Toward a Unified Classification System for Brain–Mind Disorders: Putting Calls for Integrated Clinical Neuroscience Into Action

Abstract

Dividing the brain–mind into the specialized fields of neurology and psychiatry has produced many granular advantages, but these silos have imposed barriers to comprehensively understanding and contextualizing the fundamentals governing mental life and its maladies. Scientific inquiry into these fundamentals cannot reach its full potential without interdigitating the boundaries of two specialties of the same organ for both scholarship and clinical practice. We propose that to truly integrate disorders of the brain and the mind for research and clinical care, we must carefully reexamine the classification of its disorders (nosology) as an instrument to develop a coherent pathological and psychological framework. We call on professional organizations from neurology, psychiatry, behavioral neurology, neuropsychiatry, neuropsychology, and other relevant subspecialties (eg, geriatric psychiatry) to convene a multidisciplinary task force to define the current classification principles of their subspecialties and work toward developing an integrated nosology. The effect of a shared classification system, which we acknowledge is a difficult proposition philosophically and politically, would have transformative potential across educational, clinical, scientific, programmatic, and sociocultural realms. If accomplished, this initiative would provide a definitive step toward reducing stigma (and promoting reimbursement parity) for the full spectrum of complex brain disorders (regardless of traditional neurologic vs psychiatric conceptualizations).

Promoting Growth in Behavioral Neurology: A Path Forward

“…BNNP is a unified clinical subspecialty with shared board certification. However, there continues to be a general separation of professional identity whereby neurologists who train in BNNP tend to refer to themselves as behavioral neurologists, and psychiatrists who train in BNNP tend to refer to themselves as neuropsychiatrists (Stanley et al, 2023). This separation of identity leads to an unfortunate diffusion of clinical and programmatic resources, as there generally is not a singular organizational infrastructure in which the majority of members associate (at both institutional and professional organization levels).…”

Proposal for a Mechanistic Disease Conceptualization in Clinical Neurosciences: The Neural Network Components (NNC) Model

“…Separating processes that affect the same organ (i.e., the brain) and lead to similar symptoms is arbitrary and influences our understanding of neurological and psychiatric disorders. 18 Historically, neurology and psychiatry were combined under the name neuropsychiatry, and understood as part of a single, unified branch of medicine. 19 They were later separated based on the presence (neurology) or absence (psychiatry) of somatic/motor signs and objectively identified mechanisms.…”