Malady of the mind

In “Malady of the Mind”, Jeffrey A. Lieberman argues that we are finally making progress in understanding schizophrenia. Schizophrenia has long been understood to be among the most serious and intractable of all mental disorders. The condition typically begins in early adulthood and lasts a lifetime. Its hallmark features include hallucinations, withdrawal from social situations, and serious problems in cognition, such as a highly irrational belief system and a limited attention span. In “Malady of the Mind: Schizophrenia and the Path to Prevention”, a comprehensive history of this perplexing mental disorder from the Ancient World to the present, Jeffrey A. Lieberman argues that psychiatry has finally turned a corner in determining both what causes schizophrenia and how to treat it. “Due to the progress and success of science”, he concludes, schizophrenia is “a malady of the mind no more”. It’s a bold pronouncement to make, given that Lieberman himself admits that the history of psychiatry is filled with declarations of victory over a disorder that nonetheless continues to defy efforts to pin it down. Several once-heralded treatments – say, insulin coma therapy and ice-pick lobotomies, which were both popular in the 1940s – are now dismissed as barbaric. Likewise, while anti-psychotic medications, which were introduced with great fanfare in the mid-1950s and remain today’s treatment of choice, can sometimes reduce the intensity of the most troubling symptoms, they are far from a cure. The chapters on past approaches are elegantly written and are helpful in giving context to current debates about how best to address this devastating illness. Lieberman’s current optimism, however, is rooted in the findings of biological psychiatrists over the last 40 years. A longtime professor of psychiatry at Columbia – he was department chair until a year ago when he was suspended after posting a tweet that was widely considered racist and misogynistic – Lieberman himself has been a central figure in this research, having co-authored hundreds of studies in the nation’s most prestigious medical and psychiatric journals, and written or edited 10 books on mental illness. Lieberman, who served as president of the American Psychiatric Association a decade ago, has also won several prestigious awards for his scholarly oeuvre, including the Lieber Prize for Schizophrenia Research from the National Association for Research in Schizophrenia and Affective Disorders, and the Neuroscience Award from the International College of Neuropsychopharmacology. As he sees it, biological psychiatry has made major advances that have put our understanding of schizophrenia on a more firm scientific footing than ever before. He argues, for example, that modern research supports the notion that genetic factors play a dominant role in the onset of schizophrenia. We now know, he writes, “the numerous means by which genes conspire to preserve and confer schizophrenia”. He also suggests that numerous studies of drugs such as antipsychotics, antidepressants, and stimulants show that the dysregulation of certain neurotransmitters – say, dopamine – are primarily responsible for causing the disorder. For Lieberman, schizophrenia is a brain disease that typically responds well to current medical treatments.