So much has been published in
recent years, and so much of it in the mental health professions.  Not all of
it has been exemplary, most of it entry level, much of it still tainted with a
century of blind speculation, and driven by hypotheses that would drive Scott Lilienfeld
to drink, or worse, publish another book slamming the pseudosciences and their
apologists.

Not so this slim book from Kaplan
and Hammer.  It may start off with a basic chapter, but that is where it stops
being for entry level practitioners in medicine and psychology.

The joke here is that when you are
tired of medicine, and want to leave the profession, you become a
psychiatrist.  My registrars in their postgraduate years are overwhelmed when
we give them the Kandel, Schwartz and Jessell tome Principles of Neural
Science, or worse, Gazzaniga’s magnificent doorstopper The New Cognitive
Neurosciences, with 24 sub-editors and 98 chapters in cognitive
neuroscience.

I can’t wait to show them this one.

Not that it is without flaws: after
all, the science presented here is only a few years old, so that any such book
is unlikely to be perfect, and as soon as the chapters are ready for print,
taking some years, then at publishing date, they are likely to be ancient
history.

But as Heraclites said, you cannot
put your foot in the same river twice.  So there are bound to be limitations.

In the brain behavior sciences, we
must examine why a particular patient presents with a particular behavior, at a
particular time in their lives.

This book sets out to map, for the
psychiatrist and other mental health professional with a biological streak in
them, how brain becomes mind, and what is wrong with the bad brain in various
presentations.

After an introduction to functional
neural circuitry written by Salloway and Blitz, the book introduces the reader
to neural signaling pathways, written by Kaplan and Leite-Morris.  The book
then covers schizophrenia (I would have preferred the term psychotic illnesses)
and then addiction, anxiety, depression, bipolar disorders, and then finally
Alzheimer’s and dementia in general.

The first chapter is a nice one,
with really great diagrams that beg to be scanned and power-pointed, and I beg
the authors to CD Rom and sell them, they are so good for teaching purposes.

The authors examine visual signaling
(that was predictable) but then go on to the meat and vegetables of mental
health, namely the functional organization of the limbic system, prefrontal
cortex, frontal-subcortical-thalamic circuits, and finally the brainstem
systems, all focusing on how information is processed and behaviour regulated.
Add to this volume things from Russ Barkley on the evolution of
self-regulation, use Miller and Cummings’ work on subcortical frontal
conditions, and the students are gearing up for  Kandel and Gazzaniga.  A touch
of Damasio, and the first year registrars will begin to see the DSM-IV-TR in
stark focus.  Each section of this first chapter contains some reference to
where the structures are, how they connect to other areas, what their primary
role in the brain must therefore be, and how they do this via neurochemical
pathways and how pathology emerges from disruption or dysfunction.  As the
author’s caution at the end of the chapter, if the brain were that simple that
we could understand it, then our observing brains would lack the capacity to
understand these concepts, a nice tautology, I think first pointed out by Emerson
Pugh.

The conclusions to chapter two
likewise come with caveats.  Much research is needed to determine which
molecular changes in mesocorticolimbic pathways are responsible for the effects
of drugs, and again, the pathways are part of a dynamic homeostatic second
order cybernetic system that cannot easily be illuminated on with regard to the
linear intervention of medication.  The chapter nevertheless charts, in simple
terms, the physical highways in the brain and the chemical messenger systems
that enable such homeostasis, by elucidating the signal transduction mechanism
as far as we know them.  A nice side to this book is that this chapter, like
others, is kept short and tight, only 30 pages, and reader exhaustion is
avoided.  Length is not strength after all, and this does nicely.

And of course, while this book does
all that, it refers to everyone present and gone in the literature from Kandel,
to the luckless Goldman-Rakic.

Heckers and Goff bravely take on
the review of schizophrenia, and waste a few pages on history and subtypes
which probably is unnecessary: anyone using this book would know all that, and
the subtypes are not neurologically helpful anyway.  But the rest is sheer
bliss to read, with detailed explanations of every possible sort, including all
the neurotransmitters that are necessarily connected, and not just the
monoamines, but the glutamates of the world are also here, with easily 200
references packed into the few pages allowed for this chapter, a monumental,
but tiny work.  Again, there is so much more now in 2003, just a year later
than publication date, but this is good stuff to read and absorb. It is all
made so easier by crisp and clear prose, and tight editing.

Speaking of the editor, Hammer
himself takes on the task of explaining neural circuitry and signaling in
addiction, addressing the paradigm shift that forced the entry of the book’s focused
topics into addiction studies.  No longer seen as voluntary self-administration
behavior, addiction is now seen as an understandable offshoot of normal reward
seeking behavior become brain disease, with its focus on the dopamine systems
of the subcortex.  Predictably the words nucleus and accumbens are paired, and
early on emerge in the discussion of neural circuitry.  This fourth chapter is
complex and dense, and takes some reading for the implications to sink in.  At
face value, this is about reward seeking behavior, but its implications go much
wider afield, and relate easily to social competition and learning theories in
anthropology.

Kent, Sullivan and Rauch embark on
anxiety, and again, tight writing style and clear but intricate diagrams make
it accessible, if not simple. For instance, a really useful diagram on page 137
embarks on the task of making the homeostatic feedback loops of the cortico-thalamo-cortical
circuits understandable, and relating this to OCD, and by implication, if you
read Scandanavian Nobel Prize laureate’s work for fun, related conditions such
as ADHD as well.  Again, the fingers itch for the scanner and a bit of diagram
plagiarism… sigh.

Marek and Duman cope with
depression in the same way, again with tight prose and good diagrams.  Despite
the age of the book, now out for a year, the work on brain-derived neurotrophic
factor is up to date, as is the information on the neurodegeneration of frontal
and limbic areas.

Sassi and Soares take on bipolar
disorder.  In 13 pages.  Either little is known, or they write as tightly as
the others.  Nine pages of references suggest the latter. 

Nixon works on Alzheimer’s and
dementia, and certainly concentrates on the former, since much more is known,
but the later comments on the Chromosome 17 taupathies is a little thin, and
summarizes what one will find in other tomes, such as Burns and Levy.

A noticeable and only failure of
the book is the absence of a collated index of authors, although of course each
chapter has its own.  The subject index is comprehensive.

The only thing to do is buy this
book, prescribe it to students, and honor it for what it is: good.

 

 

© 2003 Roy Sugarman

 

Roy Sugarman
PhD, Clinical Lecturer in Psychiatry, Adelaide University, Senior Cinical
Neuropsychologist, Royal Adelaide Hospital Glenside Campus Extended Care.

Categories: MentalHealth, Psychology