Book Forum

The Creating Brain: The Neuroscience of Genius, b y The next chapter guides the reader through a careful dis-
Nancy C. Andreasen, M.D., Ph.D. Washington, D.C., Dana section of the neurobiology of the creative process by explain-
Press, 2005, 197 pp., $23.95. ing the organization of the brain from the cellular and neu-
roanatomic level to the interaction of various brain regions
The Creating Brain is Nancy Coover Andreasen’s latest con- observed in functional brain imaging. These lessons are then
tribution to her ambitious goal of educating readers about the applied to explicate the mechanisms by which memory is
complex neurobiological basis of human behaviors. In her formed, the mapping of language, and the neural basis of un-
third book in this series, she addresses a question that has conscious thought.
puzzled researchers to the present day: by what process does After providing this foundation in brain science, Dr. An-
the human brain bring forth astonishing achievements in the dreasen uses it to probe the more complex topic of genius and
arts and sciences that have never before been conceptualized? insanity. Here we learn of her work with the Iowa Writer’s
Readers familiar with Dr. Andreasen’s previous works, The Workshop as well as seminal studies by Adele Juda in the
Broken Brain (1) and Brave New Brain (2), will recognize her 1920s. The overlap between creative genius and conditions
personal, conversational narrative and the breadth of her such as schizophrenia and depression is discussed in detail,
knowledge. As if she were speaking with you at dinner, she ex- with special insights into the lives of key figures such as John
plores the earliest record of human creativity inside the Caves Nash. Dr. Andreasen speaks of her own surprise at the high
of Lascaux in Dordogne, France, and then the works of Leo- rate of mood disorders among the Iowa writers, which refuted
nardo da Vinci, Michelangelo Buonarotti, William Shake- her original hypothesis that creativity would be more heavily
speare, Amadeus Mozart, Samuel Coleridge, and many oth- associated with psychotic disorders. She frames these find-
ers, including a discussion she had aboard an airplane about ings in the nature versus nurture concept coined by Francis
the nature of the creative process with playwright Neil Simon. Galton in the 19th century and illustrates the influence of
The book begins with the history of research in child devel- nurture with a detailed accounting of the environmental fac-
tors during the most creative periods in history that allowed
opment and the earliest studies in creative intelligence con-
individuals to express their natural gifts.
ducted by Alfred Binet and Lewis Terman, beginning nearly a
century ago. Dr. Andreasen’s description of the longitudinal The text concludes with suggestions on how to understand
study of “Terman geniuses” or “termites” (highly intelligent our own creating brains and strategies to enhance our creativ-
children followed from childhood to their adult years at Stan- ity and that of our children. Grandmotherly advice from Dr.
Andreasen, down to the choice of bedtime reading to the chil-
ford University) recalls nearly forgotten but important early
dren, is a warm and unique end to a book on the neurobiology
findings that developed a key distinction between intelli-
of creativity.
gence and creativity. The text cleverly uses the autobiograph-
ical accounts of a series of renowned artists, scientists, and In her preface to The Creating Brain, Dr. Andreasen briefly
writers to illustrate their special insights into their own cre- discusses her childhood and the ways in which her socially
conservative environment, particularly with regard to women,
ative process. The author highlights the astonishing similari-
interacted with her precocity, intelligence, and ambition. Her
ties between the almost unconscious, turbulent state that
parents had expressed reluctance about her plans to enter
many of these figures described as their subjective cognitive
medical school. Shortly before his death her father told her,
experience at the time of their greatest productivity. From
“And you did turn out OK after all.” Indeed she did! And the
Mozart, for example:
fields of psychiatry and neuroscience are much enriched for
that, as are the lives of those of us fortunate enough to have
All this fires my soul, and, provided I am not disturbed,
worked with her for the past 13 years and enjoyed the pleasure
my subject enlarges itself, becomes methodized and de-
of dinner and wine and conversation with her.
fined, and in the whole, though it be long, stands almost
complete and finished in my mind, so that I can survey it, References
like a fine picture or a beautiful statue, at a glance.… 1. Andreasen NC: The Broken Brain: The Biological Revolution in
What a delight this is I cannot tell! (p. 40) Psychiatry. New York, Harper & Row, 1984

164 http://ajp.psychiatryonline.org Am J Psychiatry 163:1, January 2006

2. Andreasen NC: Brave New Brain: Conquering Mental Illness in and the Single Synapse.” My colleagues and I were a bit incred-
the Era of the Genome. New York, Oxford University Press, ulous that snails could teach us anything about the complexi-
2001 ties of human beings. As Joseph LeDoux, the Henry and Lucy
SANDRA PATTERSON Moses Professor of Science at New York University, comments
Arlington, Va. at a later point in the book, Kandel’s work is taken for granted
by neuroscientists today, but it was a “long shot in 1983.”
Note: Sandra Patterson is the Editorial Director for the Journal. For me, the heart of the book is “Biology and the Future of
Psychoanalysis: A New Intellectual Framework for Psychiatry
Psychiatry, Psychoanalysis, and the New Biology of Revisited,” originally published in 1999 in the Journal (1). Kan-
Mind, by Eric R. Kandel, M.D., with commentaries by Arnold del specifies eight areas in which biology and psychoanalysis
M. Cooper, M.D., Steven E. Hyman, M.D., Thomas R. Insel, could cooperate: 1) the nature of unconscious mental pro-
M.D., Donald F. Klein, M.D., Joseph LeDoux, Ph.D., Eric Nestler, cesses, 2) the nature of psychological causality, 3) psychologi-
M.D., John M. Oldham, M.D., Judith L. Rapoport, M.D., and cal causality and psychopathology, 4) early experience and the
Charles F. Zorumski, M.D. Washington, D.C., American Psychi- predisposition to mental illness, 5) the preconscious, the un-
atric Publishing, 2005, 414 pp., $57.95. conscious, and the prefrontal cortex, 6) sexual orientation, 7)
psychotherapy and structural changes in the brain, and 8) psy-
Eric Kandel, University Professor at Columbia University
chopharmacology as an adjunct to psychoanalysis. Arnold
College of Physicians and Surgeons, was awarded the 2000
Cooper, a training and supervisory analyst at the Columbia
Nobel Prize in Medicine or Physiology for his groundbreaking
University Center for Psychoanalytic Training and Research,
work on the molecular mechanisms underlying learning and
exhorts his colleagues to accept Kandel’s challenge to study the
memory. His discoveries, based on his initial studies of the sea
“biology of subjectivity, consciousness, selfhood, and conflict.”
snail Aplysia and later studies in mice, demonstrated that
learning depends on changes in the strengths of synapses and The strength of this book is based on its clear descriptions of
that long-term, as opposed to short-term, memory requires the neurobiological correlates and underpinnings of psychiat-
the activation of a gene cascade that leads to the growth of ric clinical science and on its specific suggestions for areas of
new synaptic connections. future research, especially related to what Kandel acknowl-
This book consists of seven of his previously published pa- edges as psychoanalytic insights. A limitation is that in some
pers spanning the period between 1979 and 2000, as well as ways he is challenging an outdated version of psychoanalysis
the commencement address he gave in 2001 to Columbia’s prevalent in the United States until at least the 1970s, when,
graduating medical students. The papers focus on his neuro- indeed, many analysts behaved and taught as if the brain were
biological research, recommendations for new intellectual not a relevant organ. Kandel himself quotes Anton Kris, who
frameworks for psychiatry and psychoanalysis, and guide- says that “one listens differently now.” Contemporary medical
lines for future investigations in clinical psychiatry and psy- educators would not recognize Kandel’s characterization of
choanalysis. Each paper is accompanied by commentary medical student education as a model that focuses exclusively
from leading psychiatrists and psychologists, some of whom on teaching psychotherapy. Analysts would not universally ac-
are neuroscience researchers and some psychoanalysts. cept Kandel’s assumption that the highest aspiration of psy-
The author’s collected papers are preceded by a personal choanalysis is to become “the most cognitive of neural sci-
memoir of his undergraduate years at Harvard, when, fasci- ences.” Cognition, as most analysts use the term, simply does
nated by the insights of psychoanalysis, he decided to enter not capture all of the concerns of psychoanalysis, including
medical school in order to become a psychoanalyst. In medi- emotion, empathy, suffering, the development of selfhood,
cal school and later in his formal psychiatry training at the and the repetition of harmful or self-endangering behavior.
Massachusetts Mental Health Center in Boston in the late John Oldham describes Kandel’s last essay as “eloquent, in-
1950s and 1960s, he became profoundly disappointed with tegrative, and visionary” but acknowledges that we are far
the anti-intellectualism and biology-psychoanalysis dichot- from translating individual genetic and other information
omy he encountered in American psychiatry. This disap- into real therapeutic outcomes. I wish that more of the com-
pointment contributed to his eventual decision to pursue mentaries had similarly focused on the complexities and
neurobiological research instead of further clinical training. challenges of translating Kandel’s work into empirical clinical
He offers these essays with the “hope that molecular biology research, let alone clinical outcomes.
will provide a fresh perspective on the study of behavior and This hopeful and inspiring book will be especially useful for
that the ensuing insights will lead to a new science of the mind, two groups—for teachers of medical students, psychiatric
one that is grounded in the rigorous empirical framework of residents, and psychoanalytic candidates and for those
molecular biology yet incorporates the humanistic concepts of trained in psychoanalysis who accept the challenge of psy-
psychoanalysis.” His afterword, written in 2004, underlines his choanalytic research. It is clear, succinct, illustrated by useful
hope that psychiatry and psychoanalysis will “again capture neurobiological models, and well referenced. It details many
the best and brightest of the next generations” by joining with advances in our understanding of the way the brain works,
neuroscience to develop a true biology of the mind. specifically regarding learning and the formation of memo-
Today, it is easy to forget how revolutionary Kandel’s work ries. Especially engaging are Kandel’s vivid descriptions of his
was in the late 1970s, when he reported his findings that expe- psychiatric training, his infectious enthusiasm for teaching,
rience could alter the brain. I vividly remember, during my and his exhortations to study empirically the insights of psy-
second year of formal psychiatry training, hearing him present choanalysis, which, he says “still represents the most coher-
an early version of the first paper in the book, “Psychotherapy ent and intellectually satisfying view of the mind.”

Am J Psychiatry 163:1, January 2006 http://ajp.psychiatryonline.org 165