During most of medical history, all we knew about the brain was its gross anatomy. Then, in the late 1800s, the brain’s microscopic cellular structure began to be elucidated. Now, well into the 21st century, we also have remarkable insights into how the brain functions. Still, studying neuroanatomy is viewed as the first step in learning about the brain. Of course, this makes sense.
But, learning neuroanatomy is actually quite difficult, especially if you are a psychiatrist who is returning to this subject after having been away from the topic for some time. Therefore, the idea that one must first learn neuroanatomy can become an obstacle that limits practitioners’ exposure to many of the more exciting aspects of neuropsychiatry, behavioral neurology, and neuroscience.
In this article I describe the challenges of learning neuroanatomy. Then I tackle the question of what a psychiatric practitioner might get out of being familiar with this material, keeping in mind that, for most psychiatrists, learning neuroanatomy is not an end in itself. Rather, the goal is for the physician to be excitedly engaged in an ongoing process of expanding his or her knowledge about the brain and human behavior. Neuroanatomy is just one complex aspect of this field—one that may be assimilated over time rather than viewed as a prerequisite.
Learning neuroanatomy is difficult
What makes learning neuroanatomy difficult? First, in and of itself, neuroanatomy can be dry and boring. (Surely, I am not the only psychiatrist who finds this to be the case.) Yes, I am awed to contemplate how a mere 3 pounds of brain, the consistency of firm pudding, could possibly be the basis of who we are as human beings and also as unique individuals. It is precisely these thoughts that bring me face-to-face with one fundamental problem that many psychiatrists encounter in thinking about neuroanatomy: What does learning about brain structures have to do with what I really want to know? Indeed!
While I am very interested in the neurobiological basis of human experience, it doesn’t really matter to me whether, for example, memory consolidation or the processing of fear takes place in a brain structure called A or B. What I want from neuroanatomy are insights into behavior. Given that a person’s motivation is key to learning anything, here the psychiatrist encounters the first of many speed bumps on the road to learning neuroanatomy.
What are the other speed bumps? Undoubtedly, for anyone who has even dipped a toe into the sea of neuroanatomy, the following difficulties are likely to be familiar.
1. Neuroanatomical terminology is obscure, often deriving from Greek roots and with no modern referents to help with recall.
2. Neuroanatomical terminology is also confusing. (For example, 3 of the basal ganglia are the caudate nucleus, the putamen, and the globus pallidus. All 3, as a group, may be called the corpus striatum. Sometimes the caudate plus the putamen together are referred to as the striatum. On the other hand, the putamen may be grouped with the globus pallidus and called the lenticular nucleus. This sounds confusing because it is confusing.)
Dr. Schildkrout is Assistant Professor of Psychiatry, Part-time, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA. She is the author of 2 books, Unmasking Psychological Symptoms: How Therapists Can Learn to Recognize the Psychological Presentation of Medical Disorders and Masquerading Symptoms: Uncovering Physical Illnesses That Present as Psychological Problems.
1. Cold Spring Harbor Laboratory. 3D Brain. 2016. https://itunes.apple.com/us/app/3d-brain/id331399332?mt=8. Accessed February 2, 2017.
2. The Accreditation Council for Graduate Medical Education, The American Board of Psychiatry and Neurology. The Psychiatry Milestone Project. July 2015. https://www.acgme.org/Portals/0/PDFs/Milestones/PsychiatryMilestones.pdf.
3. Schildkrout B. How to move beyond the Diagnostic and Statistical Manual of Mental Disorders/International Classification of Diseases. J Nerv Mental Dis. 2016;204:723-727.