Toward the era of transformational neuropsychiatry.

Abstract

The time has come for psychiatry to reclaim its neurological roots and to regain its neuroscientific identity. Prior to the Freudian theory that dominated psychiatry for many decades in the 20th century, psychiatry and neurology were integrated in one department with combined training in neuropsychiatry. It is ironic that Freud, who is a neurologist, by inventing and propagating a theoretical psychoanalytic model for mental functions, contributed to the rupture of the productive unity of neurology and psychiatry. By the 1950s, psychiatry had become de-medicalized and de-neurologized due to the abstract, nonevidence-based psychoanalytic constructs, along with its entirely non-medical jargon. No wonder neurologists decided to break up from psychiatry to form their own associations and to establish separate journals. This estrangement exacerbated the fallacious artificial dichotomization of brain and mind, endowing neurology with a robust medical identity and casting psychiatry as just a philosophy of behavior with no clear medical identity and no recognizable physical findings or neurological basis for its disorder. Alas, both specialties suffered from the rupture of their longstanding union: psychiatry became brainless and neurology became mindless. With rare exceptions, across all medical schools, the departments of neurology and psychiatry currently exist and function as independent silos, with rare academic interactions. The separate training of psychiatrists and neurologists institutionalized the faulty brain–mind dualism: neurological disorders were considered ‘‘organic’’ with tangible sensory/motor impairments, while psychiatric disorders were erroneously conceptualized as ‘‘functional’’, i.e. phenotypic alterations of mood, thoughts and behavior, with no ‘‘tangible’’ neurological localizing signs. Despite the tremendous advances in neuropsychiatry and behavioral