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By Fred A. Baughman
Jr. MD © 7/27/00

As a neurologist/child neurologist, and a reader of Clinical
Psychiatric News, I never ceased to be amazed at the phenomena of ‘biological

I presume the editor of the Talk Back column [Clinical Psychiatric News, July, 2000, page 13]
chose the question to be poised: ‘Should psychiatry and neurology be combined
into one specialty, since both deal with the brain? Why? Why not?” 

“…since both deal with the brain?”  Since  when?  There are blanket claims of disease and of
‘dealing with the brain,’ but, to date, psychiatry’s  biological research has come up empty, nada, and these remain
nothing more than claims.  A review of
the joint history of psychiatry and neurology seems in order. 

From The American Academy of Neurology: The First 50 Years,
1948-1998 [Edited by Maynard M. Cohen, MD, The American Academy of Neurology,
St. Paul, MI], we  read of the birth of
neurology as a new specialty, separate from psychiatry and from the erst-while,
combined specialty of ‘neuro-psychiatry.’

The close of the Second World War
ushered in an era of unparalleled therapeutic advances.  Penicillin…soon became accessible to the
nation’s physicians, and a string of new antibiotics followed…with the earlier
introduction of diphenylhydantoin, a more effective therapeutic armamentarium
was soon developed. … Prevailing wisdom suggested neurologists were obliged to
practice psychiatry to make a living. …The American Board of Psychiatry and
Neurology certified only in both specialties simultaneously—separate designations did not exist before
.  Medical schools were without
formal divisions or departments of neurology for the most part….  The end of hostilities in Europe brought a
flood of residency applicants…New neurology programs were established and
existing ones enlarged.  On 23, June,
1948…a nucleus of 52 charter members chaired by Abe Baker approved formation of
the American Academy of Neurology…Those “whose chief interest is directed
toward the field of organic neurology
or whose clinical practice is limited chiefly to neurology” were eligible for
fellow status …The need for neurologic services, both academically and for
patient care, became generally recognized after the Academy was founded…Among
other items of importance during his presidency (Robert A. Fishman, AAN
President, 1975-77) was consideration of separation of neurology from
psychiatry in the American Boards.  Neurology
was closer to medicine, Fishman reasoned, and had only a superficial
relationship to psychiatry. …The response favored maintaining the status quo by
a margin of two to one.  The prevailing
feeling seemed to resist leaving a larger organization and taking on a new
administrative function. …separate councils were created for each of the two

What this tells us is that prior to 1948 and the birth of
the independent specialties of 
psychiatry and neurology, the two fields were married out of economic
necessity, there having been too little to do in neurology to make a living at
it alone.  It was never that their was a
common scientific basis.  Then, as now,
neurology dealt with the organic, biologic, brain and with its actual diseases.  In that psychiatry dealt only with emotional
and behavioral problems in persons with no objective organic, biologic
abnormalities, the divide—then as now, was absolute.

We also learn that their remains a joint American Board of
Psychiatry and Neurology, not because of a common scientific basis, but as a
matter of administrative efficiency. 
Neurology, “seemed to resist leaving a larger organization and taking on
a new administrative function.”

The only thing different today, just as in the subject Talk Back column is that psychiatrists
talk, to themselves, their patients, and the public-at-large as if they
routinely dealt with the brain, not the mind, and with actual diseases–those
things we all (psychiatrists too) learned in medical school were diagnosed only
by  demonstrating an objective,
confirmatory, physical or chemical abnormality.  Only their lexicon has changed; it has become that of the rest of
organic medicine when no proof whatsoever exists that a single psychiatric
condition, disorder has a single, solitary, confirmatory, physical or chemical
abnormality or marker.  The reasons for
this  must be sought.  Twenty-five years of doing ‘biological’
research on physically non-specific entities, has yielded not a thing, and that
of course, is exactly what was to have been anticipated.  Why would US psychiatry (mainly) spend
billions looking for organic/biologic/neurological dimensions to entities known
to be nothing more or less than the range of emotions and behaviors in
biologically whole, normal individuals? 
Why indeed? 

Surely the Talk Back
editors, likely from academic psychiatry, understand the eternal schism between
psychology, psychiatry and all of biology. 
Why  pose the question as though
it were a legitimate question.  They
lead off with “I think, therefore I am,” as if this could possibly be true in
the physical sciences, which all of the medical specialties are with the
exception of psychiatry. 

Respondent, Dr. Gene Wright, a child psychiatrist from Santa
Rosa, CA, had it right: “Brains and minds are not the same thing at all,” he
said, choosing not to ignore the science he learned in becoming a general
physician, as all of us do, before electing a specialty.  Sadly his voice gets no amplification from
within the establishment, committed to the illusion of biology.  Dr. Wright continues: “Saying that
psychiatry ‘deals with the brain’ is a reductionistic half-truth that obscures
the most important contributions that our specialty has to offer society.”

As much as I admire your response, Dr. Wright, it is not
even a half-truth.  The children,  patients said to have psychiatric
‘disorders’/ ‘diseases’ are, in fact neurologically, biologically and
physically normal until the brain-altering medication or medications prescribed
for them begin to circulate throughout their bodies and brains.

Dr. Mario Testani of the University of Rochester (NY)
posits: “Psychiatry’s unique domain is the mind—biopsychosocially
defined…We have unfortunately taken mind-body dualism to far, ignoring the
mind.”  It is words such a ‘biopsychosocial,’
neuropsychiatry,’  neurobiological,’
‘psychobiology,’ etc. that have blurred the line for the non-scientist,
but only the non-scientist.  Scientists,
including scientific physicians are aware that it is only the patient in whom
organic disease has been ruled out—excluded (by finding no objective
abnormality), who is a candidate for mental health, psychologic, psychiatric,
referral.  Further they, and the
psychiatrist as well know that the qualifying ruling out of organic disease is
done by non-psychiatric physicians prior to the scheduling the psychiatric
appointment.  Dr. Testani’s and anyone’s
saying something is biopsychosocial or neuropsychiatric or psychobiological,
does not give psychiatry or sociology a neurological or a biological
component.  That only comes with
objective evidence.  And again all we
have is their neurobiological lexicon—no science, no proof. 

A Dr. Ronald Rubin of Appleton, WI is particularly deluded,
urging that neurology and psychiatry be combined because the mind and the brain
are the same entity.  Where did his
medical school preparation in things normal and abnormal, go?  One hopes he knew the difference between the
separate fields of neurology and psychiatry when he chose to enter

Dr. Joel Hassman, a psychiatrist, importantly, pointed out
that in neurology, the patient requires a physical exam.  In psychiatry, however, touching patients
risks violating boundaries, even when the physicians intent is fully
ethical.  Each field, on its own merit
is a full complement of knowledge, he said. 

I have often pointed out to psychiatrist colleagues—those
given to waxing biological, that they do not do general physical examinations,
neurological examinations, laboratory, x-ray or scanning diagnostics!  How, then can they possibly claim to
demonstrate organic, biologic, chemical abnormalities—those necessary to
diagnose actual diseases.  They  are trained to do no such things and they do
no such things.  By telling their
patients (and all in their lives, as well) that they have a ‘brain disease,’ a
‘chemical imbalance’ they make a ‘patient’ out of a normal human being, they
pervert science, and they knowingly, and routinely, violate that individuals
informed consent rights.  Everything they
diagnose and prescribe henceforth is predicated upon having made a ‘patient’ of
a normal human being. 


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