Neuropathology and psychiatry

EDITORIAL Neuropathology and psychiatryMore than 100 years have now been spent looking down the microscope at various parts of the nervous system.Progress at first was slow but with the improvement of techniques towards the end of the last century neuropathology came into its own and a wide range of abnormal conditions or processes were quickly identified and even at times explained.It seemed natural in those early days for psychiatrists, as well as pathologists, to take part in this pioneer work, and modern neuropathology derives in no small measure from asylum officers like Alzheimer and Nissl.In Great Britain there were Ferrier and, later, Bevan Lewis at Wakefield, Mott at Claybury and the Maudsley, and Ford Robertson in Edinburgh.As the present century progressed, however, the early impetus slackened, and it began to look as if neuropathology would be left merely to contend with the diagnosis and classification of ever more obscure conditions.While the neuropathologists, not unlike psychiatrists, became immersed in their particular brand of disputation, the study of the nervous system would be carried forward by the biochemists, the physiologists, and all those in the younger branches of neuroscience.Neuropathologists tended at first to look on these enthusiastic new arrivals with a degree of scepticism, not least because they themselves had learned not long before how easily an advance can turn into an artefact.The hope was, however, that with time the pathologists would overcome this suspicion, and would transform their histological kitchens into biologically oriented laboratories in which the technical revolution could be more fully explored.Histochemical methods, freeze-drying of tissue, ultracentrifugation, tissue culture, phase contrast and interference microscopy, fluorescent and electron microscopy were some of the major advances any of which could be combined with the greatly improved and extended techniques for working on experimental animals and even on human tissue.Fortunately this migration into modern neurobiology has largely taken place, and neuropathology, far from sinking into a decline, has not only expanded considerably in recent years but continues to do so.Whereas a generation ago the number of trained neuropathologists in Great Britain could be counted on one hand, there are now six or seven university chairs, some 40 to 50 senior academic or hospital medical staff, and many graduate research workers.This expansion, however, has been overwhelmingly linked either to the basic sciences or, on the applied side, to neurology, to neurosurgery, and to general medicine.Psychiatry stands out as the exception and most psychiatrists today have little time either for the anatomy or the pathology of the nervous system.This lack of interest worries the neuropathologist.He knows only too well that his discipline, like others, has failed to throw appreciable light on the causation either of the major psychoses or of the neuroses.He feels, however, that because of this failure any more tangible contribution to other aspects of psychiatry has tended to be overlooked and this seems to him particularly unfortunate at a time when the field is opening up for the analysis of aberrant human behaviour in terms of abnormal cerebral structure, both at the statistical and at the molecular level.The British Neuropathological Society was sufficiently concerned about the lack of this kind of work, as well as the need for it, to instigate in 1969 an inquiry into the views of the psychiatric world.With the help of the Royal Medico-Psychological Association, 171 psychiatric and subnormality hospitals were asked about their links with neuropathology.One hundred and twenty-seven hospitals replied, 40 of which were in the subnormality group.The total number of beds covered by the answers was about 140,000.It emerged that 10% of this number of patients die each year in psychiatric hospitals (the figure is 2% for the subnormal population).In one out of six of these deaths a postmortem examination is carried out.This is usually made, often on the instruction of the coroner, to discover the immediate cause of death, and anything approaching a thorough study of the nervous