Review of A User's Guide to the Brain: Perception, Attention, and the Four Theaters of the Brain (Paperback)

"Mental problems, from hot temper to laziness, from chronic worry to excessive drinking, all have roots in the biology of the brain." (p. 357)

This is a report on a revolution taking place in neuroscience, psychiatry, psychology and kindred disciplines.The old paradigms are crumbling under the onslaught of a new understanding of how the brain really works.Harvard Medical School psychiatrist John J. Ratey's "guide" (it's more than that) is an admirable exercise in bringing us up to date on what is happening in brain science--what we suspect, what we know, and how this knowledge is affecting clinical practice.

In a sense Ratey's book is a report on a new paradigm.It is biology-based and relies first and foremost on the physiology of the brain and body as they have developed over time.Gone are the artificial constructs of Freudian psychology and the very limited black-box psychology of behaviorism.The new psychology is based on opening that black box and looking inside.Of course what we find there is enormously complex, and we are, to use Ratey's expression (p. 124), "still on the first step of a very long staircase."Yet, because of the growing power of neuroscience to study and access the living brain in ways that were impossible just a few years ago, we are entering an exciting time, full of hope and wonder.

As Dr. Ratey explains in "Acknowledgments," this book began as a cooperative research effort by many people toward writing a "primer on the brain for mental health professionals."Then it was suggested by Pantheon editor Linda Healey that a smaller version "that would try to instruct the public at large" be written.A professional science writer, Mark Fischetti, was hired and schooled.The result is a book written in an engaging and very readable manner.However, its organization--neat and reasonable as it is--actually detracts from the book's effectiveness because the most interesting and helpful chapters are near the end. I realize that Ratey and his editors and writers came to the conclusion that the material in the last three chapters, "The Social Brain," "The Four Theaters," and "Care and Feeding" could be better appreciated after having read the more fundamental material in the first seven chapters.Nonetheless I believe that a lot of people who would benefit from this very fine book will not get to those chapters.Too bad.Ratey's metaphor of the four theaters is a powerful tool for incorporating and understanding the new paradigm, while the final chapter gives us some very excellent advice on how to live fully while keeping the brain and our systems healthy.

Consequently I would propose that when Dr. Ratey updates this book (and I hope he will; there is so much happening in neuroscience that some of the information here will be dated in just a few years) that he structure the book so that it begins with Chapter 9, "The Four Theaters," followed by Chapter 8, "The Social Brain," and then the first seven chapters, concluding with the advice in Chapter 10, "Care and Feeding."For the reader, I recommend reading Chapter 9 first so that you can immediately share in the excitement that is at the heart of the book.

The "theaters," by the way, should be understood as "theaters of operations" and not theaters where movies might be shown.(Originally Ratey had used "kingdoms of the brain" as his metaphor.)The theaters are (1) perception; (2) attention, consciousness and cognition; (3) brain function (memory, emotion, movement, etc.); and (4) behavior and identity.He sees a flow of consequence (like a river) from perception to attention to function to behavior.He argues persuasively that the brain is a holistically operating entity that is constantly being changed by its interaction with the environment, a dynamic organism that is forever learning, making new perceptions and adjustments.Things can go wrong in any one of the theaters and what happens in any theater affects the other theaters down river (and even up river).What I found particularly interesting is the new approach to diagnostics and therapy this understanding affords.A good example is on pages 347-349 where Ratey tells the story of Theresa who was slow to learn, unsocial and awkward in sports.Instead of some disorder out of DSM-IV being plastered on her forehead, Ratey found that she had a perception problem, and he demonstrated how her social and functional problems stemmed from that "first theater" problem.Ratey emphasizes freeing the patient from self-doubt and personal blame for whatever the problem may be, and always looks for a biological cause first. Some bits of wisdom from the best chapter in the book, from pages 353-355:

"Modern medical practice tends to regard patients' self-evaluations as too tainted by subjectivity, but this is a grave error."

"It is quite beyond the average patient's ability, within the framework of...insight-oriented therapies, to pinpoint the true source of unhappiness and frustration."

"Prozac is hardly a remedy for the self-blame, lost opportunities, and intellectual insecurity of a lifetime compromised by unrecognized perceptual and cognitive deficits."

"We have to begin to think of the brain as a self-organizing ecosystem, one of such staggering complexity and delicate balance that almost any aspect of a patient's life may be relevant to a diagnosis or essential to treatment."

"[T]he clinician's duty...includes devoting more time to looking for what is good in patients' lives, for the strengths and talents that are not yet being fully realized, and for the secret pleasures and sources of happiness that they have never allowed themselves."

"We in psychiatry continually risk mistaking our labels for the disorders themselves."

"The brain's processes can be utterly transformed by self-discovery and the right pursuits in life."



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