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by David Horrobin Transworld Publishers Limited, 2001 Review by Lloyd A. Wells, Ph.D., M.D. on Aug 4th 2001  Horrobin has written a timely, well argued and fascinating book with two arguments; indeed, this book could have (and perhaps should have) been two books -- one on the possible role of lipids in schizophrenia, and the other on the possible role that schizophrenia and other "functional psychoses" had in the evolution of our species and its demarcation and divergence from other great apes.
The basic argument of the book is that schizophrenia (and perhaps other functional psychoses) are caused by abnormalities in lipid chemistry, caused by a change in diet at the time that mankind made its final divergence from other great apes and hominids, and that the emergence of functional psychoses was related to increased creativity, if not in those affected with major psychoses, at least in their close relatives. Horrobin clearly is wedded to his lipid hypothesis. This argument is very interesting but not ultimately persuasive. There are many hypotheses about the etiology of schizophrenia: faulty neural transmission, structural defects in the brain, altered lipid metabolism, and immunologic abnormalities, to name a few. We simply don't know, at this point. The lipid hypothesis is intriguing and certainly worth pursuing - and good investigations in this area are being conducted. Although Horrobin consistently discusses schizophrenia as emerging around the time that our ancestors becoming human, he is really talking about all functional psychoses, certainly including bipolar disorder. He bases this inclusiveness on some highly controversial literature. However, when we are talking about neural events which occurred many millions of years ago, everything is speculative, and it is reasonable enough for him to be a lumper rather than a splitter. Positive features of the book include the great interest of the topic, the facility of the writing - this book is easily comprehensible to people with minimal background in biology or psychiatry - and the ingenuity of many of the author's arguments. Some of the negative features of the book are related to these strengths. More discussion of schizophrenia's possible survival value vs. schizophrenia as epiphenomenon would have been useful. A deeper exploration of the literature on the genetics of schizophrenia and other psychoses would also have been helpful. At times, the book seems to be heded toward gossip. We learn, for example, that the author knows famous people, including Nobel Prize winners, with schizophrenic children. We start wondering, "Who are they?"! Of course, the evolutionary argument is purely speculative, but it is intriguing, as is the lipid hypothesis, which is heuristic. Could a change in our ancestral dietary patterns have led to the state of being human and to having functional psychoses? We shall never know, in all likelihood. The entire book is speculative and highly enjoyable. We can draw no lasting conclusions from it, but it will make all of us think. I recommend it to biologists, psychiatrists and philosophers.
© 2001 Lloyd A. Wells
Lloyd A. Wells, Ph.D., M.D., is a child and adolescent psychiatrist at the Mayo Clinic in Minnesota. He has a particular interest in philosophical issues related to psychiatry and in the logic used in psychiatric discourse.
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