Reviewed by E.B. Heath
The title of this book belies the depth of intriguing knowledge therein. Mind, brain, sex and hysteria! My brain leapt towards Freud, without any bidding from my mind, and that is the last location I want either to visit. How the Brain Lost its Mind: Sex, Hysteria and the Riddle of Mental Illness, co-authored by Allan Ropper and B. D. Burrell, is a historical tour de force examining the twin disciplines of neurology and psychiatry, and the scourge of syphilis that raged through Europe in the late 1700s. This book is not a dry read. Ropper and Burrell have produced a fascinating narrative full of eccentric characters.
The first eccentric character that readers meet is Jean-Martin Charcot, famous for detecting multiple sclerosis, Parkinson’s disease, and establishing the discipline of neurology. Charcot possessed all the flair of a circus ringmaster, evident when he theatrically demonstrated his theories on hysteria (roughly defined as erratic behaviour without a verifiable cause) to the medical fraternity by hypnotizing his patients. The theory he was at pains to prove was that lesions on the brain caused hysteria. He reasoned that, if symptoms persisted under hypnosis, it was proof enough that hysteria was a biological, therefore a neurological, illness, not a malady of the mind in the domain of psychiatry. As such, he caused a separation of the two disciplines rather than advocating for a more co-coordinated approach to mental illness. His demonstrations, mainly conducted on women and for the benefit of a male audience, seem to have a sexually titillating appeal. The demonstrations took place at the Salpêtrière Hospital, which Ropper and Burrell describe as a magical palace presided over by a real-life Willy Wonka. How, and on whom, these performances took place might cause the reader to wonder if the book’s publishers have made a category error and this was in fact fiction.
Few fictional works imagine a disease as awful as that caused by the bacteria of syphilis. Syphilis attacks the body via lesions and so naturally was diagnosed as a physical disease, but, when it progressed to the brain rendering its victims mad, it was not recognized as the same disease. It was then considered to be hysteria and its treatment left to practitioners of early psychiatry. Understanding syphilis becomes the backdrop to the twists and turns of this enthralling history of the separation between neurology’s and psychiatry’s approaches to mental illness. Ropper and Burrell have set out to reunite the two disciplines. They believe that understanding the differences between mental disturbances caused by disease, and those of a purely psychological nature, will give a greater understanding of disease in general.
The questions raised by Ropper and Burrell concern how we define differences between ‘brain’ and ‘mind’, and how should we define ‘mind’. The distinction is not just of philosophical interest; medical definitions of illness and treatments are organized in categories of: disease, disorder or syndrome. Whereas disease has a known etiology, mental illness remains elusive, as either waiting for a provable etiology to then be considered a disease, or considering it a to be a disorder or a syndrome?
According to Ropper and Burrell, some conditions are being upgraded from disorder to brain-based disease without supporting evidence. The case of depression is interesting: there is evidence for depression to be considered as either a brain-based disease requiring a drug regime, or, a mental condition caused by the patient’s past experience which requires counselling.
There is so much to discover about mental illness and Ropper and Burrell wonder if, as in the past, crucial issues are being glossed over. And there is always the question of whether unusual personalities that deviate from an idealized norm are being validated as syndromes.
At this point it might be as well to stress, again, that this is not a bland, couched-in-medical-jargon, read. It is also social history, touching on the lives of artists, musicians and poets and their attitudes regarding syphilis.
Dr Allan H. Ropper is a Professor at Harvard Medical School and the Raymond D. Adams Master Clinician of the Department of Neurology at Brigham and Women’s Hospital. He is also a deputy editor of the New England Journal of Medicine and a fellow of the American Academy of Neurology, Royal College of Physicians, and the American College of Physicians.
B. D. Burrell is a member of the mathematics faculty at the University of Massachusetts Amherst. A teacher and writer, he is the author of several books, including Postcards from the Brain Museum, The Words We Live By, and, jointly with Dr Allan H. Ropper, Reaching Down the Rabbit Hole.
By Allan Ropper and B.D. Burrell
Paperback – $29.99; 256pp