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.
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