Dualism and the 'Difficult Patient': Why Integrating Neuroscience Matters

Patients with psychiatric illness present a unique challenge to clinicians: in contrast to the traditional medical model, in which patients are conceptualized as being stricken by a disease, patients with certain psychiatric illnesses may seem complicit with the illness. Questions of free will, choice, and the role of the physician can cause clinicians to feel helpless, disinterested, or even resentful. These tensions are a lasting legacy of centuries of mind-body dualism. Over the past several decades, modern tools have finally allowed us to break down this false dichotomy. Integrating a modern neuroscience perspective into practice allows clinicians to conceptualize individuals with psychiatric illness in a way that promotes empathy and enhances patient care. Specifically, a strong grasp of neuroscience prevents clinicians from falling into the trap in which behavioral aspects of a patient's presentation are perceived as being somehow separate from the disease process. We demonstrate the value of incorporating neuroscience into a biopsychosocial formulation through the example of a "difficult patient."