Book Review
Mind, Brain, and Schizophrenia
N Engl J Med 2006; 355:1288September 21, 2006
- Article
Mind, Brain, and Schizophrenia
By Peter Williamson. 278 pp., illustrated. New York, Oxford University Press, 2006. $65. ISBN: 0-19-517637-5Mind, Brain, and Schizophrenia fills a gap in the psychiatric literature by offering an impressive — yet intelligible, manageable, and relatively short — review of our knowledge of the neurobiologic and neuropsychological processes involved in the development of schizophrenia. Williamson insists that psychiatrists should know more about the brain, a statement we can only agree with. Knowledge of the biology of the brain is necessary not only for scientists engaged in the search for new treatment strategies; an improvement in the treatment of patients with schizophrenia with the tools we have today also depends on improved knowledge of brain functions among clinicians. This clear and well-written book can serve as a good basis for such knowledge. We would, in fact, go as far as to state that this book should be compulsory reading for clinicians.
Williamson compares schizophrenia with heart failure, which can be a result of a range of different diseases and, as such, is itself not one disease. In this connection, it would have been obvious to include a discussion of endophenotypes — the inward manifestations of a phenotype, such as physiological, biochemical, and anatomical features — for schizophrenia. Nevertheless, even if the author uses other terms, he does review many of the currently known candidate endophenotypes.
The chapters in the book are a series of narrative reviews, and the author includes meta-analyses whenever they are available. The 72 pages of references are very useful, even if Williamson does not always give the original reference. The chapters concerning neurotransmitter disturbances, brain imaging, and neurophysiological and neuropsychological findings are clear and systematic. The discussions throughout the book are generally balanced and relevant. We did, however, find it difficult to follow the author at one point, when in relation to a discussion of Jaynes's (1977) theories about the early brain as bicameral, he states that “considerable evidence for this view was marshaled from what we know about early civilizations. Sometime around 1200 B.C., the nondominant hemisphere was inhibited by the present dominant hemisphere, leading to true consciousness and development of civilization as we know it.” To our knowledge, prosperous civilizations existed long before 1200 B.C.
Two chapters provide a good overview of central theories. Williamson does not mention the recent hypotheses on prefrontal microcircuits but instead focuses on the models based on macrocircuits that have been prominent since Arvid Carlsson revised the hypothesis for schizophrenia in 1988. This focus on earlier models may also be why the author does not go more into the more recent hypotheses about sex and schizophrenia. He states that the incidence of schizophrenia is equal in men and women, but a recent systematic review identified a male:female ratio of 1.4:1. There is also convincing evidence that the symptoms are recognized at an earlier age in men. Still, for the clinician who needs to be updated, there is more than enough new data.
The book provides very solid basic knowledge about this strange, disabling, and common syndrome. We recommend it to all psychiatrists, trainees in psychiatry, and other professionals who would like a better understanding of the brain, the mind, and schizophrenia.
Merete Nordentoft, M.D., Ph.D.
Bispebjerg Hospital, DK-2400 Copenhagen, Denmark
mn@dadlnet.dk Birte Glenthøj, M.D.
University of Copenhagen, DK-2400 Copenhagen, Denmark
