The
philosopher Hegel once said that philosophizing should not be confused with
mere analogical reflection.  This whole book is based on one analogy:  that
Americans are running around as if they were "manic". The author’s
credibility for passing this judgment appears to be that he is a psychiatrist
who has done some work on mania. 

Yet
this book has nothing to do with mania or bipolar disorder, and very little to
do with psychiatry.  It is rather a critique of American society that is rather
muddled.  On the one hand, Whybrow wants to say that American society is too
fast and furious, and that we are too single-minded in pursuing our
self-interest.  He acknowledges that this pursuit of self-interest is part of
the core philosophy of capitalism, enshrined in the work of Adam Smith and the
philosophy of America’s Founding Father revolutionaries.   Yet instead of
fleshing out this critique, he seeks to uphold it while at the same time
absolving capitalism and Adam Smith.  He does so by emphasizing what Adam Smith
had to say about "social sympathy", or the tendency of humans to
relate to each other interpersonally and in communities.  Basically, Whybrow
says we need to leaven the personal self-interest focus of our culture with a
greater appreciation of the importance of community and social connections. 

There
is nothing new about this perspective. The author barely mentions those who
have made the same argument (and then almost always in passing), and at times
he either does not know about other key thinkers or he has simply ignored
them.  For instance, Thorstein Veblen is mentioned briefly on page 41, Karl
Marx only briefly on page 234 and in one footnote in which only "Capital"
is referenced (as opposed to his much more relevant early essays on
alienation), and John Kenneth Galbraith in only a footnote without any
elaboration.  The term "present moment" is discussed in relation to a
Buddhist oriented meditative response to our current consumer society (which Whybrow
puts in the context of the ideas of a young entrepreneur he interviewed) but no
mention is made of the book by Jon Kabat-Zinn of the same name, or Kabat-Zinn
and his colleagues’ extensive work on this topic.  The term "affluent
society" is mentioned once, but the key book and ideas written by
Galbraith are not referenced or discussed.  Henry David Thoreau is not mentioned
at all in the book, despite a recommendation at the end of the book that we
should simplify our lives.  The key work of Herbert Marcuse (especially "One-Dimensional
Man"), which represents a much more profound psychological analysis of
modern society (influenced in depth by Freud and Marx) than this book, is not
mentioned at all.

Perhaps
I had been expecting something of more scholarly depth.  Or perhaps the editors
of major presses, and readers, no longer can handle such scholarship,
preferring instead, as is the case in this book, portraits of airport
discussions with yuppies.

The
only new aspects to Whybrow’s text comes down to three ideas.  One:  that
Americans are especially prone to selfish acquisitiveness due to the genetic
inheritance of a risk-taking disposition transmitted by those who emigrated
here.  Two:  that we are biologically predisposed to addictiveness and
rewarding behavior.  Three:  that we are also biologically predisposed to
empathy and social cohesiveness.  However, the third biological predisposition
is weaker than the second, and thus we need to make cultural and political
efforts to strengthen social and community bonds. 

The
evidence that he provides for the above three ideas come from the following:  1. 
Primate studies that suggest that emigration occurs more with risk-taking
impulsivity, which is associated with some decreases in serotonin activity in
the brain; and human studies that link dopamine D4 receptors with risk taking
behavior; and some evidence that offspring of such primates are also more
likely to be impulsive.  2.  Some biological studies about the role of dopamine
circuits in pleasure and addiction.  3.  Some biological studies about the
nature of empathy.  Most of this biological information is provided through
descriptions of interviews with relevant researchers, almost all colleagues of
the author at the University of California at Los Angeles.  Very little detail or context is provided to either
convince or fail to convince the reader about the validity and relevance of
these biological speculations.

The
bottom line is that Whybrow simply provides brief descriptions of the fact that
there is a biology of empathy, and pleasure, and risk-taking.  But there is a
biology to everything.  To state that there are biological aspects to
these behaviors is simply to state a fact.  This does not explain that those
biological factors are important, or essential, or more important than cultural
or political factors.  The book should have tried to make those arguments if it
wanted to break new ground. 

Further,
even if, for instance, D4 receptors had anything to do with immigration, and
some presumed biological basis to American creativity and impulsivity, I do not
understand what this has to do with mania. D4 has never been implicated in
mania or bipolar disorder; it is related to the personality trait of
risk-taking behavior. But then again, mania in this book is merely an analogy,
not a real idea with flesh and blood, nor a scientifically valid idea as it is
used in psychiatry.

This
book would have been much better if, given Whybrow’s background in behavioral
neurobiology, he provided more attention in detail to the ideas of Marx and
Galbraith and Marcuse and Thoreau.  That book could have placed Whybrow’s few
biological speculations into the context of those formidable social and
cultural critiques.  Whybrow either does not know those critiques in depth, or
he really believes it is sufficient to dismiss them with a wave of the hand,
pointing to D4 receptors.  Yet he makes no convincing case why we should agree
with this approach.  Why is it that these biological facts should explain the
excesses of our capitalist society better than some inherently problematic
aspects of capitalist ideology, or Calvinist culture, or the libertarian
politics of the Founding Fathers?  Whybrow never makes this argument; he simply
states it as a given. 

One
might make other relevant criticisms. For instance, the book jacket states that
Whybrow offers "for the first time a comprehensive physical explanation
for the addictive mania of consumerism."  What exactly is "addictive
mania"?  One might be inclined to overlook these comments as written by
marketing employees with little knowledge of psychiatry but presumably Whybrow
could have edited the jacket.  Also, I failed to find much of a physical
explanation as claimed above.   The technical points in this book are minimal
in the text, with mild elaboration in the endnotes; there is hardly any
convincing physical explanation of anything. 

The
jacket continues:  "He sheds critical light on the dangerous misfit emerging
between our consumer-driven culture and the brain systems that evolved to deal
with privation 200,000 years ago."  This is an interesting idea, but it is
clearer in the jacket than in the book. In fact, though he assumes the relevance
of evolution, Whybrow does not directly discuss the issue of evolutionary views
in psychiatry in any but the most superficial manner.

Finally,
the jacket concludes:  "Drawing on scientific case studies and colorful
portraits…"  The portraits are colorful, but I found only one clinical
case study (not the plural) and that was a lady with panic attacks, not mania.
Perhaps the book should have been titled "American Panic", but that
would have ruined the analogy.

© 2005 Nassir Ghaemi

Nassir
Ghaemi, M.D., M.A., M.P.H., Associate Professor, Department of Psychiatry and
Behavioral Sciences; Director, Bipolar Disorders Program, Emory University
School of Medicine. Dr. Ghaemi is author of The
Concepts of Psychiatry: A Pluralistic Approach to the Mind and Mental Illness,
Johns Hopkins University Press, 2003.

Categories: Depression, MentalHealth