(++++) EXTINCTION’S ERROR

Footprints of Schizophrenia: The Evolutionary Roots of Mental Illness. By Steven Lesk, M.D. Prometheus Books. $28.95.

     This is a medical book that is even more interesting for the way it says things than for the things that it says – although those are intriguing enough. Psychiatrist Steven Lesk is interested in exploring why a condition that is thoroughly maladaptive, schizophrenia, has not been evolutionarily eliminated but instead has persisted into contemporary times – and has proved remarkably resilient, despite modern medicines and various therapeutic approaches.

     The “classic symptoms of schizophrenia,” as Lesk lists them at one point, include “visual and auditory hallucinations, tactile hallucinations, delusions of a religious and sexual nature, catatonic staring, and bizarre behavior.” Clearly these impede the functioning of sufferers and should, from an evolutionary perspective, reduce the likelihood that they will reproduce and pass on whatever predisposition to the condition they possess. But matters are not so simple, as Lesk shows through an extended and sometimes Ouroboros-like set of examples drawn from a wide variety of disciplines.

     Clinical and interpretative matters aside, Lesk constantly reaches for clever and sometimes revelatory ways of involving readers in his arguments. For instance, he says there is “a phenomenon that I call the on-the-way-to-psychosis reaction, which means, essentially, that someone who is getting an inkling that their mind is about to be taken over by a powerful force reacts to this knowledge with an illness. It is the stuff of science fiction weaving its way into real life.” Elsewhere, discussing medications used in treating schizophrenia, he comments that “the psychiatrist has a vast array of cards to choose from[,] all vying to recoup their staggering production costs for their patent, and all of them, like the characters in a Cagney movie, imperfect. The goal is to find the one that fits the patient like a comfy suit, affably informal, reducing symptoms maximally with as few side effects as we can get away with.”

     This sort of prose, itself affably informal, can trip over itself when overused, and that does happen here from time to time. One single paragraph about stimulants, for example, includes multiple two-word assertive emphases. There is “…of course controlled substances…” There is “And, big finale.” There is “Bottom line, things.” And there is “And of course schizophrenia…” All within 13 lines. It is a bit breathless.

     Nevertheless, most of the time, the style carries readers through some heady and complex topics, sprinkling revelatory tidbits willy-nilly here and there. “It is known that congenitally blind people are immune to schizophrenia,” Lesk writes, and immediately sets about  tying this scarcely well-known oddity to a theory of schizophrenia, discussing language acquisition, sight templates, and dopamine. “The conceptual reality [language] provides replaces the behemoth sensory input from the eyes, and therefore any insidious takeover of their conceptualizing ways would be defended against with the vigor of an ogre.” Actually, this statement barely scratches the surface of an utterly fascinating phenomenon that could itself be the basis of a theory of schizophrenia – a theory developed by beginning with those who do not develop the condition and reasoning outward from there. The matter is ancillary to Lesk, however, which is fine – he has other fish to fry (one of his many metaphors has to do with catching fish and then cooking or discarding them).

     Reading Footprints of Schizophrenia requires a willingness to board a roller coaster of comparisons and analogies sprinkled with references to various technical/analytical studies and frequent references to Freud, Darwin, brain chemistry, and literature. The whole thing can get somewhat heady: “As if Alice could be in that wonderland but still be oblivious to the change in locale, the trait of self-observation that may be strained in the best of us dissolves completely into dust for many schizophrenics who tend to be uncritical of the warp in their demeanor.” This is a book whose style sweeps the reader headlong into fast-paced, often very erudite discussions, while its content requires frequent pauses for contemplation, evaluation, and further elucidation. It is a decidedly odd oil-and-water-like mixture (or non-mixture); but then, so is schizophrenia itself, and so is its treatment, in which Lesk has been engaged for decades. The mixture of anthropology, neurochemistry and psychoanalytic analysis and terminology here is scarcely simple to unravel, and is made rather more so (not less so) by the pervasive breeziness of the style. Nevertheless, and sometimes in spite of itself, Footprints of Schizophrenia is an exhilarating journey through both theory and medical practice. It is hard not to be mentally engaged and stimulated by a book that says, on one page, “Evolution had no idea what it was in for,” and on the very next one, “And of course the atomic bomb is a perfect example of what we were capable of once our language birthed contemplation.”