Unthinkable, Helen Thomson

Unthinkable is a journey through some non-neurotypical brains. It’s a bit of a mix, actually; some of them have neurological conditions, while others are more psychiatric, and others straddle the border. In part, it illustrates the difficulty in drawing a line between the two. Most of the cases in this book weren’t new to me (or at least, I’d read about similar ones before), although Thomson approaches each person with sympathy and a determination to try and understand them and how they think.

They’re still interesting stories, even though they’re not surprises to me, and there were some details I wasn’t aware of — for instance, the man who believed he was dead was found to have very little brain activity, when scanned, more like someone in a coma than someone alive and walking around.

It’s silly, but I did have to laugh when Thomson mentioned someone “watching manga”. Yikes.

Rating: 3/5

How to Argue with a Racist, Adam Rutherford

I’ve enjoyed Rutherford’s work before; he communicates clearly, and he’s clearly delighted by the intricacies and weirdnesses of DNA and inheritance. In this book, he tries to provide people with the tools to argue back with some key racist talking points about skin colour, intelligence, milk-drinking, ancestry and proficiency at sport. For the most part, he doesn’t argue with a specific study or source of an idea, but offers up general points. It’s actually a very ineffective way to argue with anyone who’s going to ask for evidence, however true his points are; you can explain to a horse how to get to the water, but it’s not going to go and drink no matter how long you talk at it. Or, as my grandmother says, “You can’t educate pork.”

Really, the main problem is that some people are never going to believe you, even if you can talk the hind leg off the proverbial donkey and you can provide the sources. It’s not really clear who benefits from this book — mostly, I guess, people who know people who are sat on the fence, but can listen to reason. If you know any of those, I’ll send you my copy (assuming I haven’t already sent it to someone else) and best of luck to you!

It’s still clear and engaging, but preaching to the choir (by definition, if it’s aimed at people who want to argue with racists) and without a really clear guide to how to use these talking points. Vaguely replying “yes well everyone is related to everyone else if you go back through the family lines to the 16th century” doesn’t cut it for most racists.

If you’re on the fence and you want to understand why Ashkenazi Jews aren’t inherently more intelligent than other people and African runners aren’t inherently better at sprinting than anyone, it might be useful!

Rating: 3/5

The Great Pretender, Susannah Cahalan

I was fascinated by Cahalan’s previous book, Brain on Fire, which documents her hospitalisation for psychosis that turned out to have been caused by encephalitis, prompted by an immune disorder. For a while, Cahalan was lost, but she found her way back, and The Great Pretender is in part prompted by those experiences. Looking at patients with mental health issues, she’s found herself wondering how many might be suffering from brain inflammation in the way she was, and how many could be cured partially or wholly by the same treatment. That’s how she found out about David Rosenhan’s famous study, which was born from a very pertinent question: “How can we tell the sane from the insane?”

Rosenhan’s study sounds simple: he sent nine pseudo-patients, one of them being himself, into a psychiatric ward with a simple description of non-dangerous but troubling symptoms. They all claimed to be hearing voices which said things like “hollow” and “empty”, but they dropped these symptoms as soon as they were actually in the ward. They all emerged from the wards — some after nearly two months — with diagnoses of schizophrenia.

Cahalan found this electrifying: how could psychiatrists not tell the pseudo-patients were perfectly sane? For the same reason as she was originally diagnosed as psychotic, partially: there’s no actual physical diagnostic criteria you can run someone through to prove one way or another whether they are suffering from a mental health disorder. (The DSM, a diagnostic manual, was updated to include a lot more diagnostic criteria as a direct result of this study; the issues are different now, though there are still deep issues with subjectivity and bias.) And also because all kinds of ordinary actions could be interpreted as insanity when seen in the confines of a psychiatric ward. A person taking reams of notes on everything the nurses do might be a pseudo-patient, but your first thought is probably that they’re paranoid and keeping track of the nurses as part of their out of control fear and attempt to control the situation!

In any case, Cahalan found the study fascinating and began to dig in… which is where it all began to fall apart. This isn’t a small study that no one knew about; this shaped mental health policy for years, and despite the protestations of some mental health professionals reading this book, it’s still in people’s minds. (I knew about it as a layperson, and I only had to say “Rosenhan” for my mother, a psychiatrist, to know what I was talking about.) And yet Cahalan’s investigations call it into question. It seems very likely that Rosenhan faked much of the data, as very few of the pseudo-patients could be found. One who was had a markedly different experience in the wards to the one reported, and was allegedly removed from the study… though his data still remained in the published version.

There are all kinds of little inconsistencies that pointed Cahalan to this conclusion, and I think the length of my review shows my enthusiasm and interest for the digging work she’s done here, interviewing the study participants she could find and searching for the others. She calls into question the study’s truthfulness, but not, in the end, its validity. Rosenhan’s observations struck a chord for a reason, after all. Was it bad of him to lie and fake data like this? Of course it was. But maybe psychiatry needed that.

That said, the book also showcases how far the pendulum has swung the other way, with prisons in the US absorbing many of the people originally cared for in specialised wards. And Cahalan keeps putting her finger on the sore place, again and again: we still can’t tell the sane from the insane, not really. We still don’t know the physical causes of much mental ill-health, and diagnosis requires an experienced clinician with a checklist of behaviours — and even they can be fooled by an autoimmune disease.

It’s perhaps not as gripping as Brain on Fire, but I enjoyed it and highly recommend it, and find myself largely in agreement with Cahalan’s conclusions.

Rating: 5/5