A provocative new perspective on the diagnosis, and therefore treatment, of mental illness.

SUSPICIOUS MINDS

HOW CULTURE SHAPES MADNESS

Brothers Joel Gold (Psychiatry/NYU School of Medicine) and Ian Gold (Philosophy and Psychiatry/McGill Univ.) suggest that to treat delusions simply as manifestations of psychosis, without regard to their cognitive function, is insufficient.

The authors examine the possibility that delusions are symptomatic of a malfunctioning cognitive system whose positive evolutionary function has been protection against social threats. This leads them to conclude that it is necessary to view delusions as a malfunctioning response to “social environment on its own terms and not as an illusion waiting to be reduced to biology.” Their content can be traced to a need to deal with environmental stresses and are, in part, a reflection of the culture. Turning to the field of evolutionary psychology, the Golds suggest the existence of a hypothesized brain system, the “Suspicion System,” whose purpose is to protect the individual from threats; this would have served a useful purpose in alerting our ancestors to danger. It is when these threats are misperceived without corrective cognitive input that delusion follows. Joel Gold cites case histories from his practice as an attending psychiatrist at Bellevue Hospital Center; the cases show how such malfunctioning might occur when “[d]elusional thoughts and their linguistic expression are…cognitively isolated and not integrated with other thinking.” These delusions may be due to neurological malfunction, but biological theories of mental illness need not exclude their social component. “In taking account of the role of the social world in mental illness,” write the authors, “it may be necessary to hang on to notions like threat, discrimination, exploitation and status, and there may be no way to understand these concepts other than by theories far removed from neurons….Reductionism in psychiatry constrains theory to operate within the skull or the skin. Our bet is that the outside world is going to matter as well.”

A provocative new perspective on the diagnosis, and therefore treatment, of mental illness.

Pub Date: July 8, 2014

ISBN: 978-1-4391-8155-3

Page Count: 288

Publisher: Free Press

Review Posted Online: May 18, 2014

Kirkus Reviews Issue: June 1, 2014

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A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular...

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WHEN BREATH BECOMES AIR

A neurosurgeon with a passion for literature tragically finds his perfect subject after his diagnosis of terminal lung cancer.

Writing isn’t brain surgery, but it’s rare when someone adept at the latter is also so accomplished at the former. Searching for meaning and purpose in his life, Kalanithi pursued a doctorate in literature and had felt certain that he wouldn’t enter the field of medicine, in which his father and other members of his family excelled. “But I couldn’t let go of the question,” he writes, after realizing that his goals “didn’t quite fit in an English department.” “Where did biology, morality, literature and philosophy intersect?” So he decided to set aside his doctoral dissertation and belatedly prepare for medical school, which “would allow me a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.” The author’s empathy undoubtedly made him an exceptional doctor, and the precision of his prose—as well as the moral purpose underscoring it—suggests that he could have written a good book on any subject he chose. Part of what makes this book so essential is the fact that it was written under a death sentence following the diagnosis that upended his life, just as he was preparing to end his residency and attract offers at the top of his profession. Kalanithi learned he might have 10 years to live or perhaps five. Should he return to neurosurgery (he could and did), or should he write (he also did)? Should he and his wife have a baby? They did, eight months before he died, which was less than two years after the original diagnosis. “The fact of death is unsettling,” he understates. “Yet there is no other way to live.”

A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular clarity.

Pub Date: Jan. 19, 2016

ISBN: 978-0-8129-8840-6

Page Count: 248

Publisher: Random House

Review Posted Online: Sept. 30, 2015

Kirkus Reviews Issue: Oct. 15, 2015

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Occasionally wonky but overall a good case for how the dismal science can make the world less—well, dismal.

GOOD ECONOMICS FOR HARD TIMES

“Quality of life means more than just consumption”: Two MIT economists urge that a smarter, more politically aware economics be brought to bear on social issues.

It’s no secret, write Banerjee and Duflo (co-authors: Poor Economics: A Radical Rethinking of the Way To Fight Global Poverty, 2011), that “we seem to have fallen on hard times.” Immigration, trade, inequality, and taxation problems present themselves daily, and they seem to be intractable. Economics can be put to use in figuring out these big-issue questions. Data can be adduced, for example, to answer the question of whether immigration tends to suppress wages. The answer: “There is no evidence low-skilled migration to rich countries drives wage and employment down for the natives.” In fact, it opens up opportunities for those natives by freeing them to look for better work. The problem becomes thornier when it comes to the matter of free trade; as the authors observe, “left-behind people live in left-behind places,” which explains why regional poverty descended on Appalachia when so many manufacturing jobs left for China in the age of globalism, leaving behind not just left-behind people but also people ripe for exploitation by nationalist politicians. The authors add, interestingly, that the same thing occurred in parts of Germany, Spain, and Norway that fell victim to the “China shock.” In what they call a “slightly technical aside,” they build a case for addressing trade issues not with trade wars but with consumption taxes: “It makes no sense to ask agricultural workers to lose their jobs just so steelworkers can keep theirs, which is what tariffs accomplish.” Policymakers might want to consider such counsel, especially when it is coupled with the observation that free trade benefits workers in poor countries but punishes workers in rich ones.

Occasionally wonky but overall a good case for how the dismal science can make the world less—well, dismal.

Pub Date: Nov. 12, 2019

ISBN: 978-1-61039-950-0

Page Count: 432

Publisher: PublicAffairs

Review Posted Online: Aug. 29, 2019

Kirkus Reviews Issue: Sept. 15, 2019

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