The rise of neuropsychiatry

Romberg's Lehrbuch der Nervenkrankheiten symbolizes the birth of neurology as an autonomous medical specialty studying and treating the diseases of the nervous system. It was published 5 years after Griesinger's Textbook in which, adopting and expanding Bayle's anatomoclinical model he had affirmed: 'Mental diseases are diseases of the brain'. If both psychiatric and neurological symptoms originated in the nervous system, some form of association between the two specialties was a logical step, at least at the conceptual level. One aspect of their complex relationship was the creation of neuropsychiatry which developed its most characteristic aspects in the German-speaking countries.

The universities acquired considerable power and influence in the second half of the nineteenth century. From the 1850s on, chairs were created for the teaching of the new common discipline and special institutions, the university clinics, were built with hospital beds for psychiatric patients (if their disorders became chronic they were sent to the nearest asylum), laboratories for research on neurophysiology and neuroanatomy, and special wards for the neurological cases—Griesinger's first move when he took over the chair of psychiatry at Berlin was the creation of neurological wards at the Charité. The leading neuropsychiatrists in charge of these institutions often performed research in both fields with equal competence, as shown by the work of Wernicke and Westphal, and later of Kleist and Bonhoffer, in Germany and of Meynert in Austria.

The concept of neuropsychiatry, appearing at a period during which the German school was progressively gaining influence, had a deep impact on psychiatric thought and on the psychiatric profession, even if its institutional driving force, the university clinic system, was not developed everywhere to the same extent as in Germany. For example, it was conspicuously absent in England, despite the fact that the theoretical position taken by the most important psychiatrist of the time, Henry Maudsley, was very close to that of Griesinger. The National Hospital in Queen's Square, London, founded in 1860, retained a virtual monopoly on the teaching of neurology for many decades, and psychiatry, taught essentially in hospitals, was not represented at university level until the 1930s. However, in most countries, neuropsychiatric institutions coexisted with the asylums where the alienists had the unenviable task of caring for chronic mental patients, often with inadequate means. The concept of neuropsychiatry reflected a basically biological perspective on the aetiology of the mental illnesses expressed in the creation of a new specialty associating competence in the two previously separated domains of medicine. However, it provoked ideological and professional tension between the 'pure' psychiatrists, mainly those in charge of asylums, and the neuropsychiatrists, predominantly involved in teaching and research. In the long term, this conflict was one of the factors which finally led, in the 1960s, to the almost complete administrative and institutional separation of the two specialties in countries such as France where they had been, at least formally, associated. But many traces of the old situation remain. The most influential scientific journal published in German, Nervenarzt, still deals equally with neurology and psychiatry, and the term 'neuropsychiatric' survives in the titles of many teaching and research institutions.

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