated in more objective terms. The discovery of NMDA receptor encephalitis (and other rare autoimmune encephalitides) as a treatable cause of some cases of psychosis has ushered in an era of organic considerations of neurologic processes in a host of psychiatric formulations.
Although the silos of neurology and psychiatry are artificial in many respects (not to mention recent in the history of medicine), and there is no doubt that how the two fields approach illness is distinct, there are places where we can come together and study both neurophysiology and human experience more meaningfully, collaboratively, and fully.
This issue of the Residents’ Journal riffs on places where the mind meets the brain. The contributors bring us fascinating cases in which a curiosity about both the mind and the brain is required to better understand, listen to, and engage with our patients. What we know about the manipulation of neural circuitry and its effect on cognition, behavior, and emotion will help inform training approaches to familiarize clinicians with both neurology and psychiatry in service of our patients. Our patients’ presentations often do not follow the artificial rules of division between the disciplines.
The offerings in this issue are representative of the many articles in the neuropsychiatric literature that afford a perspective on the intersection of the mind and the brain. We encourage readers to embrace each case report, review, perspective, and editorial through a lens of psychiatry’s intersection with neurology. It is our hope that these pieces will contribute to this rapidly growing field.
