Brain, Vol. 127, No. 7, 1678-1679,
July 2004
© 2004 Guarantors of Brain
doi: 10.1093/brain/awh143
Book Review |
THE SELF IN NEUROSCIENCE AND PSYCHIATRY
Department of Neurology, University Hospital Aachen, RWTH Aachen, Germany
THE SELF IN NEUROSCIENCE AND PSYCHIATRY
Edited by Tilo Kircher and Anthony David
2003. Cambridge: Cambridge University Press
Price £29.95. ISBN 0-521-53350-3.
It is only in his fifth year at Hogwarts School of Witchcraft and Wizardry when Harry Potter learns that only muggles (the non-magic folk, i.e. people like most of us) talk about ‘mind-reading’: ‘The mind is not a book to be opened at will and examined at leisure. Thoughts are not etched on the inside of skulls, to be perused by any invader. The mind is a complex and many-layered thing’ he learns during his ‘occlumency’ lesson by the much-hated Professor Snape (J. K. Rowling, Harry Potter and the Order of the Phoenix. London: Bloomsbury; 2003, pp. 468–9). And Professor Snape continues: ‘It is true, however, that those who have mastered legilimency (the ability to extract feeling and memories from another person’s mind) are able, under certain circumstances, to delve into the minds of their victims and to interpret their findings correctly ... and only those skilled at Occlumency (i.e. the branch of magic which seals the mind against magical intrusion and influence) are able to shut down those feelings and memories’ (Harry Potter and the Order of the Phoenix, pp. 468–9).
For those of us who are muggle-born and who have not (yet) been invited to Hogwarts School the task remains to approach the main constituents of the ‘self’ (or self-consciousness, as often used interchangeably throughout the book) from a more neuroscientific, non-magic viewpoint (if one is happy to follow a naturalistic view in contemporary philosophy of mind and neuroscience, according to which mental phenomena are based upon neural processes). As the editors Tilo Kircher and Anthony David put it right at the beginning of their introduction to their book, ‘Who are we and what makes us who we are? Like our world, our self is a construction of our minds. But we do not live in isolation. How does the mind construct this world and ourselves in it?’ Reformulated with respect to the intention of the book, the question of the self then is: which neural ensembles underlie and may thus be responsible for the ‘subjective’ nature of the mental and bodily states that are key candidates for a formulation of the self (or self-consciousness)?
The book tries to answer this essential question, at least in part, by providing an up-to-date review of scientific research on the self from a psychiatric viewpoint. It consists of 22 chapters from various international experts, divided into three major parts that span the ‘Conceptual background’ (Part A), ‘Cognitive and neurosciences’ (Part B) and ‘Disturbances of the self: the case of schizophrenia’ (Part C). Part C is further divided into ‘Phenomenology’, ‘Social psychology’ and ‘Clinical neuroscience’. Part A provides a very useful overview from conceptual history to the phenomenology of the self and its relation to language. In accordance with the psychiatric background of the editors, Parts B and C then really zoom in on schizophrenia-related research and how studies of the self can contribute to our understanding of schizophrenia, in which the self is supposed to become ‘disordered’, and vice versa. As Kircher and David argue in their introduction, the focus is ‘on schizophrenia because the core pathology of the disorder is a disentanglement of the normal unity of body, thoughts and emotions’ (p. 3).
If there is anything to be really criticized about this book, it is the neglect of the important contributions that neuropsychologists and neurologists could have made to a book concerned with the self and self-consciousness. The phenomenal discussion of the self has obvious affinities with the discussion of the symptoms observed in patients with schizophrenia: however, it surely goes beyond this. Berrios and Marková write in their intriguing chapter on ‘The self and psychiatry: a conceptual history’ vis ‘The Western concept of self emphasizes individualism and autonomy but this view is cultural and no more specific or truthful or advanced than the syncytial or collective view of self developed in other cultures and which revolves around family or clan rather than individual’. Consequently, the same is true for the neuroscientific approach to the self, which should be multifaceted and interdisciplinary in its best sense. The insights to be gained (e.g. from studying patients with schizophrenia) are relative to a certain viewpoint and the respective spotlight of attention. Combining data and results from studies of psychiatric patients with lesion-based studies of neurological patients suffering from stroke and subsequent deficits, such as anosognosia and neglect, is likely to prove an even more fertile approach. It is time to show that there is more to the self than just a noble metaphor with a putative correlate in the frontal lobes. Groundbreaking progress in the field is likely to stem from the linking of theories to cognitive models and experimental procedures, and the application of these to both neurological and psychiatric patients (as well as healthy normal subjects across cultures). Such an interdisciplinary approach will involve psychological testing, lesion analysis and neuroimaging [with advanced techniques that allow the investigation of architectonic (e.g. diffusion tensor imaging) and functional (e.g. effective connectivity) disturbances], as well as the analysis of genetic differences across patient populations (to name just a few relevant approaches).
Yet, at the same time, the current diversity of concepts and the multiplicity of definitions of the topic that exist already in the field of psychiatrically oriented research become obvious in the present book and call for some unifying approaches. Here, the reader of the book is sometimes left with many open questions. However, most of these provide inspiring and exciting food for thought. It is this aspect in particular which makes the present book such enjoyable reading. As the neuroscientific study of the self and self-consciousness is in its infancy in terms of established models, available data, and even vocabulary, and because of its interdisciplinary nature, a glossary would help the reader (and should be included in future editions of the book, which I hope will come).
Finally, the title of the book (The Self in Neuroscience and Psychiatry) gives away two interesting aspects. The ‘Occlumency’ against a wealth of knowledge derived from neurological approaches to the self and self-consciousness (e.g. in studies of anosognosia, neglect or extinction; see above) and, more interestingly, in a Freudian sense, the implication of a dualism of neuroscience and psychiatry. The latter contrasts, of course, with the editors’ aim to provide an update of current progress in the field of psychiatry by linking theories and experimental procedures from psychology to the results of neuroscience and psychiatric research in patients suffering from schizophrenia. Although the neuroscientific study of the self (and self-consciousness) is in its infancy, the book successfully reviews the current status of the field and illustrates the progress of this neuroscientifically oriented area of psychiatric research.
The understandable decision of the editors to focus their book on psychiatry-related contributions has resulted in a book that can be recommended particularly to those interested in the field of self and self-consciousness from a biologically oriented psychiatric viewpoint. The scientific merit of the book, however, clearly goes beyond psychiatry, and it can therefore be recommended to all those scientists and clinicians who are affiliated with research of the self and self-consciousness. Its attractive price makes it good value for money and the final recommendation (even from a neurologist’s viewpoint) is accordingly a ‘strong buy’.
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