Into the Abyss: A neuropsychiatrist's notes on troubled minds

Open a newspaper on any day of the week and there will be an article on mental health or more pertinently, ill-health. We read that the issue is affecting more and more people: the young, the old, women, men. Behaviour we used to take for granted now attracts a diagnosis...

This diagnosis, as Anthony David sees it, "often tends to take a social or political perspective," and we blame drugs, sex, abuse, religion etc. rather than looking for a physical cause. As an eminent and experienced neuropsychiatrist, however, David believes that "everything in our mental life comes down to, can be reduced to the working of the brain."

David's professional orientation, he tells us, is to look to neuroscience "for answers to some of the questions around human nature." The seven cases he discusses in this book range from sectionable mental disorders to seemingly inexplicable physical paralysis, and David seeks to make it clear that chemical or electrical malfunctions of the brain can generally be found in these disorders and can be dealt with. Diagnosis, as his accounts demonstrate, is often extremely difficult, and treatment may often be experimental, but it is clear he approaches his patients with empathy, and although he is looking for brain malfunctions, he does take their physical, emotional, and social lives into account.

David writes interestingly and in detail (with the patients' permission) about the disorders his seven patients suffer and the way these affect their lives. He tells of his own actions, the questions he asks, the responses of the patients to his investigations and treatments, and his difficulties in finding the causes of their disorders. He is honest, too, about his successes and failures.

The first patient he writes about is Jennifer, who suffers from schizophrenia and Parkinsonism. The former is caused by too much of the neurotransmitter dopamine reaching the brain, the latter by too little. Chemically reducing the amount of dopamine reaching the brain can actually cause Parkinsonism, but Jennifer, it turns out, has both schizophrenia and non drug-induced Parkinsonism. David offers clear explanations of the role of neurotransmitters in the brain, and although the scientific and Latin terms he uses with ease may be daunting for non-scientific readers, he offers good, everyday analogies.

David's chapter headings indicate something about the nature of the particular disorder he is dealing with. Chapter 2, "Strawberry Fields Forever," tells of a patient who suffered a brain injury, which had affected his memory and was causing him to doubt the reality of the world around him: "He described a pervasive sense of the world itself being changed." He felt "unreal," as if he were actually dead and hallucinating reality. David likens it to the feeling produced by psychedelic drugs, such as John Lenon wrote about in "Strawberry Fields."

In Chapter 3, David discusses depression and describes a patient suffering from depression and suicidal thoughts. And chapter 4, "Just the Two of Us," deals with bi-polar disorder and David's interactions with a young black man who has been sectioned because of episodes of violent mania. This man is waiting to be released from a psychiatric ward. He is suspicious of all medical intervention, but David makes a tentative connection with him through their shared love of music and an impromptu jam session.

Chapter 5: "You Are What You Eat" is, according to David "a nonsensical slogan." He describes the "control of appetite" as being "managed by a complex but beautifully balanced neural-humeral programme," and he goes on to explain this and to discuss anorexia nervosa, which was once "something of a medical curiosity and part of the 'differential diagnosis' of tuberculosis." Although his patient does not have this condition, she appears to have lost her appetite for no obvious reason. She eats almost nothing, is uncaring about her appearance and speaks very little: "Nothing substantial went into her mouth and nothing much came out of it." David's diagnosis of the cause is more psychological than neurological, and his approach to treatment is tentative and persuasive.

The last chapters in this book, "Silent Music" and "We Are Family," "are about how the brain and mind interact and, in a sense, vie for control." These chapters are perhaps the most curious and the most disturbing. Both deal with forms of paralysis and, as David puts it:

That brings us to the most potent and controversial symbol of treatment in psychiatry, and one which emblematises that clash between the physical and the metaphysical: electroconvulsive therapy... as well as its gentler modern cousin, transcranial magnetic stimulation.

David is clear that no one really knows how or why these work for some patients. However, as a last resort, he is willing to use them, and does so.

David's interactions with his patients bring this book to life. He is interested in his patients as individuals and wants to work with them to find the cause of the problem and the most effective treatment. At least one person comments on feeling like a guinea-pig, but is still willing to try the suggested treatments. In the end, looking at the functioning of the brain may be like looking into the abyss, but with this book David hopes to "demystify psychiatry" and "help us to change things for the better."

 

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