The Ceiling Outside: The Science and Experience of the Disrupted Mind By Noga Arikha Basic Books. 2023. £10.99 (pb). 304 pp. ISBN 9781529385489

This book is a healthy reminder that psychiatry is not just technology and clinical methodologies. The keynote is that ‘pathology is not the whole story’ of the person. As a historian of ideas and a humanist philosopher, Noga Arikha weaves into her narrative, concerning how the loss of memory affects us, her own experience of her mother's dementia alongside observations of case conferences held at Pitié-Salpêtrière Hospital in Paris. The title is taken from one of her mother's sing-song elliptical statements ‘the ceiling inside, the ceiling outside’. Arikha's stance arises from the position that our consciousness emerges through our dynamic and ever-changing embodied relationships. If we merely consider a person's ailment in isolation, we cannot hope to treat them effectively and compassionately.

She calls on a wide range of historical commentators and contemporary neuroscientists to marshal her arguments. She has an extensive knowledge of psychiatric history, alongside the work of Oliver Sacks and Antonio Damasio. As the book is primarily aimed at a lay audience she explains in a clear and cogent manner how psychiatrists and neurologists see different symptoms and disorders. This is amplified by observations such as the fact that the term ‘hallucination’ was coined by Sir Thomas Browne in 1646, long before it was used by Esquirol.

A recurrent question arises for her: ‘to what extent am I not my brain?’ As its faculties are disrupted, how does this affect our sense of self? Considered from the understanding that consciousness arises from our relationships and embodied brain, this poses existential questions that become particularly potent as we observe our relatives and patients suffering from dementia and becoming increasingly distant from us, while retaining flashes of their old selves.

Much like John Berger's book on the work of a general practitioner in the 1960s, A Fortunate Man, this is a book full of reflections on how we practise our craft and its wider implications for those with whom we work. I was particularly impressed by the discussions Arikha observed held between the neurologist and psychiatrist as they considered each of the cases. At times they were unable to come to a clear diagnosis and I was left wondering what would be the ‘care pathway’ for those who were left undiagnosed even after such erudite deliberation. In my opinion this book provides valuable insights for both patients and psychiatrists at all levels of ongoing learning.