Facing our future.

Abstract

I welcome this thoughtful, forward-thinking article on three counts. The authors represent the present and future of neuropsychiatry. They highlight that a firm understanding of the neural structures and core networks which mediate emotions, behavior, and cognition is foundational. And they propose solutions for psychiatry training programs. Over the last several decades, outmoded views have gradually given way to more modern neuroscientific thinking (Price et al., 2000). Instead of ‘‘nature versus nurture,’’ we now understand that although brain regions are not dedicated to a specific function, there are core networks based on intrinsic mechanisms which are influenced by extrinsic, environmental factors. Thus, it becomes a magnificent interplay between nature and nurture, genetics and epigenetics. The old notion of ‘‘mind over matter’’ has now shifted given our knowledge that mental forces can transform brain matter. For instance, cognitive behavioral therapy can change brain patterns to the benefit of patients with obsessive–compulsive and depressive disorders (Yoshimura et al., 2014). Another American adage ‘‘sticks and stones may break my bones but words will never hurt me’’ has been replaced by our understanding that childhood abuse, including bullying, as well as acute and chronic stress may have a permanent impact upon brain organization and behavior (Pitman et al., 2012). We are closing the gap between psychiatry and neurology, joined by the shared foundation of basic and clinical neuroscience. There is clearly ‘‘a psychiatry of neurology’’ and ‘‘a neurology of psychiatry.’’ We should abandon the term ‘‘organic brain syndrome’’ as a relic of history which has separated neurology and psychiatry. This article serves as a clarion call to close ranks in a more collaborative fashion.