REVIEW: The Broken Brain



THE BROKEN BRAIN
The Biological Revolution in Psychiatry
by Nancy C. Andreasen, M.D., Ph.D.

     This is a classic book that lays down the case for understanding the true nature of mental illness in a new way.  It was published in an America where psychoanalysis and social determinism dominated psychiatry for over a century.  Dr. Andreasen was a revolutionary when she wrote this book.  She used her impeccable credentials, displayed courage in taking a stand and evidenced competence in making the case presented in the text. It has been over three decades since she wrote the book and her original perception has transitioned from revolutionary to increasingly mainstream.  Dr. Andreasen saw what now seems obvious now but at the time was only a murky idea.  She asserts the now widely accepted idea in psychiatry that curing all mental illness requires biological solutions.
     The book begins with a brief historical perspective on mental illness that can be gleaned from ancient times to recent centuries.  Ancient writings that depict organs of the body shifting and moving as an explanation.  Demons and spirits taking control of the body from the person stricken with mental illness.  Finally a belief in the depravity of soul and spiritual darkness morphs over centuries into the idea that parents and social interactions nurture a person for a lifetime of mental suffering.  Numerous historical understandings of mental illness are detailed, documented and evidenced over the first four chapters.
     The next three chapters detail the mechanisms that underlie how the brain works and how it interacts with the body that maintains it.   The effort to explain the science of the brain is ambitious as she details anatomy, chemistry, cellular actions in the neurons and hormonal interactions with the body. The information is accurate at the time the book was written and it is now supplemented with knowledge of metabolic pathways that build the proteins and neurotransmitters used behind the blood brain barrier.
I particularly like the detailed analysis of the twin studies. Dr. Andreasen does an excellent job explaining how twins separated at birth and placed in a variety of homes provided an understanding that genetic predisposition fully explained the observed rates of mental illness. Social environment was found to be a minor contributor (if it existed at all) to the appearance of mental illness. Twins studies (a number of them) showed mental illness rates unrelated to family assignment and that genetic modeling alone predicted the rates of mental illness emergence.
There is a quick description of how proper diagnosis and appropriate medication yield what seem to be miraculous results. People with horrid thoughts and hallucinations in the throws of psychosis are dramatically and suddenly released from those thoughts, cease hallucinations and return to real world with the use of medication. Medications are fully explained and detailed as biological solutions for mental illness that are verified to work on patients who suffer from the symptoms.
The closing of the book addresses something our society has still not resolved. A person with cancer or some other somatic illness is assisted, supported, encouraged and often given reduced workloads to assist in overcoming the illness. The mentally ill person (and family members) today are often shunned, isolated, estranged from family, may forfeit a professional licence, lose a career or be terminated do due to a mental illness. The result is that the mentally ill seek to avoid diagnosis and treatment likely prolonging and exasperating the illness. The author does not think this a humane way to treat a person who is suffering from any biological pathology including those who have a mental illness.
This book was far ahead if its time in the 1980's but our biological understanding has advanced significantly since then. I would love to see another book like this that includes the explosion of knowledge about metabolic synthesis of neurotransmitters behind the blood brain barrier (orthomolecular studies included), the likely autoimmune dysfunctions that underlie the emergence of the pathologies and the possible impact of our understanding of epi-genetics. All these areas have increasingly emerged as sources of biological pathologies underlying mental illness since 2005.

This book is aimed to transition psychiatry (and society) to a new way of thinking about mental illness. Newtonian dynamics was used to discover new planets but also led to the false belief in a planet called "Vulcan" between Mercury and the Sun (explaining orbital variations of Mercury). This widely held belief in a planet that did not exist was "settled science" from 1840-1910. Later the orbit of Mercury was found to be fully explained by a new theory for Gravity called General Relativity. In another example geologists began to see that moving continents over eons of time were responsible for geological features and seismic activities on the Earth today. "Plate tectonics" was openly ridiculed from 1940-1960 (in peer reviewed Geological Journals) but is now a widely accepted principal. A predominance of psychiatrists once thought that parental approaches or traumatic childhood experiences were at the root of mental illness. Beginning in the the 1950's psychiatrists increasingly came to see mental disorder as a direct result of biological pathologies. Major transitions in thinking have happened in other disciplines but this revolution is very different because how our culture views the interaction of freedom and responsibility. The ideas that moral weakness, dysfunctional parenting and/or childhood experiences are the root cause of mental illness will be difficult to overcome among the less informed. The association of mental illness with moral failings and/or inadequate parenting still hinders data collection even today. Families often scramble to protect themselves from darkened reputations, lost careers or even prison for real or imagined "moral failings" by hiding and obscuring the episodes brought on by mental illness. This book is confident that society will increasingly becoming open to the data and facts and that the truth will emerge (even if slowly). This book is helping shorten the transition to a more humane and truthful society.

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Quotes of Interest:

    "...We...might comfort ourselves with the belief that we live in a more enlightened era.  But while it is true that we no longer confine the mentally ill in chains people who do suffer from mental illness are still often the victims of subtler versions of social stigmatization, cruelty and prejudice.  This prejudice grows out of ignorance and misunderstanding about mental illness.  It derives form a failure to realize that mental illness is a physical illness an illness caused by biological forces and not by moral turpitude. "
                                                                                                                                   pg 2

   "...Wonder drugs are now available to diminish the symptoms of three out of four of the major categories of affective disorders, schizophrenia and anxiety disorders."
                                                                                                                                   pg 191

   "...But nearly everyone assumed that mental illness was a spiritual disease, that it was caused by supernatural rather than natural forces, and that its victims were somehow responsible for their own suffering.  
     Although attitudes are changing, they continue to linger.  Unlike almost every other type of illness, mental illnesses still tend to carry an aura of guilt and moral responsibility.  Even today people suspect that a person who is mentally ill must have brought his problems on himself if he could just "shape up".  Parents of teenagers suffering from schizophrenia or depression wonder what they have done wrong, blaming themselves for beeing too strict and inducing excessive guilt in their child- or too permissive and not instilling enough control."
                                                                                                                                   pg 236

Twin studies....                                                                                              pg 227-238  
"..One is bound to conclude from these various studies of the genetics of schizophrenia that hereditary factors play a role, but are not all important."
"..Schizophrenia is more common among  people born during winter months....a modest amount of evidence suggests that patients suffering from schizophrenia may be somewhat more likely to have mild or soft signs of head injury occurring early in life ."

                                                                                                                                   pg 230
"..These results indicate that, if anything, affective disorders are even more likely to run in families than is schizophrenia."
                                                                                                                                   pg 236
  "...As in the case of schizophrenia, these studies indicate that genetic factors are important...these studies also suggest the presence of a purely genetic component that influences the development of affective disorders."
                                                                                                                                   pg 237

 "...One obvious implication of the biological perspective in psychiatry, stressed throughout this book is that the mentally ill-and their families-no longer must carry a burden of blame and guilt because they have become ill.  While episodes of illness are sometimes triggered by unfortunate life events, the basic causes lie in the biology of the brain.  The best way to treat these biological abnormalities- treatment that is not always available at present-is to correct the underlying physical abnormality, usually through the use of somatic therapy."
                                                                                                                                   pg 249

 "...From the point of view of friends and relatives, it is usually best to try to convey trust in the medical system to the patient, so that he will seek treatment voluntarily.  Nevertheless, patients can and should sometimes be forced to obtain treatment against their will if they are very ill and do not recognize it."
                                                                                                                                  pg 251

 "...While the patient may require some somatic therapy to correct an underlying chemical imbalance, he may also need psychotherapy to deal with the personal and social consequences of his illness."

                                                                                                                                   pg 256

 "...The word cure is used much to liberally today.  We need to learn to distinguish between cure and care.  People have been too often taught by both physicians and journalists to  hope for a cure when, in fact, they should be hoping for care instead."
                                                                                                                                   pg 257

  "...People with these disorders cannot and should not be deprived of their jobs, their places in school, or their professional credentials.  There is a wide range of possible outcomes for patients with schizophrenia, and their illness must always be dealt with on an individual basis."
                                                                                                                                   pg 258

 "...As we grow to understand causes, we can find better ways to prevent or to treat."
 "...In the future, society itself must march, not to they asylum, but to the streets and marketplaces where we all live in order to free the mentally ill fr0m the chains of social opprobrium and misunderstanding."
                                                                                                                                   pg 260

  
If you read this far...Wow!  Thank you!
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