The Broken Brain: The Biological Revolution in Psychiatry

Abstract

Psychiatry had to wait for a scientist with the literary talent of Nancy Andneasen to tell the world that it has come of age. The Broken Brain is not just about the biological basis of psychiatry (others have dealt with this with mixed success) but about psychiatry as a medical specialty in the broadest humanistic conception of medicine. Dr. Andreasen presents the thesis that psychoanalytic insights and behaviorat approaches to mental disorders are best interpreted in the light of the emerging neunoscientific revolution; that, atthough some psychiatrists would not admit it-and the public at large is ignorant of it-this revolution now permeates all aspects of psychiatry; that a breakdown of the brain-whether homeostatic or structural-is the final common pathway of constitutional, social, and psychological inputs; that the “broken brain” is not a metaphor: “mental illness is truly a nervous breakdown” (p. 219); and, most important, that the public, as well as some from the ranks of psychiatry, need to be awakened to the fact that mental illness is real. Page after page, Dr. Andreasen tells the lay reader that the suffering of clinical depression, neurosis, schizophrenia, or dementia is involuntary, agonizing, and as real as that of any other group of medical diseases. What is original to Dr. Andreasen is not her thesis-for that is the Zeitgeist of the new psychiatry-but the grand style in which she delivers it. Because she presents this thesis in a lucid, convincing, and humanistic style, reinforcing scientific data with compelling clinical vignettes, The Broken Brain can serve as psychiatry’s defense against the now customary attacks from within and without. This book defines the core identity of the psychiatrist-and what he or she does-more eloquently than any previous attempts along these lines. It succeeds in linking Pinel’s, Kraepelin’s, and Freud’s visions of what we are and what we do. The first, in liberating the mentally ill from their chains, liberated psychiatry from medieval ignorance and set off the new humanistic era of psychiatry. The second, in his emphasis on disease and natural and family history, charted the objective course of the illnesses that we study, dissect, alleviate, or cure. The third taught us that by a courageous, systematic, and painful look into ourselves we can be freed from the burden of neurotic reminiscences. The Broken Brain is about all this and more-how the new biology of the brain is shaping the present concepts of major mental diseases and the future of the field, how such understanding has radically changed the treatment and outcome of these diseases, and why psychiatry is a frontier discipline. The twenty-first century belongs to us. (Although it is implied in much of what Andreasen says throughout the book, I would have been happier if she had actually said that bridging the gap between the subjectivity of mental suffering and the emerging neurobiology represents the real challenge and excitement of psychiatry.) The publisher is to be congratulated for producing such an attractive volume for the price. The Broken Brain is an unusual book, a masterpiece that links Andreasen’s earlier work on the psychopathology of literature with her more recent delving into the limbic brain. In this book the reader will find rich literary allusions, such as to Gerard Manley Hopkins’ personal account of his early morning awakening and to Euripides’ account of Medea’s murdering her children. She quotes Hippocrates: “These things that we suffer all come from the brain, when it is not healthy . . . or suffers from any other unnatural affection to which it was not accustomed.” Not only does Dr. Andneasen invoke the authority of Hippocrates to support her thesis, she also devotes I 00 pages to a systematic review of the relevance of the brain to different mental diseases. Dr. Andreasen’s brilliant exposition effectively counters those who believe that psychiatric illness represents moral turpitude, inadequacy, eccentricity, or social marginality, as well as the lay belief to the effect that the professionals who treat such ills lack moral fiber. The accuracy of her analysis of the history of ideas and current trends, coupled with hen compelling prose, renders The Broken Brain the most cogent single work on what psychiatry is about. It should be required :eading in high schools, colleges, and medical schools. It should be read by all those whose lives are touched by mental illness. It should also be required reading for those who are in the habit of periodically prophesying the demise of psychiatry. Finally, The Broken Brain should be made available to clergymen, lawyers, judges, and those in public office-those who make policy decisions about how public funds should be spent on mental illness. I nominate Dr. Andreasen to receive the award that the American Psychiatric Association bestows on a psychiatrist whose work best exemplifies service to the profession-and the public.

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