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Brave New Brain: Conquering Mental Illness in the Era of the Genome
by Nancy C. Andreasen

Reviewed by
Merete Rietveld

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In Brave New Brain: Conquering Mental Illness in the Era of the Genome, Nancy C. Andreasen proclaims the dawn of a new era in research on mental illnesses. Aimed at a general reader but at times highly technical, the book contends that the simultaneous mapping of the human genome and the human brain has opened new possibilities for understanding the biological origins of mental illness.

Andreasen, chair of the Department of Psychiatry at The University of Iowa College of Medicine, introduces readers to genomic and brain-imaging technologies and describes their potential for changing the lives of people with mental illness, some of whom she profiles in the book. The title is derived from a line in Shakespeare's The Tempest ("Oh brave new world, that hath such people in it") and is meant to convey the sense of enthusiasm and optimism she perceives among clinicians and scientists in the field of mental illness.

"The terrain of the brain is being mapped in parallel with the mapping of the genome," she writes. "The convergence of these two domains of knowledge is one of the most exciting things that is happening in medicine and mental health at the moment. Their convergence has already changed how we think about both the causes and treatments of mental illness."

The book consists of four parts on different themes: how the brain works, the history of the genome, modern neuroimaging techniques, and narratives of the mentally ill. In each part, Andreasen discusses four major groups of mental illness—schizophrenia, mood disorders, anxiety disorders, and dementia.

The first part provides statistics showing that mental illnesses are both common and costly to the world economy. Andreasen personalizes these statistics by giving an account of one family's experience with depression, including their difficulties in obtaining a diagnosis and dealing with health insurance companies.

Like many of her colleagues during the past decade or more, Andreasen calls for a synthesis of approaches in describing and investigating mental illness. Two decades ago, the author, who is Editor-in-Chief of The American Journal of Psychiatry, wrote a book called The Broken Brain: The Biological Revolution in Psychiatry. It describes a shift in thinking away from viewing mental illness in 'a psychodynamic model' and toward the view that these diseases have a biological basis, just like cancer, heart disease or diabetes.

Representing the perspectives of many in the field, Andreasen argues in the new book that mental illnesses are fundamentally complex—they involve many biological and environmental risk factors and the best treatment is likely to vary from person to person. It is time, she suggests, to stop the unproductive debates over whether depression is a matter of either genes or environment and whether the best treatment is either drugs or psychotherapy.

The evidence for the complexity of mental illnesses is laid out in the second part of the book. Three chapters provide mini-tutorials on neuroscience and molecular genetics, as Andreasen covers key concepts in genomics and neuroimaging. In the introduction, she warns that readers may find these sections hard going and even suggests that some may want to skip ahead and return to these chapters later on. But, she adds, no one should feel guilty about failing to absorb the difficult material: "After all, those of us in science have spent a lifetime trying to understand the complexity of the mind and the genome."

Though challenging, these chapters are a useful reference for understanding mental illness and the brain in terms of recent advances in genomics and imaging technologies. Andreasen covers a great deal of ground through a series of short sections on topics like 'how the brain teaches itself to learn', 'disease genes', and 'tools to see the living brain.' She tackles issues large and small, from describing the use of brain imaging tools to study thoughts and emotions to answering the question: Why is gray matter called 'gray' matter? (Because postmortem brain tissue appears to be relatively dark.)

The neuroimaging chapter called "Mapping the Mind" ends with the question: Are neuroimaging tools improving the lives of individual patients and their families? The answer is no, not yet—the technologies are primarily research tools. "Magnetic resonance and functional imaging scans cannot be used to make a diagnosis, and we have no definitive laboratory markers or genetic tests, even for Alzheimer's disease," Andreasen writes.

The chapter on brain anatomy may read like a textbook, but the narratives Andreasen uses to describe personal histories of the mentally ill belong to the genre of romance novels. Stories about the ideal wife fallen to dementia or the golden child who wakes up to a schizophrenic world reveal Andreasen pulling desperately at the reader's heartstrings to generate compassion for her subjects. One does not have to imagine a stricken 'perfect son' or 'loving spouse' in order to sympathize with those who live with mental illness.

In the book's final chapter, the author writes that mapping the human genome and the human brain will give scientists the "power to understand the mechanisms that cause major mental illness and use this knowledge to relieve the pain of the millions of people who at present suffer from them." She continues: "The time when we can realistically declare a war on mental illnesses, with some hope of eventually achieving a victory, has finally come."

Andreasen cautions that the war will not be won quickly or easily. She is undoubtedly aware of other optimistic pronouncements in the history of modern medicine—the war on cancer, for example, was first declared in the U.S. in the early 1970s. No matter how enthusiastic researchers are about new biomedical technologies for understanding and treating human disease, the lesson of history is that a little caution is warranted.

Merete Rietveld is a freelance writer who lives in Palo Alto, California.

Andreasen, Nancy C. Brave New Brain: Conquering Mental Illness in the Era of the Genome. Oxford University Press, New York, 2001.

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