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that lead physicians to seek treatment or avoid it though theneed be abundantly clear.

JEAN E. MILOFSKY, M.D.Denver, Colo.

Book review accepted for publication March 2008 (doi:10.1176/appi.ajp.2008.08030345).

The Accidental Mind: How Brain Evolution Has GivenUs Love, Memory, Dreams, and God, by David J. Linden.Cambridge, Mass, Harvard University Press, 2007, 288 pp.,$25.95.

Despite its breeziness, this book will be of interest to somepsychiatrists. The author, a neuroscientist and the son of apsychoanalyst (and thus perhaps is himself something of anemblem of our times), is a professor of neuroscience at JohnsHopkins University. His survey of recent advances in brain bi-ology may be interesting and useful to psychiatrists trying tokeep up with brain research and interested in its relevance tothe interaction of nature and nurture and to biopsychosocialunderstanding. Psychiatrists may also be stimulated by theauthor’s educated undermining of the fairly common andwidespread misunderstanding that brain functioning is clearand elegantly designed.

The book addresses seminal topics such as evolution, sen-sation, emotion, learning, memory, individuality, love, sex,sleeping, dreaming, and religious impulses; this is a stimulat-ing but also fairly overwhelming list, to all of which he bringsan impressive array of neurobiological curiosity and research.He stresses interconnections and the drawbacks built into ad-vances and advantages. To psychiatric readers, who are per-haps used to seeing the brain largely as a world of synapticclefts for psychopharmacological neurotransmitters, hebroadens and reopens our minds to a wider complexity of ba-sic structure and function. He discusses genes, cell structure,membranes, pumps, messengers, facilitation and inhibition,spikes, synapses, and recycling. He occasionally reminds thereader of basic guiding principles such as 1) higher functionstend to occur at the top and forward parts of the brain, 2) thebrain is built like an ice cream cone, with added scoops, and3) localization of function is straightforward for basic subcon-scious reflexes and fairly straightforward for the initial stepsof sensation, but far more difficult for more complex phe-nomena such as memory or decision making. He gives evi-dence for interconnectedness, such as between perceptionand emotion or sensation and motor function. He discusseshow various high brain functions are built on memory andemotion. He gives evidence for the complexity of memoryand its tasks.

After chapters on brain assembly; sensation and emotion;learning, memory, and individuality; sleep, dreams, and theirpossible functions; and sex, love, and some of their varieties,he turns to the religious impulse. Though some of his pointshere, as elsewhere, seem to me at the edge of reductionism, hedoes propose and discuss a potentially important neurobio-logical contribution to the lively and odd topic of the roots ofreligion—that the human brain, which has become particu-larly adapted to creating gap-free stories, predisposes us toreligious thought.

Overall, this book tackles important and challenging cur-rent neurobiological approaches to understanding the brainand the mind, which will make it a useful book for somepsychiatrists to read. However, the breeziness of the book,perhaps designed to make it more accessible to readers,ultimately undermines its reliability. This thoughtful neuro-scientist’s book about brain evolution, structure, and func-tion, which places refreshing emphasis on some relativelymessy and ad hoc qualities of brain evolution and on the inef-ficiencies of brain design and function, seems to me signifi-cantly flawed by its frequently brash and breezy style.

For example, the last words of the introduction are “let’sroll.” The author is fond of words such as “downer” and “cool.”On the acknowledgements page, after one name there are pa-rentheses containing the word “Mom!”, and after anothername later on, parentheses containing the word “Dad!”. Thebook’s breathless subtitle—perhaps added by the publisher,but in tune with the author—is “How Brain Evolution HasGiven Us Love, Memory, Dreams, and God.” On the otherhand, in all fairness, some of the author’s catchy formulationsseem to me clear and apt, such as a couple of the chapter ti-tles: “Building a Brain With Yesterday’s Parts” and “The Unin-telligent Design of the Brain.”

Clear, precise, and modest language in scientific writing isoften taken for granted, but as this book’s awkwardness re-minds us, this is not a casual or superficial custom. Sliding intohyperbole or cuteness will probably dissuade many scientistsand educated readers from looking at this book, though thosequalities may conceivably gain some teenage and televisionattention. I was distracted by the thought that the book itselfseemed to me somewhat like a hardworking and educatedyoungster in bright would-be-cool clothes that do not quite fit.

LAWRENCE HARTMANN, M.D.Cambridge, Mass.

Book review accepted for publication March 2008 (doi:10.1176/appi.ajp.2008.08030408).

Pain and Its Transformations: The Interface of Biol-ogy and Culture, edited by Sarah Coakley and Kay Kauf-man Shelemay. Cambridge, Mass, Harvard University Press,2008, 456 pp., $49.95.

This volume is comprised of papers and editorial responsesfrom two dozen distinguished scholars, half from HarvardUniversity, focusing on pain (both physical and emotional)and its social transformation. The material for the bookcomes from a seminar series and conference chaired byArthur Kleinman and Sarah Coakley and sponsored by theMind/Brain/Behavior Initiative at Harvard. Dr. Kleinman is aformer chair of the Department of Anthropology at Harvardwho trained in psychiatry at Massachusetts General Hospital.Ms. Coakley is a professor in Harvard Divinity School. Thevolume reflects their broad yet interconnected interests.

There are a number of stellar contributions. Pain is consid-ered from a molecular and cellular level, as well as at the levelof the sadness and agony experienced by specific ethnicgroups who developed rituals to help the afflicted distancethemselves from their suffering. Music, trance, and self-muti-lation are addressed. For example, the pain (or absencethereof) of the Shi’i Muslim practice of matam, a form of self-

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flagellation using lacerating razors during the annual pilgrim-age to Karbala (reflecting on Husain ibn Ali’s martyrdom in680 CE), is addressed in some detail. Briefly discussed is theself-injurious behavior (or “cutting”) of patients with border-line personality disorder.

This volume covers the nature of acute pain (emotionaland/or physical). Herbert Benson discusses the relaxation re-sponse as it helps with pain control. The chronic pain of long-term meditators and those devoting their lives to prayer (e.g.,members of religious orders practicing ultra-intense prayingto experience the pain of Jesus) is also addressed.

Notable contributions come from Clifford Woolf’s chapter“Deconstructing Pain: A Deterministic Dissection of the Mo-lecular Basis of Pain.” Also notable is Howard Fields’ chapteron the associations of pain pathways and networks, in whichhe writes, “the brain is the site where culture and biology in-teract.” He takes on phantom limb pain, referred pain, battle-field pain, the placebo response, the gate control hypothesisin current perspective, and modulatory systems of top-downinfluence on pain. Fields concludes, “the study of stimulus-bound components is…the province of neurobiology. Thestudy of the context-determined components is an inherentlymultidisciplinary endeavor and is in its infancy.”

Judith Becker’s chapter on “Music, Trancing, and the Ab-sence of Pain” is wonderfully concise and clear. Trance con-sciousness and repetitive ritual, as in musical forms, shouldopen up ways to study the neurophysiology of consciousnesswithout the “I-ness.” Kay Kaufman Shelemay’s summary onmusic and pain is superb, as is Howard Fields’ discussion ofritual and expectation: “One big problem is that about 99% ofpain research has focused on the spinal cord, but 99% of thepain experience is in the brain, where culture, society, and ex-pectation come into play.”

Other notable contributions are the chapters from ElaineScarry, a professor of aesthetics, which looks at injuries to he-roic figures in art (e.g., works by Rubens, Pacceo de Rosa, andMantegna, plus Francis Bacon, Munch, and Kollwitz). Lau-rence Kirmayer has an important chapter and spirited discus-sion on cultural mediation of pain.

Tu Weiming reminds us that pain can be explained in evo-lutionary terms, but he posits that suffering requires a moreexplanatory model, as described in the conceptual basis ofChinese medicine. Jennifer Cole contributes a chapter on theexperience of emotional pain and suffering from a social per-spective. Her fieldwork focuses on the terrors of a remote warinvolving the Betsimisaraka tribe of Madagascar, reactivatedby new social strife and partially healed by the social ritual ofsacrificing bulls.

All of the chapters are fascinating, but there are some partsthat seem only tangentially relevant to the discussion of whatone usually considers the domain of pain: somatic discomfortassociated with physical injury. Thus the passages about thespiritual pain of Christian mystical figures such as CarmelitesSaint Teresa of Ávila and Saint John of the Cross are overlylong. Similarly, the chapter about the voices of the FinnishKarelian itkuvirsi, or ritual lament that relates to the sufferingof a whole transplanted tribe, seems to stray too far. How acommunity unburdens its sorrow is important, but whether itis relevant to pain is not clear.

The editing of the discussion transcripts for each chapterhas been done wonderfully well, but one of the editors, Coak-

ley, did not do herself that favor for her own chapter, whichhas many tediously long sentences (two back-to-back sen-tences last for 11 lines and 124 words).

This is a powerful book with many insights for those inter-ested in pain. You will probably need a dictionary to look upsome of the many abstruse terms more familiar to culturalanthropologists and philosophers than psychiatrists. And youwill probably want a pen to underline some of the partici-pants’ fascinating observations.

FREDERICK G. GUGGENHEIM, M.D.Providence, R.I.

Book review accepted for publication March 2008 (doi:10.1176/appi.ajp.2008.08030407).

Metabolic Syndrome and Psychiatric Illness: Interac-tions, Pathophysiology, Assessment, and Treatment,by Scott D. Mendelson, M.D., Ph.D. Burlington, Mass, Aca-demic Press, 2008, 224 pp., $99.95.

We live in complicated times in which physicians easily canfeel that they do not have enough time to read all the newlypublished information relevant to their practice. Books takelonger to print, become easily outdated, and are not subjectto the peer review process used for journal articles. Therefore,I usually encourage residents to use article reviews ratherthan books and to not even buy books, except for select text-books or “classic” books at least 50 years old.

I definitively dislike the majority of new psychiatricbooks—the “editor” books in which several authors, withoutcoordination, review a subject. Many of them appear to helponly the authors in their academic career. My pessimisticview is that almost all of these are not worthwhile. This bookis different in that a single author has written about an inter-esting subject, metabolic syndrome. The author is a psychia-trist with a Ph.D. in biopsychology and research experience inneuroendocrinology, focusing on the serotonin system.

First, and most importantly, I want to acknowledge the ex-traordinary merit of this book. It has 11 chapters and 970 ref-erences. Even assuming that there is some reference overlapbetween chapters, it is remarkable that the author was able tomanage 900 references and summarize them in a coherentway, and some of them are relatively recent (2006).

I found two chapters particularly interesting. The historicaldiscussion (Chapter 1) about Gerald Reaven’s work in defin-ing Syndrome X was interesting and easy to read. Chapter 10on nutritional supplements provides information on a sub-ject unfamiliar to me.

The other seven chapters appear thorough and well re-searched: “Factors That Contribute to Metabolic Syndrome”(Chapter 2), “The Pathophysiology of Metabolic Syndrome”(Chapter 3), “Metabolic Syndrome and Psychiatric Illness”(Chapter 4), “Depression, Metabolic Syndrome, and HeartDisease” (Chapter 6), “Metabolic Syndrome, Insulin, andAlzheimer’s Disease” (Chapter 7), “Metabolic Syndrome,Sleep, and Sex” (Chapter 8), and “Diets for Weight Loss andMetabolic Syndrome” (Chapter 9).

The book has the subtitle “Interactions, Pathophysiology,Assessment, and Treatment.” I found the most disappointingpart to be the section on assessments (described in Chapter11), because it did not contain practical information on how