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Christopher Dowrick, Psychiatry and the human condition. Bruce Charlton. (264 pages, £19.95.) Radcliffe Medical Press Ltd, 2000. ISBN 1-85775-314-3., Family Practice, Volume 18, Issue 1, January 2001, Page 114, https://doi.org/10.1093/fampra/18.1.114
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Extract
In this brief and idiosyncratic text, Charlton attempts the ambitious task of redefining psychopathology. He begins with a sweeping review of evolution and human history, in precisely eleven pages, which hinges on the assertion that the Golden Age for humans was the life of the hunter-gatherer. He then introduces us to the concepts of human social intelligence and the somatic marker mechanism of which the latter, he assures us, is the basis of ‘theory-of-mind’.
The body of the text involves a radical reappraisal of major psychiatric syndromes and treatments. Delusional disorders reflect the nature of social selection pressures in an ancestral environment, while ‘psychotic’ phenomena are a consequence of delirium, defined here as a state of reversibly impaired brain function. ECT is not specifically antidepressant, but simulates deep sleep to resolve delirium. Major depressive disorder is an evolved behavioural pattern, a maladaptive manifestation of sickness behaviour. It is best considered as malaise, and is caused by cytokine abnormalities, probably with an autoimmune basis. “Depressed people are physically sick but do not know it” (p. 80). On this basis the major effect of antidepressant medication is as an analgesic, ‘mood aspirin’, and conventional analgesics could therefore also be used to relieve depressive symptoms. Mania, in contrast, is a consequence of excessive arousal and analgesia, and may in time be managed effectively by simple hypnotics. Schizophrenia is an outdated concept and should be discarded, though Charlton is not clear about how to replace it. Finally, having given up hope of any political solution to the problems of human existence, he is convinced that psychopharmacology is the only sustainable basis for ensuring the good life.
