The inflamed mind: book review

The Inflamed Mind¬†is about depression and inflammation, written by Ed Bullmore, a research psychiatrist interested in immuno-psychiatry. I found it accessible and intriguing, raising many questions about how and why people with chronic illness experience mental health issues. There’s a careful analysis of how the split between body and mind, or physical and mental health, is particularly unhelpful for understanding the effects of the immune system, which are described clearly. Paying attention to the impact of the inflammatory action of the immune system could open the door to new approaches, for mental health problems which are resistant to other forms of treatment.

And that’s where it was less clear: for me, the treatment of inflammation has been brutal and I wondered at what point psychiatrists would decide immuno-suppressive treatment would be necessary for someone with depression. There was no mention of prednisolone. This is commonly used to reduce inflammation, yet many people experience long term mental health side effects. Towards the end of the book, Bullmore is careful to reject the idea of a panacea, suggesting this fuels divisions and masks complexity. He aligns his argument with individualised or personalised medicine. He points out that guidelines are great for emergencies, first aid and common ailments, but are not sufficiently sophisticated for targeting issues arising from complex, chronic health conditions. Thus immunotherapy might be for some people with depression, in some circumstances. I wished he’d been more targeted himself, perhaps on people with autoimmune conditions like me.

The focus on Cartesian dualism (body/mind split) interested me as an occupational therapist, for dividing health services according to body systems causes problems for my profession with our functional focus. Bullmore points out how mental health service users struggle to get good treatment for all their health problems, because a psychiatric diagnosis overshadows everything else. In that sense, his book is radical: routine blood tests for inflammatory markers might broaden the focus of routine practice in psychiatry. But only if there’s acceptable treatment to offer when markers are raised, surely?

Bullmore’s critique of the pharmaceutical industry is fascinating, useful for understanding how Prozac came to be so successful and why nothing has matched it since. It’s frustrating that there’s just two approaches to depression considered (Freud/psychotherapy and drugs), and only a very brief passing acknowledgement of injustice and inequality. But a more detailed analysis of the causes of depression, and different approaches, would have resulted in a longer, more complicated book. As I read it, I thought of another book which takes a more neutral stance but offers some equally fascinating insights which transcend the body/mind split (Enders 2015) and wondered what might be written next. I will be watching with interest.

Bullmore E (2018) The inflamed mind. London: Short Books.

Enders G (2015)¬†Gut: The Inside Story of Our Body’s Most Underrated Organ. London: Scribe Publications.