ABSTRACT
INTRODUCTION There has been a dichotomy, long-standing within psychiatry, between psychological and physical approaches to treatment. Enlightened psychiatric practice has looked upon these two modalities as equal in value and bemoaned the relative predominance and availability of physical over psychological treatments
A number of recent developments, most fundamentally in neuroscience, call the basis of this dichotomy into question. Historically, there has been difficulty translating observations of the ‘objective’ anatomical, physiological brain, and the ‘subjective’ brain, the mind. More recently, researchers in the field of cognitive neuroscience have addressed themselves to such subjects as affect1,2 and the origins of the experience of self and other,3 which would previously have been considered to be too ‘subjective’ to be available to rigorous scientific methodology. Researchers in developmental neuroscience have examined the neurobiological consequences of relational trauma in infancy and the impact of the emotional environment upon brain development. Links have been established between such environmental factors and the development of psychological and psychiatric symptoms in later life.4 Other studies have provided neuroscientific evidence for the presence of psychological defences.5,6 Finally, functional imaging has demonstrated neurological changes occurring following both psycho - logical and physical treatments.7 An early study undertaken by Baxter and colleagues demonstrated a similar reduction in the metabolic rate to the head of the right caudate nucleus brought about by fluoxetine and cognitivebehavioural therapy (CBT) in patients with obsessivecompulsive disorder who responded to treatment.8
