Future of psychiatry and neurology

[vmc303]

I'm very interested in the brain in general, both its functioning as a biological organ as well as the higher level "mind" processes that psychiatrists typically focus on. While I'm drawn to psychiatry because of its intellectualism, I'm not sure I agree with its foundations. I'm a firm materialist and think that psychiatric problems are ultimately neurological problems. I don't have much interest in psychoanalysis other than a passing intellectual one, and I'd much rather study pharmacology and neurosciences than conventional therapy. Counseling depressed people for hours on end seems like hell to me, but so does the opposite extreme of 15 minute med checks all day long.

At the same time though, neurology seems constrained by its focus on low level diseases. Alzheimer's and Parkinson's are fascinating, but mostly as objects of research; as a doctor, I imagine it would get frustrating never having good treatment prospects.

So my question is, where are the two fields heading? Are they due to converge? If I want to be a brain "generalist," an expert in both the biological and mental aspects of the brain, which direction should I head in? I know that in the neurosciences, they don't really differentiate between the two, so maybe there's hope for an integrated approach in medicine as well.

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[scared sh*tless]

I'm very interested in the brain in general, both its functioning as a biological organ as well as the higher level "mind" processes that psychiatrists typically focus on. While I'm drawn to psychiatry because of its intellectualism, I'm not sure I agree with its foundations. I'm a firm materialist and think that psychiatric problems are ultimately neurological problems. I don't have much interest in psychoanalysis other than a passing intellectual one, and I'd much rather study pharmacology and neurosciences than conventional therapy. Counseling depressed people for hours on end seems like hell to me, but so does the opposite extreme of 15 minute med checks all day long.

At the same time though, neurology seems constrained by its focus on low level diseases. Alzheimer's and Parkinson's are fascinating, but mostly as objects of research; as a doctor, I imagine it would get frustrating never having good treatment prospects.

So my question is, where are the two fields heading? Are they due to converge? If I want to be a brain "generalist," an expert in both the biological and mental aspects of the brain, which direction should I head in? I know that in the neurosciences, they don't really differentiate between the two, so maybe there's hope for an integrated approach in medicine as well.

Yeah it's all pretty interesting. No there aren't the really great treatment options in Psych or Neuro that you have in, say, Ortho. But then again, Cancer and Cardiology were also 'depressing', 'diagnostic' fields until hordes of talented minds descended upon the problems.

WRT psych and neuro converging, the rumor is that they will converge. I suggest you pick up the latest copy of the 'green journal' (Neurology). In addition to an interesting discussion of 'cosmetic' neurology (including an article by a philosopher!) there is a comment by the chair of UCSF neurology where he states that the future of neurology will require:
1) More research
2) More teaching by neurologists to other medical specialties
3) Better integration of Psychiatric disorders. He shares the view that Psych was basically a sideroad off of neurology that will join again soon.'

I don't agree with you that all psych disorders are neurologic though -- I think you are right WRT the big AXIS I disorders, but I think a lot of common problems seen in the out-patient setting occur with improper development...

For example, take the narcissistic doctor or neuroscientist. For some reason he didn't get validation growing up (maybe his parents didn't give conditional love, maybe he was ostrasized by his peer group) -- but for some reason he didn't develop mature ego defenses.... So instead of building good relationships his learns to live off of the scooby snacks of what he sees as validation of his supreme intelligence: papers published, awards won, and 'honors' grades. Eventually, the neglect of real relationships and the impossible weight of perfectionism cause him a breakdown. I would say that this is a psychiatric problem that is not organic.


Or then again, I could be full of ****.

I'm not even an MD! What the heck do I know?

l8r.

 

[JMD]

"I don't agree with you that all psych disorders are neurologic though -- I think you are right WRT the big AXIS I disorders, but I think a lot of common problems seen in the out-patient setting occur with improper development...

For example, take the narcissistic doctor or neuroscientist. For some reason he didn't get validation growing up (maybe his parents didn't give conditional love, maybe he was ostrasized by his peer group) -- but for some reason he didn't develop mature ego defenses.... So instead of building good relationships his learns to live off of the scooby snacks of what he sees as validation of his supreme intelligence: papers published, awards won, and 'honors' grades. Eventually, the neglect of real relationships and the impossible weight of perfectionism cause him a breakdown. I would say that this is a psychiatric problem that is not organic."


Hey VMC,
I, too, am trying to find a way to integrate my interests in the "material" aspect of psych, behavior, etc. As a current 2nd year, I am really trying to find out whether psych or neuro would be a better route. The consensus seems to be that you could tweak either specialty to suit your interests via postdocs. As you stated, the problem is that most of this stuff is the object of research... you hear about all of these fascinating neuroscience discoveries but how often do you see any of them applied in clinical practice? Then again, the idea of being a part of these fields as the discoveries are transitioned into the clinics is pretty exciting (if it actually happens).

Anyways, I just got done studying all evening and my brain is pretty fried so I will post again if people keep the thread going.

Oh yeah, regarding S.S.'s quote, I believe that your example's F'ed up need for validation is still ultimately based in his synapses (i.e.- "organic")...