"The concept and practice of "neuropsychiatry" has emerged as a function of the ever-growing body of scientific literature that links what and how we think to what and how our brains are operating.
As a neuropsychiatrist, I tend to view behavior in terms of brain function. In this way, my perspective is "from the inside out," so to speak. This is in comparison to the "outside in" approach that a psychologist or even a traditional psychiatrist might have as their reference point for understanding behavior. Both are valid.
While I fully appreciate how a person's life experience impacts his or her ability to function, it can't be denied that a person's life history is immeasurably embedded in his or her brain. If you buy the idea that the brain directs behavior, and I do, then it follows that things that disturb the efficiency of brain function will consequently disturb a person's ability to modulate how he or she thinks and acts.
Life throws some pretty hard breaks at us from time to time. A concussion, a stroke, chronic disease, a genetic disorder and so on, are all events that can tip the neurochemical balance either a little or a lot and suddenly the brain loses its ability to fully compensate. Thinking becomes less efficient, judgement is affected, and finally a person's behavior changes- sometimes in ways that are not so desirable.
However, there is some good news in this commentary; there are plenty of things to be done about behavioral disturbances. Pharmaceuticals are immensely valuable for helping patients modulate their behavior when they are not able to do it for themselves. However, medications are almost never the entire solution.
I am a strong believer in the value of the functional therapies such as cognitive rehabilitation and psychotherapy, among others. While they may not be appropriate for every person or situation, each holds its own place in the solution for stabilizing behavioral disturbances and in the recovery and rehabilitation process. Each is as critical to the completion of the therapeutic effect as medications are. In my opinion, one should not occur without the other.
Along another line of thought, it is one of our culture's greatest misfortunes for psychology and psychiatry to have arisen out of a dualistic paradigm; that is, one in which brain and mind are thought of as separate entities. That the field of medicine continues to uphold a distinction between neurology and psychiatry as separate specialties is evidence of a glaring cultural bias that serves no one in particular- other than insurance executives, of course.
To be sure, it is not likely that insurance companies will give up the resultant opportunity to deny resources based on an arbitrary and artificial distinction between "medical" (brain) and "mental" (mind) illnesses without an epic battle- a reality that is truly a travesty and demands to be corrected.
Please do your part to defeat this kind of bias.
Finally, physicians are nevertheless obligated to practice good medicine by staying informed as to the inseparable relationship between brain and behavior and to advocate for the rational and equitable treatment of illnesses of thinking and behavior (i.e., illnesses of the brain) with all other bodily illnesses.
In summary, the answer to the question is that neuropsychiatry is the neurology of behavior. Behavioral neurology is the understanding of brain systems in terms of behavior and psychology, if you will. You can see that the cumbersome distinction between neurology and psychiatry is rapidly disappearing. My hope is that it's disappearance signals a new level of maturity in our culture as it comes to terms with the fact that behavior is simply an inevitability of brain function and not a sign of moral weakness.
I long for the day when we can banish Freud to the dusty stacks, change his name to Fred for punishment
(no offense to all the "Freds" of the world), and finally get on with taking care of our people, brain disorders and all, in a respectful, equal, and humane manner."
Patricia Lowrimore, M.D.
