The British Journal of Psychiatry (2015)
206, 524–526
Book reviews
Edited by Allan Beveridge, Femi Oyebode
and Rosalind Ramsay
The Predictive Brain:
Consciousness, Decision
and Embodied Action
By Mauro Maldonato
Sussex Academic Press. 2014.
£17.95 (pb). 112 pp.
ISBN: 9781845196394
that underlie self-representation and emotion states and, by
extension, disorders of selfhood and affect that have pervasive
relevance to psychiatry. Professor Maldonado’s book provides a
valuable framework to consider such elaborations of the predictive
brain and represents a scholarly resource from an erudite
perspective.
Hugo Critchley Chair in Psychiatry, Brighton and Sussex Medical School,
and Co-Director of Sackler Centre for Consciousness Science, University of Sussex,
Brighton BN1 9RR, UK. Email: [email protected]
doi: 10.1192/bjp.bp.114.161554
A Metaphysics
of Psychopathology
By Peter Zachar
MIT Press. 2014.
£27.95 (hb). 288 pp.
ISBN 9780262027045
This is a concise but detailed book which covers a lot of ground.
Mauro Maldonato is an academic psychiatrist and neuroscientist
with a strong track record in motor control and decision-making.
This book links abstract symbolic thought and decision-making
to evolutionary origins in motor control. The text is generally
accessible to inquisitive readers in addition to the target audience
of neuroscientists, psychiatrists and philosophers of mind. A rich
account of the history of consciousness, decision-making and
motor action is presented that, importantly, goes beyond the
English-language literature. The remit stretches from evolutionary
perspectives to influential modern views of consciousness and
even to the experience-dependent application of medical
knowledge. The reader is not patronised, but drawn into the detail
and complexity of theoretical and evidence-based understanding
of the subject of the volitional and rational mind. The chapters
serve as self-contained essays that share a common theme. This
style, reviewing the topic broadly, provides a fresh contrast to
recent monographs of consciousness, where the aim is often to
convince the reader of the central merits of a single theory.
The study of consciousness is now at the forefront of
cognitive neuroscience. Major advances in understanding the
neurobiological origins of the human mind are anticipated over
the next few decades, which will bring with them practical
applications and interventions that will necessarily affect mental
health and psychiatry. Present progress with technical and
methodological aspects of consciousness science is accompanied
by the development and refinement of theoretical models among
which the notion of predictive coding and the Bayesian brain is
beginning to dominate. The central premise of the predictive
brain, first formulated by von Helmhotz, is that to make sense
of the wealth of dynamic sensory information the brain must
try to predict the source of sensory inputs. Friston and others
present these concepts as driven by functional efficiency, a need
to minimise ‘free energy’. Sensation is inference, wherein
predictive codes represent hypotheses that are tested against
incoming data, generating prediction errors. In this context
actions become embodied means for active inference, enhancing
the precision and accuracy of future predictions. Embodiment also
applies to the concept of interoceptive predictive coding, relating
to internal bodily control and viscerosensory information. This
notion is emerging as a potent model for the neural mechanisms
524
Book titles are often misleading. I once looked up books on
Chinese cooking, having just acquired a wok, and found From
Woking to Portsmouth. Sections of this book could equally well
be accommodated by the title A Psychopathology of Metaphysics,
as they concern how the mindset and personal foibles of certain
philosophers coloured their philosophical views.
This preamble is occasioned by my disappointment with the
actual contents of the book given its highfalutin title. The book
is essentially a neo-Szaszian argument for why psychiatric
diagnosis is a contentious issue. All the old chestnuts are brought
out – the ‘death of hysteria’, drapetomania (escaping slaves in the
Southern States labelled as having mental disorder) – but the
author illustrates his thesis by nibbling away at the edges. ‘Can
grief really be a disorder?’ and ‘Is narcissistic personality disorder
real?’ are actual chapter headings. To be sure, there are numerous
dubious nosological entities in DSM-5, as there have been in any
diagnostic scheme from Galen onwards. The author is tackling
small fry here, and to grace his deliberations with the title ‘a
metaphysics of psychopathology’ seems overblown.
It is not even clear quite what the author’s specific thesis is,
other than to praise the contributions of general philosophers
and philosophers of science to the problem of psychiatric
diagnosis. At least Szasz made his message clear: psychiatric
diagnostic entities were artefacts of a self-serving doctor–patient
relationship, epitomised by Charcot’s hysterics, who derived social
status as performing artists of illness behaviour while pandering to
Charcot’s own prejudices. The Szaszian legacy that all psychiatric
diagnosis is to a greater or lesser extent iatrogenic pervades this
book, but is never explicitly addressed.
There are several things to say about a book like this, and
I shall not pull any punches.
First, psychiatrists are fed up with the continual sniping at
their professional position. Originally it was sociologists who
Book reviews
inveigled bogus patients into psychiatric hospitals, then it was
psychologists who claimed that psychosis was only some point
on a dimensional scale of human distress. Now philosophers wade
in but, note, steer clear of madness and debilitating mood
disorders, as if the problematic nature of narcissistic personality
disorder undermined the entire psychiatric enterprise.
Second, no credit is given to the insight that people with
schizophrenia and depression themselves provide into the nature
of the human being. Eugene Minkowski, a French psychiatrist,
saw clearly nearly a century ago that the former held a philosophical
idealist position and the latter a materialist position, completely
undermining philosophical notions that the ‘normal’ human
being could be one of these. ‘Philosopher cure thyself ’ might
be salutary advice for a philosopher presuming to disabuse
psychiatrists of their mistakes.
Third, no cognisance is taken of those philosophers, outside the
Anglo-American tradition, who realised that the human being is a
spiritual entity as well as an animal, and that psychiatric disorders
are not ‘natural kinds’ of things such as gold (which the author
seriously considers) and are not even like physical illnesses.
I could go on. Luckily, psychiatrists, certainly of my
acquaintance, are made of stern stuff and are unlikely to be
worried by the new wave of critics of their profession.
John Cutting Honorary Senior Lecturer, Institute of Psychiatry, Psychology &
Neuroscience, King’s College London, Mill Wood, Wall Hill, Forest Row, East Sussex
RH18 5EG, UK. Email: [email protected]
doi: 10.1192/bjp.bp.114.157420
The Bipolar Express:
Manic Depression
and the Movies
By David Coleman.
Rowman & Littlefield Publishers.
2014.
£27.95 (hb). 382 pp.
ISBN: 9780810891937
the near-sneering term ‘neurotypicals’ to describe those who do
not have bipolar disorder.
Although Coleman pays lip service to the existence of
other mental disorders, he repeatedly falls back to the implied
view that all mental disorder is manic depression and any
portrayal of mental instability or distress in movies is a
portrayal of bipolar disorder. He goes further: any film made
by someone with bipolar disorder – whether it is about mental
disorder or not – is part of ‘bipolar cinema’ which ‘can be argued
to include every slasher film ever made, as well as nearly every film
noir, war movie, superhero film and other genre variants in which
psychopathologies are examined (however inaccurately)’. That is a
lot of movies.
A single case in point: he includes in the canon of bipolar cinema
the 1962 adaptation of Scott Fitzgerald’s semi-autobiographical
classic novel Tender is the Night. But Fitzgerald, like his protagonist
Dick Diver, was an alcoholic, and his wife Zelda, like his heroine
Nicole, had schizophrenia.
Coleman also risks alienating his fellow screenwriters when
he asks: ‘if a director or actor is bipolar should every film or
performance therefore be included [in the filmography of bipolar
cinema]?’ The implication is that either all the output of writers
with bipolar disorder is so classified, and they are therefore
defined by their condition in a way other film- makers are not,
or they are the anonymous surrogates who first bring films to life
but whose progeny are immediately adopted by others.
By overstating his case, Coleman does himself and his subject
a disservice, because the meat of the book is a well-researched
resource about films portraying – or made by – those with mental
disorder. Interested readers are advised to buy it for that meat,
even if they do not swallow whole the message.
Stephen Potts Consultant in Transplant Psychiatry, and Honorary Senior Clinical
Lecturer, University of Edinburgh, Department of Psychological Medicine, Royal Infirmary
of Edinburgh, Edinburgh EH16 4SA, UK. Email: [email protected]
doi: 10.1192/bjp.bp.114.161810
Ivan Pavlov.
A Russian Life in Science
By Daniel P. Todes.
Oxford University Press USA. 2014.
£25.00 (hb). 880 pp.
ISBN: 9780199925193
David Coleman’s theme is declared in his subtitle, to which he
brings credentials as a produced screenwriter who knows about
bipolar disorder from the inside. He argues for what he calls
‘bipolar cinema’ – that body of film work which portrays the
disorder in its on-screen characters, or is created by people who
experience it. He argues that bipolarity enhances the perspectives
of these film-makers and therefore the work they produce: and
further still, that many film-makers effectively use their work as
a kind of therapy.
He argues his case with a decade-by-decade survey of cinema
from its very beginnings to 2012’s Silver Linings Playbook, picking
out in detail many cases of films and film-makers to demonstrate
his central theses. There is clearly something in this, and some of
his examples, such as Charlie Chaplin, provide strong backing to
his argument. But he undermines his position by overstating it, in
prose which is by turns breathless or overwrought and which uses
The great Russian physiologist Ivan Pavlov (1849–1936) is usually
remembered as the man who trained dogs to salivate at the sound
of a bell. Indeed the term ‘Pavlovian’, meaning a conditioned
response to stimuli, has entered the language. In this monumental
and highly scholarly biography, the American historian of
medicine Daniel P. Todes points out that Pavlov never trained a
dog to salivate to a bell. Rather he was interested in what a study
of dogs would reveal about man and, in particular, ‘our psychical
525
Book reviews
experience’. In fact one of his lifelong metaphorical strategies was
to view dogs as people, and people as dogs. Contrary to the
popular perception of Pavlov as an early behavourist interested
only in outward actions, he primarily wanted to understand inner
experience.
As Todes observes, this is the first in-depth, intellectual
biography of Pavlov. Hitherto, Russian scholars were inhibited
from examining this great Russian icon by the oppressive political
climate of their native land and outsiders had only limited access
to the archives which were, in any case, written in Russian or dense
technical language. Todes has demonstrated formidable powers in
mastering these sources, and he has attractively related Pavlov’s life
to the cultural and political background of Russia. Pavlov lived
through a very eventful and turbulent period in the history of
Russia. His long life stretched from the reign of Nicholas I to the first
decade of Stalin’s rule. It took in the emancipation of the serfs,
four lost wars, three revolutions, the rapid industrialisation of
the country and the mass arrests of the Communist era.
In the 1860s when Pavlov was growing up, science became the
symbol of the new, modern Russia. The march of technological
progress would consign the old superstitions and religious beliefs
to the past. Throughout his life, Pavlov held to the view that
science was the best way of understanding humanity. For him,
man was no different from the rest of nature, and the findings
of the research laboratory could be applied unproblematically to
the human psyche.
Pavlov and his wife were acquainted with Dostoyevsky, whose
work they both devoured. Dostoyevsky had warned that the
scientistic faith of the day provided a deeply impoverished vision
of man and would lead to tyranny. Pavlov, an atheist, uncomfortably
identified with Dostoyevsky’s Ivan Karamazov, the young intellectual
whose rigorous rationality prevents him from making a leap of
religious faith and who is left at the end of The Brothers Karamazov
in a state of madness. Indeed, as a student Pavlov suffered from
526
mental instability and was diagnosed with a ‘disturbance of the
nerves’. A moving aspect of the book is how Pavlov transforms
himself from an undisciplined and unsuccessful researcher to
become a Nobel Prize winner and the Grand Old Man of world
physiology, feted at conferences throughout Europe and America.
Pavlov also became a national hero as a result of his fearless stance
against the Bolshevik regime. He was responsible for saving many
friends and colleagues from the gulag and, despite his atheistic
convictions, he stood up for religious freedom. Todes charts the
complex game that Pavlov and the Bolsheviks played, each trying
to exploit the other. Pavlov wanted research funding and the
Bolsheviks wanted to portray Pavlov to the outside world as a
shining example of the new Russian science. As a consequence,
Pavlov was granted massive institutional support and, almost
uniquely for the time, was allowed to criticise the regime.
At the end of his life, Pavlov retained his belief in scientific
endeavour but came to a more modest estimation of its ability
to explain the human condition. According to Todes, he
concluded, ‘his own research had failed to confine the psyche
within the comforting certainties of mechanistic law’. Certainly
his late foray into psychiatric research proved unilluminating.
Applying his canine-derived physiological principles to mental
illness, he produced a simple binary schema: patients’ psychiatric
disorders could be explained either in terms of the excitation or
inhibition of their nervous systems.
This, then, is likely to be the definitive biography of Pavlov for
some time to come, and it also casts much light on the history of
science and of modern Russia.
Allan Beveridge consultant psychiatrist, Queen Margaret Hospital,
Whitefield Road, Dunfermline KY12 OSU, UK. Email: [email protected]
doi: 10.1192/bjp.bp.114.161919
A Metaphysics of Psychopathology
John Cutting
BJP 2015, 206:524-525.
Access the most recent version at DOI: 10.1192/bjp.bp.114.157420
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