Projections

Starred review from April 5, 2021
Deisseroth, professor of psychiatry at Stanford University, melds the personal with the clinical in his masterful debut on how the human mind works and what can be learned when it goes awry. Using case studies that capture “the central mystery of feelings in the mind,” Deisseroth tells moving stories of patients suffering from such maladies as eating disorders (the most mysterious, he writes), psychosis (which can’t be reasoned away), and dementia (which means more than just amnesia). Deisseroth relates these stories to his experience as a psychiatrist: the central challenge of psychiatry, he writes, is “to perceive, and experience, unconventional realities from the patient’s perspective.” He also discusses the emerging field of optogenetics, which allows scientists to examine the workings of individual neurons. As a pioneer in this field, his reflections are particularly noteworthy; he accessibly breaks down the science behind the technology and makes a case for its importance, as it “allow us to link the local activity of individual cells to the global perspective of the brain.” Deisseroth also argues for the importance of science, touting the value of research and the significance of “scientific truth—a force that can rescue us from weaknesses of our own construction.” Writing with abundant empathy, Deisseroth brings his patients’ struggles to life as he educates about both neuroscience and humanity. This is a must-read.

May 1, 2021
A Stanford professor of bioengineering and psychiatry uses both of his specialties to reveal his ideas on the mind, mental illness, and human feelings. Deisseroth begins with one of the primary conundrums of his profession: In someone who suffers from psychiatric illness, the target organ isn't damaged in a visible way. One can visualize a broken leg, a weakly pumping heart, and a fibrotic liver, but there's nothing to see in a psychologically sick brain and little to investigate except with words. High-tech brain scanners don't reveal nerve function, only blood flow or tissue density, but a 21st-century breakthrough created a new technique: optogenetics, in which the author was a pioneer. Scientists have long known that certain bacterial genes produce proteins that turn light into electrical current. Recently, researchers learned how to transfer these genes from microorganisms into the cells of larger animals. If they shine a light onto an altered brain cell, it fires. Complex and branched, a single nerve cell may extend across the brain, deep into regions that govern behavior and powerful emotions. This new ability to track neural pathways has produced an avalanche of discoveries on brain function. What it hasn't produced is a definitive explanation for any mental illness, but this doesn't prevent Deisseroth from combining this information with his longtime experience in practice to muse on how brain dysfunction might produce the suffering he sees. Most of the book consists of vivid case studies in which his patients' depression, mania, dementia, or schizophrenia trigger a discussion of the background, possible mechanism, and even evolutionary role of mental illness. A schizophrenic cannot differentiate between the inner and exterior world. Most of us pay little attention to idle thoughts and musings; a schizophrenic often "hears voices." People with autism dread uncertainty, and nothing is less predictable than social interaction. Theoretical but good food for thought for anyone interested in the endless complexity of the brain.

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May 1, 2021
Stories--sprinkled with clinical and scientific observations, personal and philosophical musings--about challenging and peculiar patients are the core of this book. Psychiatrist and Stanford University professor Deisseroth diagnoses many types of mental illness, including psychosis, eating disorders, depression, dementia, borderline personality disorder, and mania. A 26-year-old man in the ER mutters, ""I don't know why I can't cry."" His pregnant wife died in a car accident eight weeks ago. He was at the wheel. A professional woman suddenly has paranoid beliefs of ""information vampires"" tapping her thoughts. This sounds like schizophrenia, but might it be something more malignant? A young man deliberately cuts his arms and has delusions of eating people. An octogenarian has become loath to speak. Feeling adrift and experiencing personal loss are common denominators in these tales of suffering in which hope can hardly keep pace. Deisseroth overly emphasizes optogenetics, neuroscience research utilizing light to influence genetically changed neurons, but his pondering of any possible evolutionary role for mental illness is compelling, as is his elucidation of the emotional burden for healers who take on devastating psychiatric situations.

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Starred review from June 1, 2021

Deisseroth (bioengineering and psychiatry, Stanford Univ.) is a pioneer in the field of optogenetics, the combination of genetic and optical methods to cause or inhibit well-defined events in specific cells of living tissues and behavior in animals. As a clinical psychiatrist, he is especially interested in using light to help decipher, and perhaps one day treat, the human brain. Here, he tells the stories of seven of his patients, including a young architect emotionally paralyzed by the death of his wife and unborn child in a car crash; a newly retired insurance executive who witnessed the 9/11 attacks; and an 84-year-old veteran with dementia who has suddenly stopped speaking. Deisseroth tells these stories from the patients' perspective, as well as from his own, with endless patience, curiosity, creativity, and humanity. He believes that the evolving field of optogenetics has helped him understand his patients more deeply, and hopes that it will help treat people living with a variety of illnesses. VERDICT An engaging, accessible blend of psychology and science, which sets itself apart with Deisseroth's lyrical writing and the empathy of his storytelling.--Marcia G. Welsh, formerly with Dartmouth Coll. Lib., Hanover, NH

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