by Nancy C. Andreasen
Oxford University Press, 2001
Review by Daniel R. Wilson, MD, PhD on May 20th 2002
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
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’.
1 Andreason, N. The Broken Brain : The Biological Revolution
in Psychiatry. New York:
Shakespeare, W. The Tempest (The Yale
Shakespeare). New Haven: Yale University Press, 1958
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.