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Trouble in mind – review link

I was asked to review this book for the British Journal of Psychiatry.  For various reasons I wrote two different reviews of which this is the first; the second will appear in the journal and anyone keen can compare the viewpoints for subtle differences.


When critics state that psychiatry lacks both a firm logical foundation and a grounding in psychology and neurobiology, Prof MacKinnon thinks that they have a point.  In addition he considers that psychiatrists have no clear concept of ‘the mind’, the organ we treat.  This is in contrast to other medical specialties; whilst a psychiatrist would struggle to explain what ‘mood’ is for, a renal physician could easily relate the dysfunction of a diseased kidney to its proper physiological function.

It is these failings that Trouble in Mind seeks to address.  The unorthodoxy of its approach is to build up, from first principles, a functional model of the mind (‘a function of brain’) and to place psychiatric problems within this working system.  With the brain’s shape and structure as a starting point, three further levels of increasingly complex cerebral activity are examined in detail.  At each level adaptive function is linked to the dysfunction seen in mental disorder

Trouble in mind threatens to be a classic of non-mainstream psychiatric thinking.  It has a novel approach that makes intuitive sense.  MacKinnon’s influences are clear.  McHugh and Slavney have been colleagues, and he cites their classic The Perspectives of Psychiatry ( several times.  As an ‘introduction’ it is cunningly aimed at trainees who may be open-minded enough to pick up and run with its ideas.  But alas it ultimately fails to deliver.

The concluding chapter ‘psychiatric mind’ is problematic.  This is dedicated to the treatment of mental illness as a problem of the adaptive mental functioning the book describes.  As the book’s crucial denouement one might expect this chapter worthy of detail but curiously it is only twenty pages long and MacKinnon’s argument is left underdeveloped and unfinished.  The reader is left without adequate guidance as to how a disciple of these insights might integrate them into everyday practice and research.

Perhaps a second edition could address this shortfall.  I hope so, as MacKinnon has a good point to make, a clear command of his subject and this book is well written and never dull.

Book website


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