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that lead physicians to seek treatment or avoid it though the need be abundantly clear.
JEAN E. MILOFSKY, M.D. Denver, Colo.

Book review accepted for publication March 2008 (doi:10.1176/ appi.ajp.2008.08030345).

The Accidental Mind: How Brain Evolution Has Given Us Love, Memory, Dreams, and God, by David J. Linden.
Cambridge, Mass, Harvard University Press, 2007, 288 pp., $25.95. Despite its breeziness, this book will be of interest to some psychiatrists. The author, a neuroscientist and the son of a psychoanalyst (and thus perhaps is himself something of an emblem of our times), is a professor of neuroscience at Johns Hopkins University. His survey of recent advances in brain biology may be interesting and useful to psychiatrists trying to keep up with brain research and interested in its relevance to the interaction of nature and nurture and to biopsychosocial understanding. Psychiatrists may also be stimulated by the authors educated undermining of the fairly common and widespread misunderstanding that brain functioning is clear and elegantly designed. The book addresses seminal topics such as evolution, sensation, emotion, learning, memory, individuality, love, sex, sleeping, dreaming, and religious impulses; this is a stimulating but also fairly overwhelming list, to all of which he brings an impressive array of neurobiological curiosity and research. He stresses interconnections and the drawbacks built into advances and advantages. To psychiatric readers, who are perhaps used to seeing the brain largely as a world of synaptic clefts for psychopharmacological neurotransmitters, he broadens and reopens our minds to a wider complexity of basic structure and function. He discusses genes, cell structure, membranes, pumps, messengers, facilitation and inhibition, spikes, synapses, and recycling. He occasionally reminds the reader of basic guiding principles such as 1) higher functions tend to occur at the top and forward parts of the brain, 2) the brain is built like an ice cream cone, with added scoops, and 3) localization of function is straightforward for basic subconscious reflexes and fairly straightforward for the initial steps of sensation, but far more difficult for more complex phenomena such as memory or decision making. He gives evidence for interconnectedness, such as between perception and emotion or sensation and motor function. He discusses how various high brain functions are built on memory and emotion. He gives evidence for the complexity of memory and its tasks. After chapters on brain assembly; sensation and emotion; learning, memory, and individuality; sleep, dreams, and their possible functions; and sex, love, and some of their varieties, he turns to the religious impulse. Though some of his points here, as elsewhere, seem to me at the edge of reductionism, he does propose and discuss a potentially important neurobiological contribution to the lively and odd topic of the roots of religionthat the human brain, which has become particularly adapted to creating gap-free stories, predisposes us to religious thought.
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Overall, this book tackles important and challenging current neurobiological approaches to understanding the brain and the mind, which will make it a useful book for some psychiatrists to read. However, the breeziness of the book, perhaps designed to make it more accessible to readers, ultimately undermines its reliability. This thoughtful neuroscientists book about brain evolution, structure, and function, which places refreshing emphasis on some relatively messy and ad hoc qualities of brain evolution and on the inefficiencies of brain design and function, seems to me significantly flawed by its frequently brash and breezy style. For example, the last words of the introduction are lets roll. The author is fond of words such as downer and cool. On the acknowledgements page, after one name there are parentheses containing the word Mom!, and after another name later on, parentheses containing the word Dad!. The books breathless subtitleperhaps added by the publisher, but in tune with the authoris How Brain Evolution Has Given Us Love, Memory, Dreams, and God. On the other hand, in all fairness, some of the authors catchy formulations seem to me clear and apt, such as a couple of the chapter titles: Building a Brain With Yesterdays Parts and The Unintelligent Design of the Brain. Clear, precise, and modest language in scientific writing is often taken for granted, but as this books awkwardness reminds us, this is not a casual or superficial custom. Sliding into hyperbole or cuteness will probably dissuade many scientists and educated readers from looking at this book, though those qualities may conceivably gain some teenage and television attention. I was distracted by the thought that the book itself seemed to me somewhat like a hardworking and educated youngster in bright would-be-cool clothes that do not quite fit.
LAWRENCE HARTMANN, M.D. Cambridge, Mass.

Book review accepted for publication March 2008 (doi:10.1176/ appi.ajp.2008.08030408).

Pain and Its Transformations: The Interface of Biology and Culture, edited by Sarah Coakley and Kay Kaufman Shelemay. Cambridge, Mass, Harvard University Press, 2008, 456 pp., $49.95. This volume is comprised of papers and editorial responses from two dozen distinguished scholars, half from Harvard University, focusing on pain (both physical and emotional) and its social transformation. The material for the book comes from a seminar series and conference chaired by Arthur Kleinman and Sarah Coakley and sponsored by the Mind/Brain/Behavior Initiative at Harvard. Dr. Kleinman is a former chair of the Department of Anthropology at Harvard who trained in psychiatry at Massachusetts General Hospital. Ms. Coakley is a professor in Harvard Divinity School. The volume reflects their broad yet interconnected interests. There are a number of stellar contributions. Pain is considered from a molecular and cellular level, as well as at the level of the sadness and agony experienced by specific ethnic groups who developed rituals to help the afflicted distance themselves from their suffering. Music, trance, and self-mutilation are addressed. For example, the pain (or absence thereof) of the Shii Muslim practice of matam, a form of selfajp.psychiatryonline.org

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flagellation using lacerating razors during the annual pilgrimage to Karbala (reflecting on Husain ibn Alis martyrdom in 680 CE), is addressed in some detail. Briefly discussed is the self-injurious behavior (or cutting) of patients with borderline personality disorder. This volume covers the nature of acute pain (emotional and/or physical). Herbert Benson discusses the relaxation response as it helps with pain control. The chronic pain of longterm meditators and those devoting their lives to prayer (e.g., members of religious orders practicing ultra-intense praying to experience the pain of Jesus) is also addressed. Notable contributions come from Clifford Woolfs chapter Deconstructing Pain: A Deterministic Dissection of the Molecular Basis of Pain. Also notable is Howard Fields chapter on the associations of pain pathways and networks, in which he writes, the brain is the site where culture and biology interact. He takes on phantom limb pain, referred pain, battlefield pain, the placebo response, the gate control hypothesis in current perspective, and modulatory systems of top-down influence on pain. Fields concludes, the study of stimulusbound components isthe province of neurobiology. The study of the context-determined components is an inherently multidisciplinary endeavor and is in its infancy. Judith Beckers chapter on Music, Trancing, and the Absence of Pain is wonderfully concise and clear. Trance consciousness and repetitive ritual, as in musical forms, should open up ways to study the neurophysiology of consciousness without the I-ness. Kay Kaufman Shelemays summary on music and pain is superb, as is Howard Fields discussion of ritual and expectation: One big problem is that about 99% of pain research has focused on the spinal cord, but 99% of the pain experience is in the brain, where culture, society, and expectation come into play. Other notable contributions are the chapters from Elaine Scarry, a professor of aesthetics, which looks at injuries to heroic figures in art (e.g., works by Rubens, Pacceo de Rosa, and Mantegna, plus Francis Bacon, Munch, and Kollwitz). Laurence Kirmayer has an important chapter and spirited discussion on cultural mediation of pain. Tu Weiming reminds us that pain can be explained in evolutionary terms, but he posits that suffering requires a more explanatory model, as described in the conceptual basis of Chinese medicine. Jennifer Cole contributes a chapter on the experience of emotional pain and suffering from a social perspective. Her fieldwork focuses on the terrors of a remote war involving the Betsimisaraka tribe of Madagascar, reactivated by new social strife and partially healed by the social ritual of sacrificing bulls. All of the chapters are fascinating, but there are some parts that seem only tangentially relevant to the discussion of what one usually considers the domain of pain: somatic discomfort associated with physical injury. Thus the passages about the spiritual pain of Christian mystical figures such as Carmelites Saint Teresa of vila and Saint John of the Cross are overly long. Similarly, the chapter about the voices of the Finnish Karelian itkuvirsi, or ritual lament that relates to the suffering of a whole transplanted tribe, seems to stray too far. How a community unburdens its sorrow is important, but whether it is relevant to pain is not clear. The editing of the discussion transcripts for each chapter has been done wonderfully well, but one of the editors, Coak-

ley, did not do herself that favor for her own chapter, which has many tediously long sentences (two back-to-back sentences last for 11 lines and 124 words). This is a powerful book with many insights for those interested in pain. You will probably need a dictionary to look up some of the many abstruse terms more familiar to cultural anthropologists and philosophers than psychiatrists. And you will probably want a pen to underline some of the participants fascinating observations.
FREDERICK G. GUGGENHEIM, M.D. Providence, R.I.

Book review accepted for publication March 2008 (doi:10.1176/ appi.ajp.2008.08030407).

Metabolic Syndrome and Psychiatric Illness: Interactions, Pathophysiology, Assessment, and Treatment,
by Scott D. Mendelson, M.D., Ph.D. Burlington, Mass, Academic Press, 2008, 224 pp., $99.95. We live in complicated times in which physicians easily can feel that they do not have enough time to read all the newly published information relevant to their practice. Books take longer to print, become easily outdated, and are not subject to the peer review process used for journal articles. Therefore, I usually encourage residents to use article reviews rather than books and to not even buy books, except for select textbooks or classic books at least 50 years old. I definitively dislike the majority of new psychiatric booksthe editor books in which several authors, without coordination, review a subject. Many of them appear to help only the authors in their academic career. My pessimistic view is that almost all of these are not worthwhile. This book is different in that a single author has written about an interesting subject, metabolic syndrome. The author is a psychiatrist with a Ph.D. in biopsychology and research experience in neuroendocrinology, focusing on the serotonin system. First, and most importantly, I want to acknowledge the extraordinary merit of this book. It has 11 chapters and 970 references. Even assuming that there is some reference overlap between chapters, it is remarkable that the author was able to manage 900 references and summarize them in a coherent way, and some of them are relatively recent (2006). I found two chapters particularly interesting. The historical discussion (Chapter 1) about Gerald Reavens work in defining Syndrome X was interesting and easy to read. Chapter 10 on nutritional supplements provides information on a subject unfamiliar to me. The other seven chapters appear thorough and well researched: Factors That Contribute to Metabolic Syndrome (Chapter 2), The Pathophysiology of Metabolic Syndrome (Chapter 3), Metabolic Syndrome and Psychiatric Illness (Chapter 4), Depression, Metabolic Syndrome, and Heart Disease (Chapter 6), Metabolic Syndrome, Insulin, and Alzheimers Disease (Chapter 7), Metabolic Syndrome, Sleep, and Sex (Chapter 8), and Diets for Weight Loss and Metabolic Syndrome (Chapter 9). The book has the subtitle Interactions, Pathophysiology, Assessment, and Treatment. I found the most disappointing part to be the section on assessments (described in Chapter 11), because it did not contain practical information on how
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