Customer Reviews

In Search of Madness: Schizophrenia and Neuroscience

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"In Search of Madness is a wonderful book that provides a real education in attempts to understand schizophrenia over the last 20 years. Parts of it are quite challenging for a general reader, but Heinrichs writes so well and provides such helpful background information that the effort is worthwhile. Unlike many books on the subject, this one does not spoonfeed the reader or offer assurances that research has almost discovered the causes of schizophrenia. It is a disarmingly frank

appraisal of evidence in many interesting fields of research, from what causes delusions and hallucinations to what is wrong in the brain chemistry of a person with the illness to how children of a parent with schizophrenia differ from other children. Then in the last chapter Heinrichs puts it all together and shows just what a challenge schizophrenia is to neuroscience. I have never run across such a comprehensive analysis and I think it is a must-read for those of us fascinated with this illness. Another thing I really enjoyed were the three case histories that appear at the beginning and then are woven into the chapters in various ways as illustrations of research issues and findings. This adds a clinical and more personal aspect that enriches the material and aids understanding. The author clearly has great empathy for his subject as well as the intellectual breadth and writing skills needed to produce a great scientific "story." In Search of Madness is a special book and the best thing I have read on the subject since Irving Gottesman's Schizophrenia Genesis came out in 1991."

If you are like me, you have spent tons of time reading the literature on schizophrenia from the earliest treatises on Dementia Praecox by Kraepelin in 1896 and Bleuler on schizophrenia in 1911, through, for examples, Arieti (1955), Bateson (1956), Meehl (1962), Kety, Rosenthal & Wender (1968), Kendler (1982), Erlenmeyer-Kimling (1987), Andreason (1996), Weinberger, (1997), Gur (1998), Nemeroff (2004). By now, you might want to play d-fence, that is, corral the theoretical and empirical keepers from the vast and bewildering herd of disparate research findings and conjectures.

R. Walter Heinrichs, a neuropsychologist and Professor of Psychology at York University, Toronto, in his aptly titled IN SEARCH OF MADNESS, has accomplished this magnificent feat; first, by emphasizing that the usual statistical tests of "significance" are silent with regard to the evidential strength of a research finding. Secondly, he reviews the schizophrenia literature, zeroing in on a study's real level of significance through the use of Jacob Cohen's d scores (cf. STATISTICAL POWER ANALYSIS FOR THE BEHAVIORAL SCIENCES, Lawrence Erlbaum, 1988), a technique that measures the amount of sample overlap. d scores around 3.66 indicate virtually no sample overlap, while scores around .80 indicate an overlap of about 50% between a study's control group (e.g. normal subjects) and target population (e.g. schizophrenics). Thirdly, he applies statistical confidence intervals to groups of studies done in the period from 1980 to 1999 that he or other researchers have put through meta-analysis. Through this meticulous review process, Heinrichs sends packing some favored "facts" about the schizophrenias. Result: there is, so far, no reliable evidence that schizophrenia can be attributed to maternal exposure to Rubella (d=.02), excess winter births (.05), frontal lobe impairment (PET volume d scores around .55), genetic markers (too conceptually blurry for analysis) and excessive dopamine (e.g. .11). It is not that schizophrenics show no signs in these areas. However, so do enough normal folks that you can't separate them from schizophrenics. On the other hand, there are some signs of this illness that do differentiate schizophrenics from normals to a substantial degree: P50 evoked potential gating (d=1.55), impaired verbal memory (1.41) and vulnerability to backward visual masking (1.27).

If one were limited to an initial read from the thousands on schizophrenia, this would be my pick. Over 850 studies are cited and there are detailed historical, theoretical and empirical explications that cover almost all the bases, including the diagnostic picture, biology, neuroanatomy, neurochemistry, psychogenesis and neurogenesis. A companionate survey is A.R. Cellura's THE GENOMIC ENVIRONMENT AND NICHE-EXPERIENCE (Cedar Springs Press, 2006).