Brave New Brain: Conquering Mental Illness in the Era of the Genome
Nancy C Andreasen
http://bmj.com/cgi/content/full/323/7322/1192/a
Oxford University Press, £19.99, pp 368
ISBN 0 19 514509 7
In 1984 Professor Andreasen published a book called The Broken Brain: The
Biological Revolution in Psychiatry. This influenced many latter day
psychiatrists (myself included). Now Andreasen has produced a work in which
she attempts to assay the field of contemporary psychiatric research, as
psychiatry enters the 21st century, sandwiched between two major technological
developments: the sequencing of the human genome and the use of neuroimaging
to examine the structure and function of the living brain.
Is there a need for such a work? Are we not already deluged by brain books?
Certainly, if there were a need then Andreasen would be a suitable guide. She
is editor of the American Journal of Psychiatry, has contributed to the
composition of the Diagnostic and Statistical Manual of Mental Disorders, has
made significant contributions to the field of schizophrenia research, has
studied the relationship between creativity and mental illness scientifically,
and has also published early work on post-traumatic stress disorder (before it
acquired that name). So, on all levels she is amply qualified. But do we need
another book?
This book differs from others in that it is written by someone who has
conducted original research, while continuing to treat patients. Andreasen can
write scientifically, while also addressing the concerns of lay people. Many
of the chapters begin with case vignettes (some of them very moving) and
throughout Andreasen see-saws between cogent descriptions of scientific
concepts and reference points that all will understanda film that deals with
schizophrenia, a novel whose character was depressed, and so on. This is a
detailed text, not a coffee table book. It explains the principles of the new
genetics, the anatomy of neurotransmitter systems, and the methodology of
brain scanning. In four chapters devoted to diseases, Andreasen explains
schizophrenia, mood disorders, dementia, and anxiety. She does not shirk
ethical dilemmas and possesses a humane voice.
Where are the weaknesses? As with any book that attempts to cover a broad
field, some infelicities occur. These are probably slips of the pen: the
putamen lies lateral and not medial to the globus pallidus (p 73); reduced not
elevated serotonergic tone is associated with impulsivity and suicide (p 311);
and in the index, the name of one British psychiatrist is left floating, with
no page attribution (obsessives will find Johnstone, Eve, on p 143).
Elsewhere, the balance of Andreasen's expertise is clearly present in the
schizophrenia chapter, while that on dementia lacks the same degree of detail.
However, these are minor points. I think a lay reader, a medical student, or a
generalist who wishes to update on current psychiatry will find much that is
useful and inspiring in Brave New Brain.
--- --- --- --- ---
Useless hypotheses, etc.:
consciousness, phlogiston, philosophy, vitalism, mind, free will, qualia,
analog computing, cultural relativism, GAC, Cyc, Eliza, cryonics, individual
uniqueness, ego, human values, scientific relinquishment, malevolent AI,
non-sensory experience
We move into a better future in proportion as science displaces superstition.
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