In my 18 years of practice as a psychiatrist, I have witnessed many doctor colleagues referring or sending their relatives to a neurologist for an emotional or psychological issue. If this is the situation amongst doctors, then you can imagine the plight of a common person. Getting appropriate help is essential and important. Many common people want a “brain doctor” but the concept of a brain doctor is vaguely understood in society. To understand “brain doctor” we need to understand the brain itself. The brain is a complex organ with various structures that work together to regulate numerous functions. People also think the “mind” is important for all brain function. But the question is, where is the mind? Can we see it?
The mind rests in the brain. It is part of the very nervous system which the brain is made up of. Nerve cells and neurons are the important units of this nervous system. There are approximately 100 billion neurons in a mature adult brain. So let’s understand the nervous system and the mind.
Function of the nervous system:
1. Body movements and coordination.
2. Consciousness.
3. Speech.
4. Control of sleep-wake cycle.
5. Control of involuntary body functions like heartbeat and breathing.
Function of the mind:
1. Thinking.
2. Emotions / feeling.
3. Behaviour.
4. Motivation.
5. Intelligence.
6. Perception.
7. Memory.
8. Judgment.
9. Conscience.
If you focus in detail, you will observe that the functions of nervous system are:
1. Measurable, observable and demonstrable.
2. Concrete functions.
3. They are like the hardware of the brain.
But if you look at functions of mind, they are
1. Experienced but cannot be measured like how much motivation? How angry or sad? The answer will be “very” or “less” — it can't be concretely measured.
2. They are abstract.
3. They are like the software of the brain.
So, all the functions of mind manifest through thinking (thought), feeling (emotions), actions (behaviour). These three are very dynamic. Hence it is often difficult to understand what started first — thought, feeling or action.
Thus, neurologists deal with the diseases that are measurable and demonstrable, and can be detected through an MRI or CT scan of the brain, while psychiatrists deal with diseases of emotions, thoughts and behaviour which are not spotted on MRIs or CT scans.
Neurological diseases can have various causes, and they often result from complex interactions of genetic, environmental and lifestyle factors. Some common causes include:
1. Infections like meningitis or encephalitis.
2. Trauma: head injury or trauma to spinal cord.
3. Autoimmune disorders: like multiple sclerosis.
4. Metabolic disorders: like diabetes or electrolyte imbalance or bodily dysfunction causing neurological complications.
5. Vascular causes: disruption of blood flow to the brain causing stroke or neurolgical damage.
6. Toxic exposure: certain chemicals and toxins or drugs.
7. Tumours: abnormal growth in brain.
8. Degeneration of brain: as age increases, certain brain degeneration happens.
All the above causes have definite reasons, can be measured or detected by investigations, and can be treated to a certain extent.
Psychological disorders, also known as mental or psychiatric disorders, can have a variety of causes, often involving a complex interplay of biological, psychological and environmental factors. We are in an early state of understanding neurochemical interplay. Psychological, personal, familial and environmental factors play a crucial role.
Some common contributors include:
1. Genetic factors: family history often contributes to earlier onset of illness.
2. Trauma: physical or sexual abuse, witnessing traumatic incidences in childhood precipitates psychological illness. Again the amount of this trauma can not be measured. It is the perception and meaning of this trauma to the particular individual that matters.
3. Environmental factors: violence, poverty, misconceptions are important factors that trigger diseases, as well as become a hindrance in treatment.
4. Psychological factors: Personality traits, coping styles, and cognitive patterns can influence susceptibility to certain disorders.
5. Substance Abuse: Addiction to any substance can precipitate psychological illness, or itself cause the illness.
6. Medical illness: Various illnesses can have an impact on psychology, and on the neurochemicals in the brain.
7. Social isolation: Lack of social support or feeling of isolation can contribute to mental health issues.
8. Social and cultural factors: Cultural expectations, discrimination and societal pressures can affect mental well-being.
A psychiatrist is trained to understand biology as he is a basic graduate in medical sciences, with an MBBS degree. Psychiatry post-graduation helps him to understand social, environmental, personal and cultural factors contributing to mental illness. While a neurologist is a medical doctor who understands brain structure and the nervous system. He is trained to identify and treat nervous diseases arising from vascular, metabolic, degenerative and toxic disorders as well as those related to trauma to brain structure. Hence any observable and measurable diseases like stroke, paralysis, and infections like meningitis, encephalitis will be treated by a neurologist. An illness like depression, anxiety disorder, schizophrenia, mood disorder will be treated by a psychiatrist. Stress, distress and motivational-related psychological aspects are also taken care of by a psychiatrist. Ailments of school-related issues such as school phobia, exam anxiety and learning disorders are addressed by a psychiatrist.
However, just giving some medicines will not suffice in treating a psychiatric illness. It can make the person symptom-free, but we psychiatrists want the person to be disease-free. We want the person to function to his utmost potential. This aims to aid the person’s development by addressing personal, social and environmental factors.
(Dr Shailesh Umate is a consultant psychiatrist, sexologist and addiction specialist, whose mission is spreading awareness about mental health and well-being)
