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Book Review   |    
Paul Noroian
Psychiatric Services 2007; doi: 10.1176/appi.ps.58.8.1132
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by F. Scott Kraly, Ph.D.; New York, W. W. Norton, 2006, 256 pages, $23.95

Dr. Noroian is assistant professor of psychiatry at the University of Massachusetts Medical School and chief of psychiatry at Worcester State Hospital, Worcester.

What is going on in the brain of a person suffering a debilitating psychological disorder?" This is the question posed by F. Scott Kraly in the preface to his new book, Brain Science and Psychological Disorders. The book aims to provide an overview of the science behind our understanding of psychopathology and psychiatric treatment. The book addresses mental illness from the synapse, to the problem behavior, to the prescription. Early chapters deal with the etiology and treatment of psychiatric disorders. The book then reviews our current understanding of how the brain and nervous system work, including a summary of neuroanatomy and neurophysiology. It closes with the scientific theory behind major psychiatric disorders and with the author's perspective on research into these disorders.

One consistent theme of the book is how little we know about the neurochemistry of the brain, especially as it relates to behavior. Kraly points out how treatments for mental illness are based on their effectiveness in reducing symptoms and suffering and not necessarily on an understanding of how they act on the brain. He reviews the process by which medications are approved by the Food and Drug Administration and reminds us that mechanism of action is not a criterion for approving new psychotropic medicines. In clinical vignettes, the book addresses the challenges faced by patients in making sense of their symptoms and the challenges faced by clinicians in explaining how illnesses develop and how treatments work.

Kraly outlines how our knowledge of psychopharmacology has informed our understanding of how the brain works and how it breaks down. He devotes a chapter to how nerve cells communicate with each other. The book highlights the complexity of the neurotransmitter-receptor interaction and how synaptic processes form the basis for an understanding of behavior and pathology. A central point of the book is that both drugs and psychotherapy alter the neurochemistry of the central nervous system and that these changes form the common scientific basis for different treatments. In reviewing the major classes of psychiatric illness, the book presents data on the neurotransmitters and brain regions associated with the disorders. The book also provides schematic diagrams of the pathways in the brain associated with the disorders. Specifically, the book devotes a single chapter to each of the following disorders: depression, mania, anxiety disorders, substance use disorders, bulimia, anorexia, attention-deficit hyperactivity disorder, and schizophrenia.

Brain Science and Psychological Disorders is a useful tool for students in the mental health fields. It outlines the basic science of the brain, behavior, psychopathology, and psychiatric treatment in a clear and concise manner. Practicing clinicians will appreciate the connection of specific conditions and treatments to their basic science roots. The clinical vignettes remind us of how the basic science is relevant to our patients and their treatment, though I would prefer that the author had avoided describing patients as "schizophrenics" or "anorexics." This text is not exhaustive in its presentation of research and theory in regard to the major psychiatric disorders, and it does not include data on personality disorders and sexual disorders. The information presented about placebos and pharmacotherapy is simplified.

However, the book serves as an introduction to brain science. It is not written for the research scientist and is not meant to guide the treatment of patients. Ultimately, the book reminds us of the great strides made in understanding and treating mental disorders. It also makes us painfully aware of how little is known about the processes that underlie mental illness and how difficult it is to answer to the author's opening question.

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