Why psychiatry and neurology cannot simply merge.

Dr. Pies is with Tufts University School of Medicine, Boston, Massachusetts. Address correspondence to Dr. Pies, Tufts University School of Medicine, BOX 1007, 750 Washington St, Boston, MA 02111; [email protected] (E-mail). Copyright 2005 American Psychiatric Publishing, Inc. C the case of the optician and the art critic. Each is viewing a painting at a museum, and each is asked to describe the image. The optician says, If we superimpose an x and y axis on this image, we find that at x 4 and y 5.2, there is an essentially rectangular patch of yellow that continues along the horizontal axis until x 5.1, where it changes to Prussian blue. The art critic says, It is a man in a yellow rain coat, with an angry expression, and large, steel-blue eyes. Scruton comments that, “ . . . you could imagine these descriptions being . . . so complete that they would enable a third party to reconstruct the picture by using them as a set of instructions. But they have nothing whatever in common. . . . You cannot switch from one narrative to the other and still make sense . . . ” In this editorial, I argue that—like the optician and the art critic—neurology and psychiatry are guided by significantly different narratives or what postmodern philosophers like to call discourses. Discourses are essentially the “ . . . complex[es] of credentials, protocols, jargon, and specialized knowledge that defines theory and practice within the human sciences . . . ” Discourses include the linguistic core of a discipline, as represented in its textbooks, journal articles, and habitual modes of presenting data. I would like to suggest that, while not nearly so far apart as the optician and the art critic, the disciplines of psychiatry and neurology still utilize discourses too disparate to permit a merger of the two fields in the very near future. Thus, my argument is that psychiatry and neurology cannot simply merge. I hope it will become clear that this is quite a different claim than, psychiatry and neurology simply cannot merge. With the appropriate transitional mechanisms and discourses, there is reason to believe that psychiatry and neurology will someday find themselves subsumed in a larger and broader discipline that I call encephiatrics.