Neurology and Psychiatry - Two Sides of the Same Coin

Early 20th-century brain model, photo by David Matos, free to use under the Unsplash License

The brain is arguably the most intriguing organ in the human body - its mechanisms drove me to write this article and compelled you to read it! While most organs have only one dedicated medical speciality, the complexity of the brain has given rise to two disciplines: neurology and psychiatry.

The differences between neurology and psychiatry

Let's consider the following scenarios to understand how neurology and psychiatry differ from each other:

John Doe suffers a blow to the head and loses his memory - he would be seen by a neurologist, who is more focused on the physical aspects of brain conditions.

Jane Doe believes herself to be dead - she would be seen by a psychiatrist, who is more focused on behavioural symptoms, including those presented in mood and thought disorders.

In addition to having different clinical and research interests, neurology and psychiatry are separated by theory, vocabulary, research methods, and institutional frameworks. Despite all these differences, both John and Jane Doe's conditions would have been classified as 'nervous disorders' 200 years ago when the study of the brain and mind fell under a single category - neuropsychiatry.

How the rift between neurology and psychiatry came to be

In the early to mid-19th century, breakthroughs in neuroscience, particularly in the anatomy and pathology of the brain, led to the emergence of neuropsychiatry in the Western world. Although the leading scholars of the time (like Charcot and Freud) favoured a joint approach to neurological and psychological disorders, methodological differences existed. Neurologists relied on laboratory techniques, e.g., postmortem and microscopic analysis, whereas psychiatrists favoured symptom descriptions. However, they shared a common goal: characterising the structure and function of the nervous system.

Despite studying the same organ, the rift between neurology and psychiatry widened in the 20th century due to the emergence of conflicting philosophical rationales, theories on the causes and pathogenesis of disorders, and treatment methods. As a result, negative attitudes between both communities grew, collaboration between neurologists and psychiatrists declined, and different institutional frameworks were adopted. Even the prestigious journal 'Archives of Neurology and Psychiatry' was dissolved into separate journals with distinct agendas: JAMA Neurology and JAMA Psychiatry.

Possible renaissance of neuropsychiatry

Increasing evidence from recent advances in neuroscience research blurs the line between neurological and psychiatric disorders. For example, obsessive-compulsive disorder (OCD) is traditionally considered a psychiatric condition, but increasing brain serotonin levels using selective serotonin reuptake inhibitors (SSRIs), a neurological method, may control the symptoms of OCD. This suggests that neurology and psychiatry should not be siloed and considered wholly distinct entities since there are interconnected mechanisms between the two disciplines, and patients would benefit more from interdisciplinary care. Many prominent figures in neuroscience, including Nobel laureate Eric Kandel, echo the sentiment of bridging the divide between neurology and psychiatry as the multifactorial nature of brain disorders is becoming increasingly recognised.

The integration of neurology and psychiatry to date has only been partially successful. Still, gradual steps are being taken to forge a path forward to a renaissance of neuropsychiatry while preserving the identities of neurologists and psychiatrists. The United States offers a fellowship training programme for behavioural neurology and neuropsychiatry, enabling psychiatrists and neurologists to develop proficiency in key skills and knowledge in each other's fields. There has also been a move to establish a common clinical language and dismantle the strict categorisation of symptoms. By maintaining a broad perspective and an alliance with each other, specialists can transdiagnostically care for patients and further advance brain disorder research.

Much like the organ they study, neurology and psychiatry are two halves of our complete understanding of how the brain works and its associated disorders. With our ageing population and growing awareness of mental illness, it is more important than ever to embrace and implement a collaborative and synergistic approach to neuroscience-related patient care and research.

References

Arzy, S. and Danziger, S. (2014) ‘The Science of Neuropsychiatry: Past, present, and future’, The Journal of Neuropsychiatry and Clinical Neurosciences, 26(4), pp. 392–395. doi:10.1176/appi.neuropsych.13120371.

Baker, M.G. (2002) ‘The wall between neurology and psychiatry’, BMJ, 324(7352), pp. 1468–1469. doi:10.1136/bmj.324.7352.1468.

Cleveland Clinic (2025) What is a psychiatrist? What they do and when to see one, Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/articles/22702-psychiatrist (Accessed: 27 March 2025).

Ibáñez, A. et al. (2016) ‘Social Neuroscience: Undoing the schism between neurology and psychiatry’, Social Neuroscience, 13(1), pp. 1–39. doi:10.1080/17470919.2016.1245214.

Perez, D.L. et al. (2018) ‘Bridging the great divide: What can neurology learn from psychiatry?’, The Journal of Neuropsychiatry and Clinical Neurosciences, 30(4), pp. 271–278. doi:10.1176/appi.neuropsych.17100200.

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