Mental Health
Resources

 email page    print page

All Topic Reviews
50 Signs of Mental IllnessA Beautiful MindA Beautiful MindA Bright Red ScreamA Casebook of Ethical Challenges in NeuropsychologyA Corner Of The UniverseA Lethal InheritanceA Mood ApartA Research Agenda for DSM-VA Slant of SunA War of NervesAbnormal Psychology in ContextADD-Friendly Ways to Organize Your LifeAddiction Recovery ToolsAdvance Directives in Mental HealthAggression and Antisocial Behavior in Children and AdolescentsAl-JununAlmost a PsychopathAlterations of ConsciousnessAm I Okay?American ManiaAmerican Psychiatric Publishing Textbook of Neuropsychiatry and Clinical NeurosciencesAn American ObsessionAngelheadAnger, Madness, and the DaimonicAnthology of a Crazy LadyApproaching NeverlandAs Nature Made HimAsylumAttention-Deficit Hyperactivity DisorderAttention-Deficit/Hyperactivity DisorderBeing Mentally Ill: A Sociological Theory Betrayal TraumaBetrayed as BoysBetter Than ProzacBetter Than WellBeyond AppearanceBeyond ReasonBinge No MoreBiological UnhappinessBipolar DisorderBipolar DisorderBipolar Disorder DemystifiedBlack-eyed SuzieBlaming the BrainBleeding to Ease the PainBluebirdBlueprints Clinical Cases in PsychiatryBody Image, Eating Disorders, and ObesityBorderline Personality DisorderBrain Circuitry and Signaling in PsychiatryBrave New BrainBreakdown of WillBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerCalm EnergyCassandra's DaughterCaught in the NetChild and Adolescent Treatment for Social Work PracticeChildren Changed by TraumaChronic Fatigue Syndrome (The Facts)Clinical Handbook of Psychological DisordersClinical Manual of Women's Mental HealthCognitive Theories of Mental IllnessCommonsense RebellionCommunity and In-Home Behavioral Health TreatmentComprehending SuicideConcise Guide to Child and Adolescent PsychiatryConquering Post-Traumatic Stress DisorderConscience and ConvenienceConsciousnessConsole and ClassifyContesting PsychiatryCoping With TraumaCopshockCrazy for YouCrazy in AmericaCrazy Like UsCreating HysteriaCritical PsychiatryCruel CompassionCultural Assessment in Clinical PsychiatryCulture and Mental HealthCulture and Psychiatric DiagnosisCultures of NeurastheniaDaddy's GirlsDante's CureDarwinian PsychiatryDaughter of the Queen of ShebaDaughters of MadnessDeinstitutionalization And People With Intellectual DisabilitiesDelivered from DistractionDepression In Later LifeDepression SourcebookDepression-Free for LifeDescriptions and PrescriptionsDestructive Trends in Mental HealthDevil in the DetailsDiagnosis: SchizophreniaDiagnostic and Statistical Manual of Mental Disorders DSM-IV-TRDirty Filthy Love DVDDisorders Of DesireDisrupted LivesDissociative ChildrenDivided MindsDr. Andrew Weil's Guide to Optimum HealthDr. Weisinger's Anger Work-Out BookDSM-IV SourcebookDSM-IV-TR CasebookDSM-IV-TR in ActionDSM-IV-TR Mental DisordersE-TherapyEccentricsElectroshockEmergencies in Mental Health PracticeEmergency PsychiatryEmotional and Behavioral Problems of Young ChildrenEmotions and LifeEmpowering People with Severe Mental IllnessEssential PsychopharmacologyEssentials of Cas AssessmentEssentials of Wais-III AssessmentEthics and Values in PsychotherapyEthics in Mental Health ResearchEthics in Psychiatric ResearchEthics, Culture, and PsychiatryEverything In Its PlaceFamily Experiences With Mental IllnessFatigue as a Window to the BrainFear of IntimacyFinding Iris ChangFinding Meaning in the Experience of DementiaFlorid StatesFolie a DeuxFor the Love of ItForensic Nursing and Multidisciplinary Care of the Mentally Disordered OffenderFountain HouseFrom Madness to Mental HealthFrom Trauma to TransformationGandhi's WayGender and Its Effects on PsychopathologyGender and Mental HealthGenes, Environment, and PsychopathologyGetting Your Life BackGracefully InsaneGrieving Mental IllnessHandbook of AttachmentHandbook of DepressionHandbook of Self and IdentityHealing the SplitHerbs for the MindHidden SelvesHigh RiskHope and DespairHow Clients Make Therapy WorkHow People ChangeHow to Become a SchizophrenicHow We Think About DementiaHughes' Outline of Modern PsychiatryHumanizing MadnessHysterical MenHystoriesI Hate You-Don't Leave MeI Never Promised You a Rose GardenI Thought I Could FlyI'm CrazyImagining RobertImpulse Control DisordersIn Others' EyesIn Two MindsInsanityIntegrated Behavioral Health CareIntegrative MedicineIntegrative Mental Health CareIntuitionJust CheckingKarl JaspersKissing DoorknobsKundalini Yoga Meditation for Complex Psychiatric DisordersLaw and the BrainLaw, Liberty, and PsychiatryLegal and Ethical Aspects of HealthcareLiberatory PsychiatryLife at the BottomLife at the Texas State Lunatic Asylum, 1857-1997Life Is Not a Game of PerfectLithium for MedeaLiving Outside Mental IllnessLiving with AnxietyLiving With SchizophreniaLiving with SchizophreniaLiving Without Depression and Manic DepressionLost in the MirrorLove's ExecutionerLoving Someone With Bipolar DisorderMad in AmericaMad TravelersMad, Bad and SadMadhouseMadnessMadness at HomeMadness in Buenos AiresManaged Care ContractingMandated Reporting of Suspected Child AbuseManic Depression and CreativityMary BarnesMasters of the MindMeasuring PsychopathologyMedia MadnessMedicine As MinistryMelancholy And the Care of the SoulMemory, Brain, and BeliefMental HealthMental Health At The CrossroadsMental Health Issues in Lesbian, Gay, Bisexual, and Transgender Communities Mental Health MattersMental Health Policy in BritainMental Health Policy in BritainMental Health Professionals, Minorities and the PoorMental IllnessMental Illness and Your TownMental Illness, Medicine and LawMental SlaveryMindfulness in Plain EnglishModels of MadnessMothers Who Kill Their ChildrenMozart's Brain and the Fighter PilotMultifamily Groups in the Treatment of Severe Psychiatric DisordersMuses, Madmen, and ProphetsMyths of ChildhoodNapkin NotesNeural MisfireNew Hope For People With Bipolar DisorderNight Falls FastNo Enemies WithinNolaNormalNot CrazyNovember of the SoulOf Two MindsOn Being Normal and Other DisordersOn Our Own, TogetherOn The Stigma Of Mental IllnessOrigins of Human NatureOut of Its MindOut of the ShadowsOvercoming Compulsive HoardingPathologies of BeliefPathways through PainPersonal Recovery and Mental IllnessPersonality Disorder: Temperament or Trauma?Pillar of SaltPoints of ViewPoppy ShakespearePosttraumatic Stress DisorderPsychiatric Cultures ComparedPsychiatric Diagnosis and ClassificationPsychiatric Genetics and GenomicsPsychiatric Illness in WomenPsychiatrists and Traditional HealersPsychiatryPsychiatry and ReligionPsychiatry in SocietyPsychological Dimensions of the SelfPsychology and the MediaPsychopathia SexualisPsychopathologyPsychopathyPsychotic DepressionQuitting the Nairobi TrioRaising a Moody ChildRapid Cognitive TherapyRebuilding Shattered LivesReclaiming Soul in Health CareReclaiming the SoulRecollection, Testimony, and Lying in Early ChildhoodRecovery from SchizophreniaRecovery in Mental IllnessRedressing the EmperorRelational Mental HealthRemembering TraumaRepressed SpacesResearch Advances in Genetics and GenomicsRestricted AccessRethinking the DSMReviving OpheliaRewarding Specialties for Mental Health CliniciansSaints, Scholars, and Schizophrenics: Mental Illness in Rural IrelandSchizophreniaSchizophrenia RevealedSchizophrenia: A Scientific Delusion?Self-Determination Theory in the ClinicShunnedShynessSigns of SafetySilencing the VoicesSlackjawSocial Cognition and SchizophreniaSocial Inclusion of People with Mental IllnessSoul Murder RevisitedSounds from the Bell JarSpeaking Our MindsSpontaneous HealingStop PretendingStraight Talk about Psychological Testing for KidsStranger Than FictionStreet CrazyStudy Guide to the DSM-IV-TRSurviving Manic DepressionSurviving SchizophreniaSurviving SchizophreniaTaking Charge of ADHD, Revised EditionTaking the Fear Out of ChangingTalking Back to PsychiatryTarnationTeen LoveTelling Is Risky BusinessTelling SecretsThe Age of InsanityThe American Psychiatric Press Textbook of PsychiatryThe American Psychiatric Publishing Textbook Of Child And Adolescent PsychiatryThe Anger WorkbookThe Anorexic SelfThe Behavioral Medicine Treatment PlannerThe Betty Ford Center Book of AnswersThe Bipolar ChildThe Bipolar Disorder Survival GuideThe Body in PsychotherapyThe Borderline Personality Disorder Survival GuideThe Broken MirrorThe Burden of SympathyThe Cambridge Medical Ethics WorkbookThe Case for Pragmatic PsychologyThe Center Cannot HoldThe Chemical Dependence Treatment Documentation SourcebookThe Chemical Dependence Treatment PlannerThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Condition of MadnessThe Construction of Power and Authority in PsychiatryThe Couples Psychotherapy Treatment PlannerThe Criminal BrainThe Cultural Context of Health, Illness, and MedicineThe Day the Voices StoppedThe Death of PsychotherapyThe Depression WorkbookThe Difficult-to-Treat Psychiatric PatientThe Early Stages of SchizophreniaThe Employee Assistance Treatment PlannerThe Employee Assistance Treatment PlannerThe Epidemiology of SchizophreniaThe Essential Family Guide to Borderline Personality DisorderThe Essentials of New York Mental Health LawThe Ethical WayThe Evolution of Mental Health LawThe Explosive ChildThe Fall Of An IconThe Fasting GirlThe Forensic Documentation SourcebookThe Forgotten MournersThe Gift of Adult ADDThe Good EaterThe Green ParrotThe Healing Power of PetsThe Heart of AddictionThe Heroic ClientThe Insanity OffenseThe Invisible PlagueThe Last Time I Wore a DressThe Limits of Autobiography The LobotomistThe Madness of Our LivesThe Mark of ShameThe Meaning of AddictionThe Meaning of MindThe Medical AdvisorThe Mind/Mood Pill BookThe Most Solitary of AfflictionsThe Mozart EffectThe Naked Lady Who Stood on Her HeadThe Older Adult Psychotherapy Treatment PlannerThe OutsiderThe Pastoral Counseling Treatment PlannerThe PDR Family Guide to Natural Medicines & Healing TherapiesThe Places That Scare YouThe Plural SelfThe Problem of EvilThe Psychology of Religion and CopingThe Quiet RoomThe Real World Guide to Psychotherapy PracticeThe Right to Refuse Mental Health TreatmentThe Rise of Mental Health NursingThe Roots of the Recovery Movement in PsychiatryThe Savage GirlThe Self-Help SourcebookThe Talking CureThe Trick Is to Keep BreathingThe Unwell BrainThe Virtuous PsychiatristThe Way of TransitionThe Wing of MadnessThe Wisdom in FeelingTheoretical Evolutions in Person-Centered/Experiential TherapyTherapy's DelusionsTheraScribe 3.0 for WindowsThis is Madness TooThoughts Without a ThinkerThrough the Looking GlassTo Have Or To Be?Toxic PsychiatryTransforming MadnessTraumaTraumatic PastsTraumatic Relationships and Serious Mental DisordersTreating Affect PhobiaTreating Chronic and Severe Mental DisordersTreating Self-InjuryTreatment and Rehabilitation of Severe Mental IllnessTreatment Plans and Interventions for Depression and Anxiety DisordersTwinsUnderstanding and Treating Violent Psychiatric PatientsUnderstanding Child MolestersUnderstanding DepressionUnderstanding ParanoiaUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnholy MadnessUnspeakable Truths and Happy EndingsUsers and Abusers of PsychiatryViolence and Mental DisorderVoices of MadnessVoices of RecoveryVulnerability to PsychopathologyWarning: Psychiatry Can Be Hazardous to Your Mental HealthWashing My Life AwayWhen History Is a NightmareWhen Someone You Love Is BipolarWhen the Body SpeaksWhen Walls Become DoorwaysWitchcrazeWomen and Borderline Personality DisorderWomen and Mental IllnessWomen Who Hurt ThemselvesWomen's Mental HealthWrestling with the AngelYou Must Be DreamingYour Drug May Be Your ProblemYour Miracle Brain

Related Topics
Schizophrenia RevealedReview - Schizophrenia Revealed
From Neurons to Social Interactions
by Michael Foster Green
W.W. Norton, 2002
Review by Jack R. Anderson, M.D.
Jan 29th 2003 (Volume 7, Issue 5)

I

As a curve approaches closer and closer to its mathematical asymptote but never quite reaches it, so the human mind has approached complete understanding of itself and its illnesses over the centuries and millennia of recorded time, and this philosophical asymptote will in all probability also remain forever just beyond our grasp. However, when you read this book I think you will agree that Professor Green has advanced our knowledge of the mental illness we call “schizophrenia” to a point closer to complete understanding than we have ever been before.

As I began reading, I wondered how and where the author had developed the communication skills that make his book such a pleasure to read and so easy to understand. Then when I glanced through the extensive bibliography I learned that since 1986 he has written 15 articles and two books, including this one, all about schizophrenia—some by himself and some in collaboration with other authors. His fluency is an encouraging example of the old saw “Practice makes perfect.”

II

 I didn’t agree with everything in the book. For example, Dr.Green doesn’t believe hydrotherapy was an effective treatment for schizophrenia. Back in 1939 when I was helping wrap disturbed patients in wet sheets and immerse them in continuous tubs, I thought the treatments were therapeutic. The patients became less agitated and their hallucinations and delusions abated noticeably. I have to admit that his opinion, based on a perspective of sixty-some years after the fact, has more claim to validity than mine, which was formed during the heat of battle so to speak—for a vigorous struggle was often required to physically control patients during the administration of wet sheet packs and continuous tub treatment.

I also thought that ECT and insulin coma were effective therapies for schizophrenia, but again I concede the unreliability of my opinions, which are not based on any sort of scientific rigor as are Professor Green’s. As he correctly points out in the book, the course of schizophrenia is so variable and unpredictable that no matter what is done to schizophrenic patients, some of them will improve immediately after the “treatment,” thus encouraging the kind of faulty reasoning called “post hoc, ergo propter hoc.”

III

The title,” Schizophrenia revealed” and the sub-title, “ From Neurons to Social Interaction,” make implicit promises to the reader—promises that the author faithfully keeps. He organizes his arguments around three key concepts: “neural connections,” “neurocognitive deficits,” and “functional impairment.”

He discusses the contributions of neuroimaging techniques such as MRI’s and PET scans to the understanding of neurodevelopmental factors that result in neurocognitive deficits. For example, studies have shown that a virus such as influenza can disrupt neurodevelopment of the fetus during the second trimester of pregnancy—the trimester when neurons produced in the inner layer of brain are transported outward to their final destination. Because some neurons do not arrive at their intended addresses, interneuronal communication is disrupted. From this neural disconnection syndrome, neurocognitive deficits develop.

Schizophrenogenic cognitive deficits include difficulties with executive functions such as planning, problem solving and alternating between two or more tasks; immediate and long-term memory; and social cognition—the ability to perceive what other people are thinking and feeling. These and similar neurocognitive deficits cause confusion and  misunderstandings and often result in functional impairment.

IV

In the chapter “Interventions for Schizophrenia,” Dr. Green explains that first generation anti-psychotic drugs, like chlorpromazine and haloperidol, reduced delusions and hallucinations but did little or nothing for neurocognitive deficits, so that patients, although no longer psychotic, were still functionally impaired to the point of being disabled. Newer antipsychotics—clozapine, risperidone, olanzapine, quetiapine and ziprasidone—to the contrary—show promise for improving verbal fluency, immediate memory and secondary verbal memory. (Another new antipsychotic medication, aripiprazole, which was introduced after this book was published, also promises to reverse some of the neurocognitive deficits.)

In addition to pharmacological interventions, this chapter discusses the possibility of training patients to develop better neurocognition, a treatment called “cognitive rehabilitation.” Assertive community training, “ACT, “ social skills training and family context interventions are also recommended as adjunctive therapies to maximize the number of patients who can resume community functioning.

V

The chapter “The Genetics of Schizophrenia” clears up a lot of misconceptions about its heritability. I can remember arguments in some of my pre-med classes in the mid-thirties about whether the schizophrenia gene was dominant or recessive. Now,  the chapter informs us,  most researchers believe that not one single gene, but rather the  interaction of a large number of genes, is involved in the transmission of the illness across generations.

Family studies verify the idea that mental illness is a family affair. 12 percent of the children of schizophrenic individuals develop the disease as compared with only 1 percent of the general population. Twin studies reveal that if one monozygotic twin has schizophrenia, the odds are about even that the other twin will too. With dizygotic twins the concordance rate is only 17 percent. Obviously, if only genetic factors were involved in the development of schizophrenia, then the concordance rate for monozygotic twins, who have identical genotypes, would be 100 percent.

One adoption study compared rates of schizophrenia in adoptees from non-schizophrenic mothers raised in families where one of the adoptive parents developed schizophrenia, with rates of similar adoptees raised in families without psychiatric problems. As the study found no difference in the rates of schizophrenic symptoms in these two groups of children, they concluded that, although schizophrenia runs in families,  “we do not ‘catch’ it just by living with our parents.”

Another adoption study, carried out in Northern Finland, compared rates of two groups of adoptees born of schizophrenic mothers, one group raised in healthy family environments and the other in families rated as “disturbed.” They found that the adoptees raised in healthy families, despite their mothers’ schizophrenia, had no higher rates of psychosis and other mental illness than a comparison group of adoptees born of non-psychotic mothers. To the contrary, those raised in disturbed families did have higher rates. The author concludes that what is inherited is not schizophrenia, but a disposition for schizophrenia and that many nongenetic factors are needed to produce a phenotype that qualifies for the schizophrenic diagnosis.

VI

Schizophrenic patients, their relatives and friends would benefit greatly from reading this highly informative and skillfully written book; Professor Green’s optimism is infectious and perhaps the high rate of suicide among patients would be ameliorated. Mental health professionals would do well to study it to better understand the persistence of disabling neurocognitive deficits after pharmacological treatments have relieved the psychotic, negative and disorganized symptomatology, and to realize the necessity for ongoing community based treatment and training programs.

“Schizophrenia Revealed” should be required reading for the powers that be who construct the invaluable Diagnostic and Statistic Manual of the American Psychiatric Association. The diagnostic criteria for schizophrenia might be more selective if they included Professor Green’s insight that schizophrenic patients are genetically vulnerable individuals who suffer disrupted neural connections during neurodevelopmental processes, which lead to disabling neurocognitive deficits and, with other developmental stresses, to the “Class A symptoms” listed in DSM-IV-TR. Such inclusion might reduce the number of patients who, over a period of a few years, are variously diagnosed as schizophrenia, schizoaffective disorder, bipolar disorder and schizotypal personality disorder.

The author is right—the book does an excellent job of demystifying schizophrenia. It is hoped that, as neuroimaging techniques are sharpened, disruptions of neural circuits can be identified more accurately and earlier. Then timely interventions may prevent or ameliorate neurocognitive deficits and minimize the occurrence of psychotic, negative and disorganized symptom complexes. Newer medications will focus more on socially and vocationally disabling behavior caused by the neurocognitive deficits.

The costs of schizophrenia—personal distress, family disruption, and the financial burdens of treatment expense and lost productivity—can be dramatically reduced by acting on the insights contained in this book. I think we all, schizophrenics and non-schizophrenics alike, owe Professor Green a vote of thanks.

 

© 2003 Jack R. Anderson

 

Jack R. Anderson, M.D. is a retired psychiatrist living in Lincoln, Nebraska.


Share

Welcome to MHN's unique book review site Metapsychology. We feature over 7900 in-depth reviews of a wide range of books and DVDs written by our reviewers from many backgrounds and perspectives. We update our front page weekly and add more than thirty new reviews each month. Our editor is Christian Perring, PhD. To contact him, use one of the forms available here.

Can't remember our URL? Access our reviews directly via 'metapsychology.net'


Metapsychology Online reviewers normally receive gratis review copies of the items they review.
Metapsychology Online receives a commission from Amazon.com for purchases through this site, which helps us send review copies to reviewers. Please support us by making your Amazon.com purchases through our Amazon links. We thank you for your support!


Join our e-mail list!: Metapsychology New Review Announcements: Sent out monthly, these announcements list our recent reviews. To subscribe, click here.

Interested in becoming a book reviewer for Metapsychology? Currently, we especially need thoughtful reviewers for books in fiction, self-help and popular psychology. To apply, write to our editor.

Metapsychology Online Reviews

Promote your Page too

Metapsychology Online Reviews
ISSN 1931-5716