Splitting the brain: The divergence of psychiatry and neurology


Queen's University at Kingston, 2-274 Bagot Street, Kingston, ON, Canada K7L 3G5
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Within clinical medicine, the nervous system carries the curious distinction of being the only functional unit to have two major specialties devoted to its study - psychiatry and neurology. Perhaps more curious is that although physicians from both fields treat diseases of the nervous system, they appear to be very different clinicians. For example, their training emphasizes different skills, they speak different medical languages, they belong to separate professional organizations, and some have argued they have different personalities.

This contrast was not always so pronounced. In England and the U.S. during the mid 19th century, alienists - the predecessors of psychiatrists, and "nerve" doctors - the predecessors of neurologists, were more similar than they were different. Both physicians followed similar medical training, their patients often had comparable symptoms, and both emphasized the organic nature of illness while using psychological therapies. Perhaps the biggest distinguishing factor between the two physicians was that alienists worked with the poor and neglected in insane asylums, while "nerve" doctors worked most often in private practice with paying clients.

This small dissimilarity however, would steadily widen. During the rest of the 19th century, significant advances in medical science and a new emphasis on research transformed clinical medicine. Neurological disease classification changed from a disorganized array of disease symptoms such as "paralysis" and "tremors" into distinct clinical entities supported upon a strong anatomical base. Despite these changes in the rest of medicine, psychiatry remained largely the same. Isolated from their medical colleagues in state run asylums that did not encourage research and scholarship, psychiatry missed out on the research race. Moreover, what neuroanatomical research had been done in psychiatry had been of little practical value to the diagnosis or treatment of the insane.

By the end of the 19th century, the search for a madness lesion had failed and the psychological approaches espoused by Kraeplin and Freud gained influence. Meanwhile, neurology followed the rest of medicine down the reductionist path. Neurology and psychiatry had split the brain into the physical and the psychological and were moving in opposite directions.


Plenary 2   (Constantin von Monakow Lecture)
Wednesday, 15 September 1999

The Neurosciences and Psychiatry: Crossing the Boundaries

Joint Congress of the European Association for the History of Psychiatry (EAHP), the European Club for the History of Neurology (ECHN), and the International Society for the History of the Neurosciences (ISHN)

Zurich and Lausanne, Switzerland, 13-18 September 1999