Into the Abyss

A Neuropsychiatrist’s Notes on Troubled Minds

Anthony David

Oneworld 2020

Hb, 216pp, £14.99, notes, ind, ISBN 9781786077059

Into the Abyss: an apt title for exploring the often challenging realm of mental illness and the complexity of dysfunctional brains – or is it minds? Much like the nature versus nurture debate: both can be significant to an individual’s mental and physical developmental outcomes. Neuropsychiatrist Anthony David’s book reads well because the complicated and fascinating subject matter, describing the world of neuropsychiatry through his experiences of it, is presented in a warm and accessible style. The book offers a unique window into the individual worlds of some of his past patients.

Anthony David demonstrates how the biopsychosocial model can be used in the translation of the origin, presentation and formulation of patient treatment. This is portrayed across a number of respectful, idiographic case studies of patients he has encountered over his working life. That’s not to say that reductionism does not play a role here; it does, and as a medical professional he admits that he believes “everything in our mental life does come down to, can be reduced to, the workings of our brains” as indicated in one patient diagnosed with an inoperable brain tumour. However, it has been well established how biology alone is not the only explanatory or contributory factor when our minds and bodies malfunction. As human beings we are subject to a vast number of internal and external influences that shape our mental and physical worlds, and it is clear that the author appreciates this fact, and his varied experiences in the field of his expertise have revealed this interconnectedness time and time again.

I appreciated his genuine interest, concern and compassion for the individuals he has treated, always and most importantly respecting them as human beings in their own right. He is also very honest about his working experiences and how he has formulated his thoughts, diagnoses, treatment options and his carefully considered conclusions regarding the holistic picture of his patients: their life journeys, experiences, beliefs, and aspirations. The book leads the reader through each individual case with literary ease and clarity of explanation, generating understanding and a familiarity, as the reader becomes acquainted with each patient through his gentle, observant, often witty and always engaging narrative.

I sometimes felt I wanted to know even more about the patients he writes about – but that’s not necessarily a negative. Significantly, it was pleasing to see how Anthony David sees this deeply personal view into the minds, bodies, and lives of his patients, and their trust in him, as much more than a job, or even a vocation; it is an absolute privilege. Rosie Freedman

★★★★