A User's Guide to the Brain: Perception, Attention, and the Four Theaters of the Brain

by John J. Ratey

Published by Pantheon

404 pages, 2001

Buy it online






Gray Matter Revealed

Reviewed by Margaret Gunning


Anyone who has ever read the poetic musings of neuroscientist Oliver Sacks knows that the human brain is fertile territory for literary treatment. Books on the brain abound, some of them highly technical, others (such as Sacks' works) tending towards the philosophical or even existential. Neuropsychiatrist John Ratey specializes in taking highly complex ideas about how the mind functions and rendering them understandable to the general public, as in his popular co-written works Shadow Syndromes and Driven to Distraction.

Ratey firmly believes that human behavior springs from biology. His ideas contrast sharply with the old Freudian notion that psychological dysfunction must stem from faulty toilet training or an Oedipus complex. If the mechanics of the brain become disturbed even slightly, particularly in the area of perception, it can create a cascade of processing problems that can eventually render a human being incapable of normal social or intellectual function. Rather than stigmatizing the mentally disturbed or the socially awkward, he feels we should be trying to zero in on which system in the brain is not functioning properly, so that new and better coping strategies can be devised.

This is the bare essence of a long and complex book which takes us deep into the labyrinthine structure of the brain in an attempt to explain to the "user" just how the whole complex system works. "Brain science is its own priestly sect," Ratey explains in his introduction, "a mystical order quite closed off to the uninitiated. I will be working my hardest throughout this book to give to you, the reader, a chance to learn about the brain's complexity without jargon."

The problem with this early promise is that it is impossible to speak of brain function without using a great many scientific terms. Ratey ventures into such complex and diverse phenomena as phantom limb syndrome, dyslexia, autism, obsessive-compulsive disorder, Tourette's Syndrome, attention-deficit disorder and addiction. A typical passage (in this case, on female sexual response) reads like this:

The ventromedial nucleus of the hypothalamus is essential to female sexual behavior. The hormones estradiol and progesterone act here.... The periaqueductal gray matter is connected to the reticular formation of the medulla and the spinal cord, which is activated in the lordosis response, or female sex posture.

Such technical language, while probably necessary to getting the information across, is not very sexy, making for a bit of a trudge through the long explanatory passages.

But interspersed throughout are fascinating case studies which help bring the book alive and put a human face on the enigma of the brain. Ratey cites the case of well-known autistic writer Temple Grandin, who solved the problem of how to approach people socially by walking slowly towards a set of automatic doors over and over again. "Temple resorted to a host of unusual practices to rewire her faulty brain circuits in order to control her conduct," he writes. "She developed the circuits that enabled her to approach the supermarket doors, and then used these newly trained circuits to help position herself with relation to other people."

Then there is Rickie, a bright young woman whose eyesight was normal but whose brain was unable to make sense of what she saw: "At times everybody and everything seemed far away. She felt as though she was sitting in a closed box and seeing things 'through a pinhole.' But she didn't tell anyone; everyone already thought she was strange, and she certainly didn't want to say anything that made her seem even more like a 'weirdo'."

Rickie's disability led to a downward spiral in which she was eventually misdiagnosed as a borderline schizophrenic. "Her fate was sealed," Ratey writes, "for in psychiatry in those days there was an awful truism: A diagnosis is destiny." Only when a developmental optometrist correctly diagnosed her perceptual problem and fitted her with a special pair of glasses did her life begin to improve. "Rickie has recovered not only visually," writes Ratey, "but psychologically as well." Such stories are not only fascinating but uplifting and reveal the strong relationship between healthy brain function and the ability to lead a satisfying, productive life.

Though Ratey is strong on biology, he does not dismiss the powerful effect environment can have on a human individual: "Genes and environment interact to continually change the brain, from the time we are conceived until the moment we die." This process of continual change indicates that the brain is much more like a flexible, dynamic ecosystem than a sterile computer. Nor is the brain merely a system made up of "one part, one function." Even if a major area of the brain is destroyed by accident or stroke, it can often compensate by using other areas to take over for such crucial functions as speech, memory and movement.

In other words, the brain is very smart, not to mention resilient and resourceful. Ratey calls it "the supreme survival organ." Though the book's subtitle refers to the "four theaters of the brain," Ratey curiously does not even introduce this central idea until the next-to-last chapter. This model sets out four related systems, or "theaters," that interact to form the whole brain: perception, consciousness, function and identity/behavior.

Though this fresh way to view the brain is interesting, Ratey's proposal for revolutionizing the rather dusty field of psychiatry is far more provocative and relevant. In spite of all we are discovering about brain function, psychiatry often lags far behind: "Mental health practitioners continue trying to treat affect (emotional disturbance) directly, as if it were the illness itself, rather than attempting to investigate the ways in which it might be a consequence of a patient's underlying disorders."

What comes through most of all is Ratey's compassion for the mentally disturbed and if ever a group of people needed a passionate, informed advocate, it's this one. If A User's Guide to the Brain has the effect the author hopes, soon the way we approach mental disorders will change quite dramatically, from merely treating symptoms to tracing behavioral problems right down to their biological source. | June 2001


Margaret Gunning has reviewed over 130 books but never gets tired of the grand adventure of reading. Her poetry has appeared in Prism International and Room of One's Own. She has written a novel (A Singing Tree) and a book of poems (Nonsongs and Neopsalms), and is currently at work on her second novel, Better than Life.