Disorders of the mind have meant different things to different people at different times. In Plato’s “Phaedrus,” Socrates extols divinely inspired madness in mystics, lovers, poets and prophets; he describes these disturbances as gifts of the gods, rather than maladies. Premodern Europeans more commonly despised the insane, but barely distinguished them from others their society rejected; madmen were imprisoned alongside beggars, blasphemers and prostitutes. Some modern cultures have notions of mental disorder that seem almost as strange to us; syndromes with names like latah, amok and zar defy traditional classifications of Western psychiatry and often call for spiritual rather than medical responses.
Our own culture’s conception of the varieties of mental illness took shape first from a deck of cards curated by the pioneering German psychiatrist Emil Kraepelin over a century ago. Each of the cards contained an abstract of a patient’s medical history, and by grouping them according to similarities he observed among the cases, Kraepelin delineated for the first time some of the major categories physicians now use to diagnose psychiatric diseases. Since the 1980s, Kraepelin’s characterizations of psychosis, mania and depression have been virtually codified in the Diagnostic and Statistical Manual of Mental Disorders, the clinician’s bible for evaluating patients. Kraepelin was a staunch critic of psychoanalysis and passionate advocate for understanding mental phenomena in strictly biological terms — attitudes now also ascendant in psychiatric biomedicine.
Kraepelin’s ideas permeate “The Disordered Mind: What Unusual Brains Tell Us About Ourselves,” Eric Kandel’s engaging new overview of contemporary thinking about the intersection of mental health and neuroscience. Kandel’s chief aim is to explore “how the processes of the brain that give rise to our mind can become disordered, resulting in devastating diseases that haunt humankind,” and he declares at the outset his intention to weave Kraepelin’s story throughout. The book’s very structure emulates the organization of a neo-Kraepelinian diagnostic manual, with a succession of chapters devoted to conditions including schizophrenia, bipolar disorder and autism . Kraepelin’s lasting influence can be felt in the way Kandel reduces these mental conditions chiefly to microscopic causative factors in the nervous system. According to Kandel, mental illnesses are simply brain disorders, and all variations in behavior “arise from individual variations in our brains.”
[For more on this story by Alan Jasanoff, go to https://www.nytimes.com/2018/0...ncollection%2Fhealth]
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