Boundary debates: The new challenge of psychiatry

Abstract

Byline: Philip. John Changing Boundaries Boundary between Behavior and Biology is arbitrary and changing. It has not been imposed by the natural contours of Disciplines, but by lack of knowledge at the time (E.R. Kandel) Body-Mind Dualism The boundary, the dichotomy between body and mind held sway for a long time. This Cartesian dualism achieved a shrewd truce between the church in the 17[sup] th century and science, by partitioning body and mind into two domains. Such a dichotomy then appeared logical - what was 'visible' went to science and what then was 'invisible' went to the church and the charlatans. This shrewd and clever truce enabled spectacular progress in all other disciplines of medicine except the 'science of mind', which simply could not have progressed asking more of philosophical and sociological questions than biological.[sup] [1] Even as the science of mind subsequently progressed, its boundaries have been under perpetual violation and incursion - by empiricisms in the past decades, and 'overlapping' fraternity at present because we cannot, as yet, clearly define this business of 'mind'. With the exponential technology available today that creates windows to 'peep' into live brain cells as they go about performing the mental functions, the mind may appear as arising purely from physical processes such as electrical signals or complex cellular chemicals. On a different plane, the mind transcends the physical, as something evanescent and ethereal that may be closer to the philosophical or spiritual concept of the soul! So, here we are - does the soul belong in psychiatry, neuro-theology, philosophy or theology? The boundaries are still indistinct as indubitably expressed by Prof. Mike Trimble, Professor of behavioral neurology at the Institute of Neurology, London, in his recent book - 'The Soul in the Brain'. However, when your temperament and training are right, if you open up a brain, the mind will eventually fall out.[sup] [2] Psychology and the Isolation of Psychiatry The dualism between psychology and psychiatry too is a derivative of the faded mind-brain issue, which once created professional contest and personal vanity within the field of behavioral sciences. Psychiatrists must never discard or diminish the environmental influences in the etiopathogenesis of psychiatric disorders. Nevertheless, those in our own profession who pretend that psychiatry is not a branch of medicine, in order to facilitate 'multi-disciplinary approach', contributed to the abysmal isolation of psychiatry from the rest of medicine.[sup] [3] As a consequence, even physicians sometimes fail to distinguish psychiatrist from a psychologist! While training at National Institute of Mental Health and Neuro Sciences (NIMHANS), many in our generation went through these boundary tensions. But fortunately, those were related to 'hierarchical' disputes and the movement that we then spearheaded settled those issues once and for all. Even in a multi disciplinary system, the hierarchical order cannot be compromised at any cost; in fact hierarchy only strengthens a holistic approach to management.[sup] [4] Technology has transformed the operating boundaries between psychology and psychiatry in the clinical practice of medicine, and ended psychiatry's isolation. Mind being generated by the nervous system, we discern that psychiatry is a pure branch of medicine. Psychiatry should be perceived and practiced as application of basic neurosciences to man's day-to-day problems.[sup] [1] Therefore, psychiatrists are primarily physicians. Period. Boundary between Behavior and Biology Expanding knowledge of the roots of behavior in neurobiology is fast merging frontiers and obliterating boundaries between related disciplines such as neurology, psychiatry and pediatrics. As Kandel implied, the arbitrary boundaries between behavior and biology are not imposed by contours of the medical disciplines. …