Ward et al.

Andreasen's The Broken Brain

Reading Questions

There are at least two ironies about Freudian theory. One is that Freud started out as a neurologist who used neural mechanisms to explain mental disturbances. He ended up as a broad ranging theorist of both the abnormal and the everyday mind. Second is the irony that though Freud's psychoanalytic approach started in Europe, its home for the past 50 years has been clinical psychology in America. The Europeans were more interested in another approach to mental disorders.

European neurologists like Kraepelin founded another tradition of inquiry into mental illness that our final book explores for us: the medical model. Almost all the significant work in the physiology of mental illness done before 1940 was done in Europe. Americans were too fascinated with Freud to pay much attention. But America sat up to take notice when, in 1952, dramatic progress in treating schizophrenia was made with a chemical derived from allergy medications. Within the next 20 years, the population of mental hospitals had dropped by 50%. This represents a tremendous number of people who were once confined who now had regular and somewhat reasonable lives. The conditions in the hospitals changed too. Straightjackets, a common restraint before drugs, became very rare. Many of the patients who still had to stay in mental hospitals were able to develop hobbies, interact with people, and enjoy their life more. The revolution in treatment produced by the discovery of antipsychotics was truly remarkable.

Andreasen is a psychiatrist who has been involved in research on the chemical basis of schizophrenia for several decades. In this very accessible book she provides a description of the way medical doctors approach mental illness as a physical problem that has psychological results.

Note that Andreasen is honest about areas where medical therapy have not helped those with mental illness (e.g. some depression) but is mostly uninterested in figuring out why. And when she does get interested in figuring out why, it is because some physiological mechanism might be involved. Andreasen is a thoroughgoing physicalist, at least in her interests. Second, note that one purpose of this book is to remove the moral burden from the mentally ill (they must be bad people) and convince us to think of the mentally ill as like people who have a heart disease. This is a laudable goal, but it tends to push her even further back into her physicalist trench.

Finally, there is a lot of detail you can skim over here. You want to get an idea of the whole system. When we talk about the limbic system, for instance, don't get hung up on whether the habenular nucleus is a part of the limbic system or not. Instead think about how the limbic system as a whole modulates emotional activity and why this might be important.

The organization of the book

In chapter 1, Andreasen provides a compelling case study about how social disapproval contributes to the death of a depressed medical doctor. This is the moral touchstone of her argument for the physical nature of mental illness - we will be giving people a better chance to live if we treat mental illness this way. Chapter 2 is a short history of the "biological revolution" I refer to above, along with some sad tales of early treatment of the mentally ill. Chapter 3 should be in some ways a review for you, since several of the models covered there you have already seen.

In What is Mental Illness Andreasen lays out the four major syndromes of mental illness. Keep your eyes open for how they can shade into each other: how symptoms of one can mimic symptoms of another, or how two syndromes might coexist simultaneously. Along with chapters 8 and 9, chapter 5, What is the Brain, is the core of the book. Andreasen reviews both the structural organization of the brain (what's on top, what's more primitive) and the neurochemical basis of activity in the brain (how neurons signal each other). The chapters on diagnosis are fascinating, and important to psychiatric practice, but not crucial for our purposes.

Chapters 8 and 9 (on treatment and research respectively) are where you will find the biological stories for each of the syndromes laid out in exquisite detail (exquisite for an introductory level, that is). Here is the Cliff Notes version of what you will need for the take home exams. But remember that you need to understand two previous chapters to get the most out of these: the chapters on the major syndromes and the chapter on the brain.

We will be talking about these physical explanations for mental illness in terms of levels of explanation. There are several physical levels of explanation. There is a physics level explanation of how protein binds to receptor cells. There is a chemical level explanation of how certain agents block certain neurotransmitters. And there is an anatomical level of explanation about what place in the brain controls which behaviors. But levels go beyond the physical too. Mental events (like ruminating on a depressing idea) are important. Social occurrences (like others' perceptions of one's own competence) can certainly have important effects. Sociological causes are important too (like the social status of women). As you read, look for the clues pointing to levels of explanation.