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Texbook of Evolutionary Psychiatry and Psychosomatic Medicine: The

Origins of Psychopathology, (2nd edn)

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DOI: 10.1192/bjp.bp.116.193029

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 The British Journal of Psychiatry (2017)
210, 301–305
Book reviews
Edited by Allan Beveridge, Femi Oyebode
and Rosalind Ramsay
The Intentional Brain:
Motion, Emotion, and the
Development of Modern
Neuropsychiatry
By Michael R. Trimble.
The Johns Hopkins University Press.
2016.
£12.59 (hb). 328 pp.
ISBN 9781421419497
A fascinating but conceptually elusive subject, ‘neuropsychiatry’
has no universally accepted definition. More than simply the
interface between two allied medical specialties, it is a field
fundamentally and necessarily connected with the humanities:
history, politics, anthropology and philosophy. Expecting a heavily
scientific tome, I was delighted to discover that The Intentional
Brain is an accessible text principally about history and culture;
intimidating in its ambitious scope (Trimble is frighteningly well
read!), but nonetheless immediately readable. Trimble’s particular
skill is to bring narrative clarity to a complex and developing field,
providing depth to everyday clinical practice.
The book reads as a distillation of Trimble’s hard-earned
wisdom about the historical mind/brain dilemma. Entertainingly
informative and with broad interdisciplinary appeal, the text is
an invigorating tour de force covering evolution and medical
discovery, creativity and emerging civilisations, traversing ancient
concepts of consciousness, the development of dissection and
anatomical drawings, the contribution of the Enlightenment and
both World Wars. In a chronologically appropriate, increasingly
scientific manner, the account moves from the observational to
the experimental. Thus, we uncover the earliest accounts of
epilepsy, hysteria and psychosis, then learn of the advances offered
by histopathology, the controversy surrounding phrenology and the
localisation of cerebral functions, and finally, about the vital role of
electroencephalograms in developing our collective understanding.
Testament to the diversity of Trimble’s influences, his chosen
protagonists in this adventure include expected household medical
names (Charcot, Parkinson, Broca, Wernicke, Maudsley, Sacks),
alongside great thinkers (Hippocrates, Descartes, Paracelsus,
Nietzsche) and literary giants (Shakespeare, Coleridge and
Wordsworth). I also learnt about Martin Luther, Leonardo Da
Vinci, King George III, and more besides. However, this range
of sources gives the text a scattergun feel at times, as it seeks to
cover such extensive ground. There was a whole section on the
brain and poetry, which felt over-inclusive.
Importantly, however, Trimble demonstrates that all
psychiatrists require a grounding in the history of human thought.
He reminds us that neuropsychiatric phenomena, in particular
epilepsy, ‘the sacred disease’, used to be (and often still are)
mistaken for supernatural or religious experiences, illustrating that
society directly influences medicine.
It is an earnest text, with occasional space for humour, a
diverse range of illuminating anecdotes, and fascinating links with
literature. It is a history of two complementary but at times
conflicted subspecialties. It reminded me exactly why I love
psychiatry, for its complex history and ongoing scientific mystery.
If you are feeling in need of a reminder of how far we have come,
Trimble may provide just that inspiration.
Rory Conn ST6 Trainee in Child and Adolescent Psychiatry, Tavistock and
Portman Mental Health Trust, 120 Belsize Lane, London NW3 5BA, UK. Email:
rconn@doctors.org.uk
doi: 10.1192/bjp.bp.116.197780
Surfing Uncertainty:
Prediction, Action,
and the Embodied Mind
By Andy Clark
Oxford University Press. 2016.
£19.99 (hb). 424 pp.
ISBN 9780190217013
Our understanding of ‘how the brain works’ has expanded
enormously in recent decades. Nevertheless, the relatively new
field of neuroscience is still searching for a ‘unified theory’ of
brain function – one that can explain how the brain finesses
perception, action and attention using a more general (neuro-
computational) framework.
In his engaging new book, philosopher Andy Clark sketches
out what is arguably the best current contender for such a unified
theory: the predictive processing hypothesis. This hypothesis
makes the bold claim that practically everything that the brain
does can be understood by viewing it as an organ that is ceaselessly
attempting to predict the future (more precisely, to predict its
moment-by-moment exteroceptive and interoceptive inputs).
Under this hypothesis, vision, for example, is achieved not by
decoding the signals coming in through the optic nerve in a
stepwise fashion, but by comparing the actual incoming sensory
signals against the predicted signals, given the brain’s internal
representation of the world. This ‘top-down’ view of brain
function is a radical departure from the account found in most
undergraduate textbooks.
Clark argues convincingly that the predictive processing
hypothesis is not just of interest to basic neuroscientists, and outlines
recent work that has applied the model to psychiatric disorders
including schizophrenia, autism and functional neurological
disorders. His enthusiasm for the predictive processing hypothesis
is evident in his writing, and he succeeds in conveying the
hypothesis’ key ideas in an accessible manner.
Surfing Uncertainty stands out from most accounts of the
predictive processing hypothesis in the existing literature by
avoiding the use of mathematical equations and opting instead
to use illustrative examples. Despite its informal tone, however,
this erudite text does not shy away from the minutiae of
301
 Book reviews
experimental findings and neuroanatomical details, and any
prospective reader should be warned that this is not an ‘easy read’.
Nevertheless, I would encourage all those interested in
understanding the brain to meet the challenge enthusiastically –
Surfing Uncertainty just might change your view of the brain
(and of reality) forever.
Matthew M. Nour Academic Clinical Fellow in Psychiatry, South London and
Maudsley NHS Foundation Trust, London, UK. Email: matthew.nour@kcl.ac.uk
doi: 10.1192/bjp.bp.116.190512
Neuroimaging and
Neurophysiology
in Psychiatry
By David E. J. Linden.
Oxford University Press. 2016.
£29.99 (pb). 140 pp.
ISBN 9780198739609
The ever-growing availability of brain investigation techniques
opens up new avenues for the improvement of psychiatric
practice. However, busy psychiatrists do not always find it easy
to keep up to speed with all technological developments and their
multifaceted clinical applications, and so this book by David Linden
is a welcome help. As an agile and introductory volume, it clearly
explains the basic physics and physiology behind the main
techniques of neuroimaging, including magnetic resonance imaging
and positron emission tomography, as well as non-invasive neuro-
physiology (mainly electroencephalography). It comprehensively
covers clinically relevant aspects of neuroimaging and neurophys-
iology, which are discussed in the light of up-to-date information
in a concise and clinically relevant manner.
An introductory chapter on the clinical and research uses of
neuroimaging and neurophysiology in psychiatry is followed
by two chapters presenting an overview of the most relevant
techniques of neuroimaging and neurophysiology (with brain
stimulation). Chapters 4 and 5 locate the clinical indications of
neuroimaging and neurophysiology within the diagnostic work-
up of patients with psychiatric disorders. Neuroimaging and
diagnostic disease markers are covered, as are key insights into
the mechanisms of mental disorders provided by modern neuro-
imaging techniques. Of particular interest is chapter 8, as it
touches on the forensic implications of ‘mind reading’. The final
two chapters outline the therapeutic applications of neuroimaging
and neurophysiological techniques. Both the iconography and the
bibliographic apparatus are of the highest standard.
Thanks to the author’s knowledge and first-hand experience
with the latest research, this book provides a valuable and easy-
to-read reference that will help clinical neuropsychiatrists in their
everyday practice. It is at most a minor exaggeration to say that
with his recent books David Linden is personally responsible for
charting the rapidly changing territory between neurology and
302
psychiatry for the benefit of the current generation of neuro-
psychiatrists. His efforts and endeavours have achieved the
important goals of informing psychiatric practice and ultimately
improving the quality of patient care.
Andrea E. Cavanna Department of Neuropsychiatry, The Barberry National Centre
for Mental Health, 25 Vincent Drive, Birmingham B152FG, UK. Email:
A.Cavanna@ion.ucl.ac.uk
doi: 10.1192/bjp.bp.116.193003
Texbook of Evolutionary
Psychiatry and
Psychosomatic Medicine:
The Origins of
Psychopathology,
(2nd edn)
By Martin Brüne.
Oxford University Press. 2016.
£44.99 (pb). 496 pp.
ISBN 9780198717942
The origins of psychopathology is a topic approached in main-
stream psychiatry by examining genetic factors, pathophysiology
and the developmental factors (ontogeny). Martin Brüne, like
other evolutionary psychiatrists, finds this approach incomplete
and proposes that these proximate causes of psychopathology
should be complemented by ultimate causation ones (phylogeny
and adaptive functions). By doing that, the four ‘why’ questions
suggested by Tinbergen (function or adaptation, phylogeny,
mechanism and ontogeny) would be covered. This is possibly
the main theme of this book and has influenced the structure of
its chapters.
The book therefore is not a list of evolutionary theories of
psychopathology. Instead, it is largely written using a standard
psychiatric textbook layout. Clinical chapters are divided into sections
similar to any other introductory textbook of psychiatry, such as
symptomatology, epidemiology, risk factors, pathophysiology,
differential diagnosis, course and outcome, and treatment, in
addition to a section which provides an evolutionary synthesis.
Part one of the book, which provides the theoretical background,
covers evolutionary principles, human life history in addition to
causes of psychopathology, the human brain and psychiatric
assessment in line with the approach described above.
In sections called ‘Afterthought’, added to chapters in part 1
and 3, Brüne outlines concepts, impressions and insights which
provide a different dimension to the content of the chapter and
sometimes clarify difficult ideas. Examples of these afterthoughts
include ‘genetic determinism’, ‘the possibility to prevent mental
illness’, ‘what non-verbal behaviour can tell us’ and ‘the social
brain hypotheses’. The last is one of many examples in this book
used to highlight the importance of the social context in the
origin of psychopathology. This is used to dispel a common
misconception that the evolutionary approach is a reductionist
enterprise that aims to explain psychopathology in purely genetic
or molecular terms. Another example is a new addition to chapter
1 in this second edition, ‘the differential genetics of susceptibility’
– the concept that genetic variation can promote vulnerability or

protection depending on the nature of early life experiences.
Although the clinical chapters in part 2 follow a DSM-5
approach to categorisation, the author takes pains to underline
the dimensional nature of psychiatric conditions, which is another
important theme of this book. He explained that a different
approach to categorisation based on evolutionary themes would
have been too radical and would defy the purpose of this book
as an introductory textbook of psychiatry.
I would personally recommend this book to psychiatrists,
researchers and interested medical students. I think it would be
of special importance for psychiatric trainees, because in addition
to the classic knowledge base necessary for their training and
exams, it will also provide them with a more coherent theoretical
formulation and context than they can find in current mainstream
texts.
Mohammed J. Abbas consultant psychiatrist, Bradgate Unit, Glenfield Hospital,
Groby Road, Leicester LE3 9EJ, UK. Email: Mohammed.abbas@leicspart.nhs.uk
doi: 10.1192/bjp.bp.116.193029
The Welfare Trait:
How State Benefits
Affect Personality
By Adam Perkins.
Palgrave Macmillan. 2016.
£20.00 (pb). 201 pp.
ISBN 9781137555281
In this book, Adam Perkins, neurobiologist of personality, makes
a powerful claim: namely, that social policy structure can
influence personality function: especially in those people whose
dysfunctional personalities mean that they operate in antisocial
ways. He specifically argues that high levels of child benefit
encourage people with antisocial personality disorders (ASPD) to
have more children; children that they cannot afford to care for,
and who are at increased risk of neglect and abuse. These neglected
and uncared for offspring are at increased risk of becoming the
next generation of adults with personality dysfunction, who rarely
engage in paid work, may commit more crime than those without
such dysfunction, and who generally may be (as Perkins puts it) ‘a
drain on the public purse’.
Perkins perfectly understands the political implications of
what he is saying, and how his book will be used by political
theorists who favour a smaller role for the state. He offers little
evidence against his position, and I suspect he is not unhappy with
the positive reviews of his book in the Spectator and other right-
of-centre publications. But it is true that there is good-quality
evidence for the transmission of dysfunctional personality traits
by epigenetic means across generations, and also evidence that
parental personality dysfunction negatively impacts on parenting
sensitivity and attunement. If we really wanted to decrease future
Book reviews
crime rates and the incidence of child maltreatment in the years to
come, we would discourage people with ASPD from having
children. This would not be a complete or sufficient response;
but in terms of utilitarian philosophy, it would be a start.
The key word here is ‘utilitarian’; and Perkins’ books suffers
from a lack of any ethical critique of his claims. There are of course
many counter-arguments to his position, too numerous to discuss in
detail in a short book review. The main argument is that we could
offer therapy to people with personality dysfunction, including
people with ASPD. A national treatment trial is underway, which
focuses on reduction of aggression; similar interventions are being
offered that focus on parenting. Perkins presumably would argue
that it’s cheaper just to stop child benefit; which reminds me of
the evidence that some researchers have found for a linear
relationship between a tendency to utilitarian reasoning and
scores for psychopathy.
Gwen Adshead Ravenswood House, Mayles Lane, Fareham PO17 5NA, UK.
Email: gwen.adshead@southernhealth.nhs.uk
doi: 10.1192/bjp.bp.116.187757
From the Couch to the
Circle: Group-Analytic
Psychotherapy in
Practice
By John R. Schlapobersky.
Routledge. 2016.
£36.99 (pb). 498 pp.
ISBN 9780415672207
I was first exposed to the power of group therapy as a medical
student, sitting in on the daily large patient group run every
morning by the consultant psychiatrist on my in-patient ward.
My interest in groups continued as a junior trainee psychiatrist,
and although I benefitted from excellent supervision, I would have
welcomed this book to help me make more sense of the theory
underpinning the interventions I was learning to practise.
John Schlapobersky is a leading British group analyst and this
book represents his work as a clinician, teacher and trainer of
group-analytic psychotherapy in the NHS, private sector and
other settings over the past 35 years. It is divided into three
sections. The first covers the basic principles of group-analytic
psychotherapy, which build the foundation from which the creative
work of therapy can develop. These include its developmental
nature, its language, speech and silence, and its various structural
configurations in terms of frequency, duration and composition of
groups. The second section further elaborates on the basic
principles of analytic group therapy through the clinical concepts
of structure, process and content. The third section explores in
more depth the dynamic processes of change – the roles of
transference, countertransference, containment, symbolisation,
metaphor and meaning. Schlapobersky deftly integrates temporal
303
 Book reviews
and spatial dimensions of group-analytic therapy in revealing how
its developmental phasic nature – the group progressing through
relational, reflective and reparative stages; from monologue to
dialogue to discourse; and from cohesiveness to coherence – is
intertwined with the group’s complex interpersonal dynamics that
form the relational matrix at any one time. Engaging clinical
vignettes included throughout give voice to discussions on theory
and technique and bring the text alive.
It is difficult to pay justice in this brief review to the book’s
value for not just being one of the most comprehensive and
accessible textbooks about group therapy for many years, but also
for its wisdom about human nature, the complexities of inter-
personal relationships and the dynamics of groups. There is some
repetition; however, the elegant prose greatly outweighs any minor
irritation at too much cross-referencing to other chapters.
This book will be of use to psychiatrists and other mental
health professionals at all stages of their career, and who are
involved in any type of group work. It will hopefully inspire others
to undertake such work and to become convinced of the centrality
of the analytic group method within a model of therapeutic
psychiatry that informs the totality of our field.
Jessica Yakeley Consultant Psychiatrist in Forensic Psychotherapy and Director,
Portman Clinic, Director of Medical Education, The Tavistock and Portman NHS
Foundation Trust, Portman Clinic, 8 Fitzjohns Avenue, London NW3 5NA, UK. Email:
jyakeley@tavi-port.nhs.uk
doi: 10.1192/bjp.bp.116.193094
EMDR Therapy
for Schizophrenia
and Other Psychoses
By Paul William Miller.
Springer Publishing Company.
2015.
$65.00 (pb). 296 pp.
ISBN 9780826123176
Dr William Miller has written a beautifully presented and
interesting introduction to eye movement desensitisation and
reprocessing therapy (EMDR). Excitingly, it refers to the relatively
new idea that EMDR might be a therapy useful for the treatment
of psychotic disorders, but this risks disrupting the focus of the
book.
For a work about EMDR, quite a bit of this text refers to more
general topics. Early chapters explore the relationship between
trauma, psychosis and schizophrenia, followed in later chapters
by the psychopathology of dissociation and psychotic disorders,
clinical skills in psychotic disorders, and a critique of modern
psychotherapeutic methods within the framework of a slightly
strained Disney metaphor (‘Psychotherapy for psychosis and
schizophrenia: the Wizard of Oz fallacy’). The extent to which this
book is an advance of an argument that EMDR is effective, a
model for the mechanism by which EMDR might work, or a
manual for the implementation of EMDR in schizophrenia is
304
not clear. Finally, as a relatively junior psychiatrist and relative
novice to EMDR, to me the book was a rich, characterful
introduction to the development of EMDR as an intervention,
but I was left uncertain about the empirical evidence, its
applicability to EMDR in clinical settings, or the compatibility
of EMDR with modern clinical practice.
Chapters are composed of short sections, are well referenced
and clearly written. Each has a very short ‘intention’ at the
beginning, which helps to orient the reader. Case descriptions of
patients with psychosis treated with EMDR, presented at the
end of the book, help to paint a picture of the therapy in action,
but often emphasise an optimistic approach.
In conclusion, this book is not a destination for those of us
who are interested in a dispassionate evaluation of the evidence
base for EMDR. Rather, it is a description of an emerging
treatment from a singularly interested observer and practitioner
of this fascinating intervention.
Vishal Bhavsar Clinical Research Training Fellow, Department of Psychosis Studies,
7th Floor Main Building, Institute of Psychiatry, Psychology and Neuroscience, King’s
College London, London SE5 8AF, UK. Email: vishal.2.bhavsar@kcl.ac.uk
doi: 10.1192/bjp.bp.116.185363
Small Acts
of Disappearance:
Essays on Hunger
By Fiona Wright.
Giramondo. 2015.
AUS$24.95 (pb). 224 pp.
ISBN 9781922146939
Fiona Wright is an acclaimed writer from Sydney who is recovering
from anorexia nervosa. In 2016, Wright was awarded the prestigious
Kibble Literary Award for her semi-autobiographical essay
collection, Small Acts of Disappearance: Essays on Hunger. I was
curious about its success and wanted to see what it could teach
a psychiatry trainee about the internal world of a person suffering
from an eating disorder.
The collection consists of ten essays, in mostly chronological
order, and progresses through the phases of Wright recognising
she has a disorder, identifying its precipitating and maintaining
factors, and starting the recovery process. The majority of the
essays are Wright’s reflections on her own illness, which lasted
over 8 years. Wright also reviews the existing scientific and
literary research on eating disorders, which provides an interesting
and informative interlude while also illustrating her own
intellectualisation of her disorder.
Small Acts explores how anorexia maintains its grip on
an individual, beyond the textbook fear of fatness. Wright,
interestingly, never uses terms such as ‘fat’ in reference to herself.
Instead, she addresses two drives that maintained her illness: the
sensation of hunger and the need to be small. From her opening
lines onwards, we learn how hunger can be experienced as a
positive internal sensation. The importance of being small is

frequently referred to and has its own essay, ‘In Miniature’, which
weaves the history and philosophy of miniature objects with
Wright’s reflections on why this was such a stronghold, or as it
might appear to us, an overvalued idea.
Wright’s essays permit a reasonable psychiatric formulation
but they are not a full psychiatric history. She has, of course,
chosen what not to publicise. Her family relationships, for
example, are not explored in great depth. Her rumination disorder
and anorexia are difficult to disentangle, both for herself and the
reader, particularly as the narrative indicates that the rumination
disorder leads to anorexia, yet Wright alludes to anorectic
cognitions before the disorder developed. Regardless, the book
highlights the complex psychopathology and the importance of
exploring the patient’s narrative of their symptoms.
Book reviews
Small Acts gives a valuable insight into a disorder that thrives
on secrecy and is presumably difficult to discuss in public. It
addresses the tyranny of an eating disorder from multiple
perspectives, with beautiful poetic prose and wide-ranging
historical insights, and is recommended to anyone interested in
the complex relationship people can develop with food and with
themselves.
Sophie Gascoigne-Cohen Core Trainee in Psychiatry, North Central London
Programme, HLDP, 7th Floor, River Park House, 225 High Road, Wood Green,
London N22 8HQ, UK. Email: Sophie.Gascoigne-Cohen@nhs.net
doi: 10.1192/bjp.bp.117.198655
305
 Texbook of Evolutionary Psychiatry and Psychosomatic
Medicine: The Origins of Psychopathology, (2nd edn)
Mohammed J. Abbas
BJP 2017, 210:302-303.
Access the most recent version at DOI: 10.1192/bjp.bp.116.193029

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