from the Weekend Australian newspaper recently:
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Brave New Brain: Conquering Mental Illness in the Era of the Genome
By Nancy C. Andreasen, M.D., Ph.D., Oxford University Press, 368pp, $65.00
Strong Imagination: Madness, Creativity and Human Nature
By Daniel Nettle, Oxford University Press, 235pp, $69.95
Reviewed by Damien Broderick
A few years ago I sat down late one evening in front of the telly with a
cuppa and a slice of cake, and out of the blue my pulse accelerated madly.
What the--? My heart hammered; awful dread flooded me. I lay flat on the
floor and took my pulse, gazing up blurrily at the wall clock. Over 110 a
minute. I'm a skinny character, in pretty good nick. While I hadn't lifted
weights for a while, I walk a lot, don't smoke, eat and drink moderately.
It seemed possible that I was, well, dying.
Alone in the house, I literally crawled to the phone and rang my brother
the medico. Every family should have one. `You're hyperventilating,' he
told me calmly. `Breathe into a paper bag.' That would elevate my carbon
dioxide levels to slow my respiration, I knew, but I gasped that it was my
runaway heart, not my lungs, that bothered me. `You're having a panic
attack, nothing to worry about,' he assured me. Unconvinced, my body and
mind droned with doom.
I was wired up for 24 hours with a pulse tracker, had an echocardiogram.
Nothing physically amiss. All in the head, as they say. It recurred a
couple of times later, at the most inconvenient times (twice in restaurants
with dear friends), along with that terrifying, overpowering sense of fatal
dread. Part of the condition, they told me. Transmitter chemicals get out
of whack in the brain, triggered by stress hormones, and upset the organic
pacemaker that regulates heart beat. What had caused it? I realised
(ironically, given the work I do) that the first episode was a delayed and
unvoiced rage reaction to an especially mean-spirited and unfair review of
one of my books I'd read earlier in the day.
Dr Nancy Andreasen need fear no such reaction if she chances upon this
review. I recommend her book to anyone intrigued by the enormous changes
that science and technology are making to our understanding of the mind, in
health and illness. That's not to say her book is flawless; she's an
experimental neuroscientist and psychiatrist, not a professional writer, so
some of her book reminds me of those corny Reader's Digest medical
articles: `I am Joe's Liver'. Parts of Brave New Brain (itself a less than
happy title for a book extolling technical advances) turn into `I am
Joanna's Anterior Cingulate Sulcus', or tell little parables about anxious
Michelle or `mellow Melissa', or lurch into textbookese: `Dopamine, a
catecholamine neurotransmitter, is the first product synthesized from
tyrosine through the enzymatic activity of tyrosine hydroxylase'. These
glitches are forgivable, I think, in such a rich and mostly accessible
display of neuroscience's remarkable new treasure house.
Andreasen is a well-credentialed guide for the tour. As chair of psychiatry
at Iowa University, she's been a key player developing those new imaging
techniques that show us the inner workings of the living brain, down to
sub-millimetre resolution, without opening the hood. Her early medical work
with profoundly traumatised burns patients made her the ideal choice, as
the Vietnam war wound down, to revive and advocate the more general topic
of post-traumatic stress disorder, a term she devised for DSM III, the
1970s' psychiatric bible. Drawing on her recent imaging work, she's
developed a model of schizophrenia as an explicit brain disorder, marked by
`misconnection syndrome', a series of physical disruptions in the growing
brain. Last year she was one of just twelve US scientists to receive the
President's Medal.
Starting from basics, her book lays out the key information needed to make
sense of later detailed accounts of how scanning and genome advances
clarify what goes wrong in the brains and experience of people suffering
schizophrenia, emotional or mood disorders, the dementias of old age, and
those anxiety states of the kind that clobbered me. Inevitably, much of
this opening background has a homework flavour, so I'd recommend diving
straight into chapter six, where the astonishing tale of neuro-imaging is
told--explaining lucidly how PET scans and functional magnetic resonance
(fMR) images catch the living brain in mid thought, tracking which bits do
what.
You can watch as unpleasant pictures and thoughts activate the deep,
ancient limbic system, while joyful ideas light up the distinctively human
cortex. It's encouraging. So too is the prospect that ever more nuanced
non-invasive probes will show us the workings and defects of what is
misleadingly dubbed `the human heart'--now relocated into that most
mysterious and complex of organs, the brain.
But is all this too `reductionistic', too dismissive of those stigmatised
as `mentally ill''? In the '60s and '70s, madness was briefly glorified.
Psychotics were allegedly victims of malign family dynamics but also heroes
of the revolution against throttling orthodoxies. The bankruptcy of such
romantic posturing (I fell for it myself) was revealed by the rise of new
medicines and scanners, and by the suffering it had wrought on the ill and
those nearest to them.
Anthropologist Daniel Nettle revives a similar topic, proposing that `the
more extreme positions on the spectrum of mental life are… typical not just
of malfunction--mental illness--but of the best in mental
functioning--inspiration and creativity.' He cogently explores this link
between `the lunatic, the lover and the poet', while recognising that
madness, even manic madness, is no fun: `never forget for a moment that the
psychoses are severe, crippling, often lethal diseases'. Serotonin and
dopamine systems, he concludes, make us who we are, yet they are not our
choice but the parental gift of our genes. Luckily, genes are not the whole
of destiny, and madness is indeed in some respects the far side of
Shakespearean flourishing. Art as well as panic can make our pulse race,
and so can love.
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