But Then They Came Apart…
Several influences conspired together, some originating within neurology, others within psychiatry. In the wake of the remarkable discoveries of Broca, Wernicke, Hughlings Jackson and others, neurologists became cerebral cartographers, keen to localise functions and lesions in the brain with maximum precision, preferably within a single Brodmann area (figure 9). This led quite naturally to a focus on 'low hanging fruit'—elementary aspects of sensation and motor control lent themselves readily to this approach; some discrete cognitive functions, like face recognition for example, could also be neatly localised. But mood disorders, obsessive compulsive disorder, autism, schizophrenia were much less tractable to localisationalists, and were exiled from neurology partly for this reason.
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Figure 9.
A colourised version of Brodmann's cytoarchitectonic map (with acknowledgment to Professor Emeritus Mark Dubin, University of Colorado-Boulder).
Powerful forces within psychiatry had also been pulling neurology and psychiatry apart. One of these forces owed much to a man whose initial training, interests and ambitions were neurological—Sigmund Freud (figure 10). Educated in Vienna toward the close of the 19th century, the young Freud was fascinated by the relationship between mind and brain. He investigated the local and systemic properties of cocaine, dissected the nervous system of lamprey and crayfish, studied aphasia and wrote an early manuscript on the neurological basis of mind, his 'Project for a Scientific Psychology'. But after studying with Charcot in Paris, and encountering the puzzling phenomena of hysteria and hypnosis, his intellectual direction changed. While he never lost his interest in neurology, he developed the hugely influential theory of psychoanalysis which interpreted mental disorder in primarily psychological terms, and sent 20th century psychiatry on its own unique trajectory.
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Figure 10.
Sigmund Freud. Credit: PA.
A third influence was fed by a recurring line of thought about psychiatry, which crystallised in the 20th century in the 'antipsychiatry movement' associated with Laing (figure 11) and Szasz. This movement rejected the 'medical model' of mental disorders, downplaying the role of the brain and the body. Instead, antipsychiatry underlines the importance of the social and economic environment in engendering mental illness, and recognises the (real) risk that psychiatry may be abused by oppressive regimes, as it was in the last century in Russia, China and elsewhere. The moving 1960s film 'One Flew over the Cuckoo's Nest', which depicts psychiatry as a tool of control and oppression in the USA, captured the spirit of antipsychiatry (figure 12). Whatever view one takes of mental illness, antipsychiatry provides a salutary reminder that conceptions of mental illness cross the uncertain boundary between science and society.
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Figure 11.
R D Laing.
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Figure 12.
Screen shot of Jack Nicholson in 'One Flew Over the Cuckoo's Nest'.
One other influence may have played a part. Though attitudes to the relationship between mind and body have varied from culture to culture and time to time, the broad distinction may be a 'human universal'. Surveys, including one conducted among Edinburgh undergraduates 10 years ago (figure 13), reveal notably 'dualistic' view of mind and brain among scientists and laymen. If we are indeed all 'Descartes' babies' at the start of our lives, we have a predisposition to oppose mind and body, or mind and brain, despite their intimate inter-relationships. This can lead to an unreasonably sharp distinction between the specialists who care for their disorders.
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Figure 13.
Attitudes to mind and brain, from Demertzi et al.