Book Review

The Future of the Brain: The Promise and Perils of Tomorrow's Neuroscience

N Engl J Med 2005; 352:2760-2762June 30, 2005

Article

The Future of the Brain: The Promise and Perils of Tomorrow's Neuroscience
By Steven Rose. 344 pp., illustrated. New York, Oxford University Press, 2005. $28. ISBN: 0-19-515420-7

In 1990, President George H.W. Bush inaugurated “The Decade of the Brain.” In The Future of the Brain, Steven Rose suggests that the first 10 years of the new millennium be designated “The Decade of the Mind.” This juxtaposition of brain and mind crystallizes the book's message.

Rose is a neuroscientist who studies the molecular mechanisms of memory in animals. He is also a consummate essayist who has written extensively for the general public, conveying complex science in simple terms and at the same time questioning how well or how poorly science fares when assaulting fundamental questions about life. In his book Lifelines: Life beyond the Gene (Oxford, England: Oxford University Press, 2003), Rose attacks the radical reductionism of molecular biologists who argue that everything we do is dictated by our genes. He now applies a similar line of reasoning to challenge the neuroscientific reductionists who believe that all feelings and thoughts can be explained by molecular neuroscience. Rose has been aptly dubbed the “conscience” of neuroscience.

What most bothers Rose is encapsulated in the first sentence of the first chapter: “`Better Brains' shouted the front cover of a special edition of Scientific American in 2003.” Rose is distressed by the tendency of scientists and their apostles in the media to make too many promises to the public. He is particularly vexed by pharmaceutical solutions to society's ills, such as the quest of large pharmaceutical concerns to create a “smart pill,” as well as stimulants that many of us feel are overused in the treatment of hyperactive children.

In contrast to many authors who espouse a thesis and then bludgeon the reader with 500 pages on what could have been circumscribed in a single paragraph, Rose develops his thesis gently and elegantly, laying his groundwork in a series of chapters that summarize what we know about the brain. He almost literally begins from the beginning, explicating the genetic code and then reviewing the evolution of the nervous system from that of the most primitive organism to that of the human. He proceeds with a detailed analysis of the development of the brain, showing how ontogeny recapitulates phylogeny. He reviews the ways in which the adult brain regulates perception, conceptualization, and emotions through diverse neurotransmitter systems. He describes what is known about the aging brain. Chapters are devoted to mental illness as well as to the major drugs used to treat real or imagined disabilities.

In contrast to many books that “dumb down” science for the lay public, Rose displays respect for the intelligence of his audience. Although the book is accessible to the educated nonscientist reader, Rose's discussions of science with regard to the brain are sufficiently sophisticated that the professional researcher has much to learn. A unique strength of Rose's presentation is his emphasis on the historical background of present-day knowledge. Of equal importance is his critical analysis of the epistemological aspects of neuroscience. For instance, in the chapter dealing with mental illness, he relates the classic study of David Rosenhan, “On Being Sane in Insane Places” (published in Science in 1973), in which Rosenhan and a team of volunteers sought admission to psychiatric hospitals by claiming that they heard voices. Once inside the hospital, they behaved normally and maintained that the voices had ceased. The physicians caring for them regarded their protestations of normality as evidence of abnormality and were reluctant to release them. To add insult to injury, Rosenhan subsequently announced that another group of “pseudo-patients” would be presented to psychiatric hospitals in the vicinity, whereupon there was an epidemic of diagnoses of pseudo-patients — who never existed.

Rose is highly critical of the excesses of psychopharmacology, perhaps too much so. He devotes substantial space to the use of stimulant drugs such as Ritalin (methylphenidate) to treat attention deficit–hyperactivity disorder. He properly questions how one can diagnose as a “disease” a condition characterized by a child's being more active or paying less attention than “the majority” of children in the classroom. He is dubious about the reality of a disorder that is diagnosed in England at 1/10 the rate in the United States. It is easy to ridicule the field of psychiatry when a diagnosis is made on the basis of aberrant behavior, rather than something concrete such as a bacterial infection. It is also true that psychiatric diagnoses are influenced by fashion, especially that of available new medications. Thus, when lithium was introduced for the treatment of mania in the early 1960s, the diagnosis of this condition increased severalfold within two years. Nonetheless, the most critical psychiatric researchers would agree that bipolar disorder is an illness and that there is genuine reality underlying at least a substantial number of cases of attention deficit–hyperactivity disorder.

Rose is at his best when, by integrating a vast body of knowledge, he illuminates the limitations in our use of existing neuroscience to control, predict, and excuse behavior. For instance, he reviews studies showing that abnormal variations of the gene for the enzyme monoamine oxidase, which degrades neurotransmitters such as serotonin and dopamine, predispose persons to violent behavior. Will possession of such a gene be used in court to excuse murder? In discussing the role of determinism as a link between brain and behavior, Rose quotes Francis Crick, who maintains that we are “nothing but a bunch of neurons,” whereas Rose would argue that our free will and individual responsibility are independent of the molecular details of genes and neurons.

In summary, Rose has provided a powerful contribution to the literature. His book will be of interest to both lay and professional readers, to scientists, philosophers, and anyone else who is curious about the workings of the brain and the promise and perils that brain research holds for the future.

Solomon H. Snyder, M.D.
Johns Hopkins Medical School, Baltimore, MD 21205
ssnyder@jhmi.edu