Over the years, I’ve grown increasingly fascinated with neuroscience and its relation to neurology and psychiatry. Advances in neuroscience research have paved the way for a greater understanding of our brain and associated conditions, yet we have only scratched the surface in terms of extensive and complete comprehension. Still, neuroscience has been paramount in closing the divide between neurology and psychiatry, and thus the perception of the patients afflicted with psychiatric disorders.
First things first—It is important to note that while I do not advocate for distinguishing mental or psychiatric conditions from neurological conditions, it is on average how most people understand it. The vast majority of people hold a false distinction between psychiatric and neurologic disorders and treat them respectively. What I mean by that is that most people have a tendency, subtle or not, to treat neurological conditions as they would any disease and believe it occurred organically and requires some form of medical treatment to cure or control. On the other hand, psychiatric conditions have a confounding stigma attached to them whereby people believe patients are “crazy” or “it’s all in their heads.” What I would say to them is that they are both all in one’s head. Both psychiatric and neurological conditions are consequences of disorders of the brain’s circuitry. When there is a miswiring in the brain for any reason, pathologic behavior or loss of cognitive abilities can result. In short, they are all physiological conditions. No one chooses them, and no one can magically heal them alone.
Nonetheless, most people are ignorant regarding this topic. When I say ignorant, I mean more along the lines of obtuse and unintelligent, lazy even. Frequently there is a history of ingrained belief systems by the time they learn anything to the contrary. Education, socioeconomics, and cultural beliefs play significant roles in whether a person will grow up to understand these conditions appropriately. The alternative is that they are force-fed nonsensical information meant to shame and denigrate others. It’s unfortunate but prevalent, and it doesn’t stop at the uneducated. Some of the worst remarks I’ve witnessed originated from practicing physicians that should know better.
What’s interesting is how we’ve viewed psychiatric conditions as a society over generations. It wasn’t until the 20th century that we started separating the disciplines. Initially, neurology and psychiatry had much more holistic approaches to diagnosis and treatment and were unified branches of medicine. Over time this changed, leading to a change in perception by laypeople. For example, Abraham Lincoln was tormented with depression and anxiety his entire life. During those years, depression was referred to as “melancholy.” There seemed to be this general understanding that it was organic, something people were born with, and that it would never subside. That people understood it was organic is fantastic in many ways because there was no blame or maligning; it just was. That no reasonable treatments existed during that time was not so fantastic and often resulted in stints or lifetimes in asylums or even death. In fact, Lincoln had a family history of depression and wrote extensively about his depression, constantly fearing its depths. Fast forward just 50 years to the early 1900s, and terms like “hysteria” were coined with an added shift toward labeling women. Treatments were extreme, and the outlooks or overall prognoses were not much better. It’s pertinent to note that as the divide grew between neurology and psychiatry, so did public perception. Mental illness became a source of blame and shame.
The blame/shame game is still alive and well today. It’s peculiar that several other developed nations have a far more holistic approach to the issue. Treatment and resources are readily available, and the stigma is far less evident. Whether someone sees a therapist, enters rehab, or takes medication for a psychiatric disorder isn’t salacious, but more just a part of life. In contrast, the resources are scarce in the states, and sometimes abysmal to nonexistent. Even with the increase in the availability of healthcare in the last seven years, coverage for psychiatric conditions is still sketchy at best. Advances in treatment and healthcare costs are at an all-time high, yet options for psychiatric care sit at the bottom of the list despite an overwhelming and growing need. This has to change.