An understanding of the ways the specialities of neurology and psychiatry were formed could help decide how mental and brain disorders should be conceptualised, Fred Ovsiew, professor of Clinical Psychiatry and Behavioural Sciences, Feinberg School of Medicine, Northwestern University, U.S., has said.

Attempting to understand this through a study of history would also provide directions in training clinicians to evaluate and manage many of these disorders.

Prof. Ovsiew was delivering the 30th T.S. Srinivasan Endowment Oration, sponsored by the T.S. Srinivasan Charitable Trust and the T.S. Srinivasan Centre for Clinical Neurosciences and Health Policy, Voluntary Health Services, on "Hysteria: The road less travelled between the brain and mind."

At the dawn of the specialities, psychiatry treated people with severe mental disease, often due to structural brain disease; neurology looked after patients with milder mental disorders without structural brain disease, but more due to ideas and emotions; psychiatry began in lunatic asylums that were run by specialists who believed that mental disorder was due to brain disease.

The institutional setting had an impact on how these specialists conceived their work and on how their speciality developed.

Prof. Ovsiew said the early neurologists expressed their low opinion of the psychiatrists' work, but did pretty little themselves to contribute to the understanding of mental disorders. Instead, their research contributed to the understanding of brain disease.

At the same time, the study of hysteria led to the recognition that ideas and emotions had an impact on illness.

He quoted from the work of eminent medical personalities like Charcot, Hughlings-Jackson and Freud and mentioned about their role in defining the illness.

Reversal

While hysteria had been in the realm of neurologists until then, the revised understanding of the role of ideas and emotions became the pivot on which psychiatry turned to the domain of ideas; away from brain disease, he said. At the beginning of the 20th century, the reversal occurred - neurologists began treating patients with structural brain disease; and psychiatrists increasingly started taking over the neurologists' patients. They also began dealing with ideas and emotions, largely without reference to identifiable brain diseases.

Oration medal presented

Earlier, Venu Srinivasan, chairman and managing director, TVS Motor Company, presented the oration medal and scroll to Prof. Ovsiew.

He also launched a compilation of writings, earlier published in the The Hindu, "Cerebral Musings," to commemorate 30 years of the T.S. Srinivasan Oration.

The orations were part of the T.S. Srinivasan Centre's attempt at taking science to society and empowering people to ask the right questions about their health, E.S. Krishnamoorthy, its director, and honorary secretary, VHS, said.