Psychiatry is the medical specialty that studies and treats a variety of disorders that affect the mind—mental illnesses. Because our minds create our humanity and our sense of self, our specialty cares for illnesses that affect the core of our existence. The common theme that unites all mental illnesses is that they are expressed in signs and symptoms that reflect the activity of mind—memory, mood and emotion, fear and anxiety, sensory perception, attention, impulse control, pleasure, appetitive drives, willed actions, executive functions, ability to think in representations, language, creativity and imagination, consciousness, introspection, and a host of other mental activities. Our science explores the mechanisms of these activities of the mind and the way their disruption leads to mental illnesses. When disruption occurs in syndromal patterns in these multiple systems of the mind, we observe disorders that we diagnose as dementias, schizophrenias, mood disorders, anxiety disorders, or other mental illnesses. Our specialty is defined by our patients, our science, and our history, not by the form of treatment provided (e.g., psychotherapy, medications), nor by the presence or absence of known mechanisms of illness. Psychiatry is defined by its province: the mind. We are fortunate to have chosen to explore such interesting territory.
If psychiatry deals with diseases of the mind, does it also deal with diseases of the brain? Unequivocally, yes. What we call “mind” is the expression of the activity of the brain. “Mind” is our abstract term that refers to mental functions such as memory or mood, while “brain” is the neural assembly of molecules, cells, and circuits that produce those functions. The two are as inseparable as the dancer and the dance, the chestnut tree and its leaf, blossom, or bole. Some of us who work in psychiatry think more about mind and some think more about brain. But we are looking at the same thing from two different perspectives, not at two different things.
We are physicians to both the mind and the brain. We modulate the psyche with psychotherapies that address mind mechanisms such as memory or consciousness, but this modulation works at the neural level by producing changes in the brain. We also modulate the psyche by prescribing medications that work directly at the neural level, but we see their effects at the level of mind as we observe a depression lifting or hallucinations diminishing. At present, mental illnesses include some with known brain mechanisms (e.g., Alzheimer’s disease), some with suspected and partially demonstrated brain mechanisms (e.g., schizophrenia), and some with mechanisms that clearly reflect an interaction between the brain and personal experiences (e.g., posttraumatic stress disorder). Since the mind is the organ expression of the activity of the brain, we can hope that some day we will achieve a complete understanding of all mental illnesses as both mind and brain diseases. And that psychiatry will still exist until the illnesses themselves cease to exist—as the medical specialty responsible for the study and treatment of mental illnesses.
This excerpt is from an editorial, What is Psychiatry? written by Nancy Coover Andreasen, MD, PhD, and published in the American Journal of Psychiatry, 154:5, May 1997
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