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Book review

Karl Deisseroth: Projections. A story of human ­emotions

DOI: https://doi.org/10.4414/sanp.2021.w10049
Publication Date: 15.12.2021
Swiss Arch Neurol Psychiatr Psychother. 2021;172:w10049

Andreas Steck

Please find the affiliations for this article in the PDF.
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Gütersloh: Random House; 2021.

256 Seiten.

Price: 35,90 CHF.

ISBN: 978-1-984853-69-1.

The author is a professor of Bioengineering, Psychiatry and Behavioral Sciences at Stanford University in California. Karl Deisseroth is well known as a neuroscientist for applying optical and genetic strategies, in short optogenetics, to study neural circuit functions in neurological and psychiatric disorders. But he is also a clinical psychiatrist caring for patients. It is through the lens of this dual perspective, as a clinician and scientist, that the author describes a fascinating journey in the inner world of the mind, mixing neuroscience and deeply moving patient histories. The bewildering intensity of emergency psychiatry provides the context for the patients’ stories. We should not expect a text book approach; on the contrary, the author uses first-person accounts, covering a wide range of different mental disorders. Along with patients suffering from eating disorders, he discusses cases of depression, mania, autism, borderline personality disorder, dementia and schizophrenia. Deisseroth is at his best when he connects psychiatric disorders with knowledge from modern neuroscience. However, he makes clear that he values literature as much as science in thinking about the mind. For him ideas from literature are important for understanding patients and he illustrates the descriptions of clinical cases with quotes from writers as diverse as Ovid or Tony Morrison. Deisseroth has an uncanny ability to connect neuroscientific knowledge with human stories, avoiding any dogmatism. Describing depression in a patient, he dwells on the anatomy of the deep brain structures associated with negative valence and considers the evolutionary aspects of cranial nerves responsible for the expression of emotions. In a chapter called Broken Skin, Deisseroth reminds us that skin and brain both arise from ectoderm, our initial boundary, crafting a fundamental borderline between self and non-self. One cannot avoid thinking about Didier Anzieu’s work about the skin-ego, the envelope on which the feeling of well-being is based. We carry a narrative in our minds explaining ourselves and others, thus helping to maintain our sense of identity. The story of a patient – suffering from a borderline personality disorder – serves as a skilful demonstration of how early-life stress may lead to emotional dysregulation, impairing the building of a sound self. A case of multi-infarct dementia serves to illustrate how much memory depends on feelings: “There may be little justification to store and recall memory of an experience, unless the experience matters enough to elicit a feeling”. This statement serves to explain why cognitive decline goes together with increased anhedonia. In a final chapter, the author muses on where ongoing neuroscientific developments will lead us, but this is of course a story that has not yet been written. This is a fascinating book for anyone interested in neuroscience and disorders of the brain.

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