Disturbances of the Mind

January 28, 2010

In this cleverly constructed book, several of the puzzles of present-day neurology are considered alongside accounts of the lives and times of those with whom they are eponymously associated. Parkinson's disease, Alzheimer's disease, and Korsakoff's, Tourette's and Asperger's syndromes feature among the better-known instances, but lesser-known syndromes such as the those of Clerambault and Capgras (perhaps more psychiatric than neurological) are also considered. Each receives a chapter to itself.

The author's particular skill is in making his subject matter interesting at several levels and to different groups of readers. His accounts of the successes and sorrows of those who are seen (not always accurately, as he points out) as the discoverers of these well-known diseases are historically vivid without resorting to hagiography; and the story of the fortunes of their brain-children as they negotiate the fluctuations of medical and social fashion since their conception is absorbing. The reader need not be a professional medic or psychologist to appreciate these accounts, but nor will the relevant professionals be bored or disappointed by them: Douwe Draaisma's research is thorough and his treatment of the issues penetrating as well as clear. He has a rare talent for writing informatively and entertainingly without losing depth.

However, this is not just a historical account, and Draaisma does not merely record events. One of the more fascinating aspects of the book is the clarity with which it demonstrates that what were (in the main) neurological puzzles in the past remain neurological puzzles today. We are no clearer now about the significance of the tics and compulsive imprecations shown by his patients than was Gilles de la Tourette when he first described them more than a century ago; controversy over the origins of "childhood autism" is no more resolved than it was in Hans Asperger's and Leo Kanner's heyday; the sombre tale of Alzheimer's disease highlights the frustrating lack of progress in understanding the processes involved, let alone treating them successfully. The advance, if one can call it such, of medical science is a halting and uncertain affair, greatly dependent on the fashions and prejudices of the day - and fashion and prejudice are not, of course, just features of the past. As the author shows in his discussion of Korbinian Brodmann's mapping of the brain, the possible significance of the apparently observable differences in brain structure between different racial groups and between men and women will be interpreted and critiqued according to the social preferences of the time.

Draaisma does not shy away from his own critique of the work of some of those he considers. For example, in according eponymous status to the syndrome evinced by Phineas Gage after a metal rod was forced explosively through his forebrain (a story that never palls in the retelling), Antonio Damasio not only "jazzed up" the circumstances of the event, but, according to Draaisma, seriously misrepresented Rene Descartes in attributing an "error" to the Cartesian account of the relation of mind to body. This defence of a 17th-century honorary Dutch philosopher by a contemporary Dutch professor of the history of psychology makes for particularly illuminating reading.

A close consideration of the procedures of those clinicians whose names came to be associated with the conditions they described clearly taught Draaisma considerable respect for their methods. He makes the point that, while the number of cases they considered was often very small, their concern with the whole person before them and the context of his or her life had a lot to be said for it in throwing light not just on the conditions themselves, but also upon what it was like to suffer from them. This aspect of the clinical picture tends to be lost in the modern obsession with statistical validity, which itself, he suggests, is not necessarily the guarantee of objective accuracy we may take it to be. We accept the assumptions of our times as uncritically as, for example, the Victorians did theirs.

The book as a whole stimulates thought, raises questions to which there are no obvious answers (but are nonetheless worth asking for that reason) and makes no attempt to tidy or simplify issues that clearly remain a long way from resolution. One of the most satisfying things about it is that it draws one into reflections and speculations of one's own that would require further investigation if only such were possible. It has an honesty, clarity and depth that involve the reader and which one would wish to find more often than one does in books that have general as well as specialist appeal.

It is a nicely produced book, illustrated with black-and-white photographs, and is translated unobtrusively by Barbara Fasting.

Disturbances of the Mind

By Douwe Draaisma. Cambridge University Press. 366pp, £16.99. ISBN 9780521509664. Published 5 November 2009

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