Metabolic Brain Diseases and Their Treatment
- Author:
Tayleur Stockings, M.B., B.S., D.P.M. Bailliere,
Tindall & Cox. 16s.
Dr Tayleur Stockings’ book is indeed a challenge to orthodox psychiatry. It remains to be seen if this challenge will be taken seriously. While many psychiatrists have been contemplating the possible interpretations of mental disease in terms of neurometabolic disorder, few would probably venture to express such dogmatic opinions on existing evidence.
In common with other workers in this intriguing field, the author’s interest has apparently been stimulated by the results of experimental mescaline intoxication, where phenomena more generally associated with ” functional ” psychoses, can be attributed to a toxic factor.
Dr Stockings has elaborated an hypothesis based on the response either to convulsion or to insulin coma therapy, and abandoning existing classifications he re-groups the psychoses (” Neurometabolic Encephalopathies “) into ” dysoxic ” and ” dysglycic ” types. Roughly speaking various forms of depression, certain forms of mania, and the simple and catatonic varieties of schizophrenia, appear under the heading of ” dysoxia ” whereas simple mania and hypomania, hebephrenic schizophrenia, and the paranoid psychoses are regarded as forms of ” dyxglycia “.
It is, from this point onwards, that the author’s fundamental conceptions may well arouse a storm of criticism from clinicians and logicians alike. It would be impossible, and perhaps unjustifiable, to attempt to review all the possible sources of contention, which range from the classification itself, to the occasions when the case reports might be interpreted differently with regard to therapeutic indications. The overall objection lies in the dogmatic attitude arising from a clinical study, which however thorough, has its obvious limitations. The empiricism of present day physical methods of treatment in psychiatry should not permit reference to a ” specific response” to electrically induced convulsions or hypoglycaemic comas, even if the theories expressed in this book should prove to be fundamentally correct. It must be stressed that the first chapter of neuro-biochemistry is, as it were, now being written, and any attempt to incorporate the small body of established facts into a system of psychiatric nomenclature, is at the best a shrewd guess.
If the reader is prepared to overlook these shortcomings, he will find many interesting facets of the neurometabolic problem. The author rightly points out that conditions of war expose psychoses at an earlier stage, and draws an enlightening picture of the acute organiclike features which may herald in a psychosis before it crystallizes into its more classical form. This perhaps is the most convincing evidence of a neurometabolic hypothesis, and is backed up by the development at a later stage of phenomena which suggest chronic and progressive organic changes (“secondary deterioration “)?
The highly controversial nature of the subject matter of this book hardly renders it suitable for general consumption, but experienced psychiatrists should read it. Even its most questionable dictates may arouse something more profitable than righteous indignation ! A.J.G.
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