Brave New Brain

Nancy Andreason, Andrew H. Woods Professor of Psychiatry at the University of Iowa, should need little introduction.  She is Editor-in-Chief of the American Journal of Psychiatry, recipient of the National Medal of Science (US), a force in the progress of the Diagnostic and Statistical Manual of Mental Disorders, a prodigious scholar in schizophrenia research and pioneer in the scientific study of brain imaging as well as creativity & mental illness. 

With ‘Brave New Brain’ Andreason offers something of a sequel to her influential 1984 book The Broken Brain: The Biological Revolution in Psychiatry.  The latter popularized the recognition of a major ‘paradigm shift’ in psychiatry and psychopathology as it heralded the succession by biology of the older psychoanalytic era.  Her new book is a comprehensive – if popular – update on much new in neurobiology of mental illness, particularly the convergent trends in brain imaging and genomic techniques.  It has been asked ‘do we need another such book?’

The answer here is ‘Yes, we do’.  While Brave New Brain is not of great use to specialists, it is that sort of imminently readable synoptic that helps a broad public continue to lift away the veil of stigma that still too-often attaches to psychiatry and psychiatric patients.  That is, it constitutes a sound summary of current knowledge concerning the human brain and genome and, more significantly, emphasizes how these two areas are increasingly confluent.  Less convincing is the suggestion that mental illness is soon, if at all, to be conquered.  

Andreason – with a PhD in English -- was first a Shakespearean scholar and she borrows the title for her book from The Tempest (“Oh brave new world, that hath such people in it”).  This is a robustly pro-scientific book without the ambivalence about the march of science that informed Aldous Huxley’s related title.  Andreason’s book is affected by the trend to journalistic tones that increasingly characterize the interactions of notable scientists and their publishers (does anyone much these day publish true scholarly ‘tomes’?), but fortunately this book springs from an expertise of one who has long been at the forefront of research and clinical care. 

The case vignettes draw out more technical material -- relevant genetics, neuroanatomy, neurotransmitters and brain imaging -- is rendered with great clarity.   Likewise, the review of four major classes of mental disease – schizophrenia, mood disorders, anxiety & dementia – are presented in an accessible yet substantive manner.   This is perhaps especially true of her discussions concerning her main scholarly interest -- psychosis.

All in all, there is little in this book to criticism, especially given its clear aims.  A ‘few slips of the pen’ have been identified by prior reviewers (viz: the putamen lies laterally not medially to globus pallidus (p 73); impulsivity and suicide correlate with reduced not elevated serotonergic tone (p 311); and Johnstone, Eve, on p 143 is not properly noted in the index).   But these errors are exceptionally few and limited in scope.

So, Andreason has achieved a fine summary of the field with an optimizism for the future of mental illness research and amelioration.  For the most part, this effort should aid, comfort and instruct laypersons, family members and some patients.  It is, probably, a bit of a moral dilemma for luminaries such as Andreason whether their time and talent should be directed to such an audience (and market!) or, rather, toward an integrative work that is both enlightening for and challenging to colleagues.   

Though it is now many years distant, I am proud to count Nancy Andreasen, among my many superb tutors in psychiatry.   She remains a most energetic scientist with a missionary zeal.  This readable book recaps much of the remarkable progress made in the neurobiology of mental illness but is not merely ‘triumphal’. 

REFERENCES:

¹  Andreason, N.  The Broken Brain : The Biological Revolution in Psychiatry.  New York: HarperCollins, 1985

²  Shakespeare, W.  The Tempest (The Yale Shakespeare). New Haven: Yale University Press, 1958

Dr. Wilson is Professor & Chairman of Psychiatry and Professor of Anthropology at Creighton University.  He has a BA in Anthropology from Yale, an MD from Iowa, ABPN-Psychiatry via Harvard Medical School and a PhD in Biological Anthropology from Cambridge.  Dr. Wilson has authored over a hundred articles, chapters and books mostly in psychopathology and evolutionary epidemiology.  He maintains active research in neuropsychiatry as well as on-going field studies to ascertain base rates of psychopathology among persons in pre-industrial societies.