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An interview with the author

Vernon M Neppe MD, PhD
on his book
Cry the Beloved Mind: A Voyage of Hope






What is the book about?
Cry the Beloved Mind provides insights on brain medications and medical social issues.
 
Who is it written for?
I have gone to great pains to ensure it is readable for the general reader particularly patients and families.
 
What proportion of the population would this target?
Possibly almost everyone. Studies vary depending on criteria or severity, but possibly half the population have some psychiatric difficulty at some point in their life, and a quarter or more of a severity enough to need medication.
 
But what about your medical colleagues? Could they benefit?
I would hope so. Several of my medical and psychological colleagues have found it worthwhile.
 
Such as?
Medicine, psychology, sociology, pharmacy, nursing, psychiatry and neurology rather obviously. Imagine needing to learn an area and being able to be fascinated while being educated! I have already been very gratified by the responses from these groups and hope it will be regarded as a pleasurable educational text-book. Strangely, I even see a place for this book even in contemporary English literature- I see this book as a text-book in several different college or senior high school courses.
 
Why literature? What's so special about the book?
Because it is written in a new area, sciction.
 
What's that?
Sciction is "science through literature": I had originally defined this as "science through fiction" but that definition is misleading in that the book is actually classified as "non-fiction". In this instance, medical science is portrayed through fictitious dialogues with composite patients but the patients reflect combinations of real individuals. The characters in the twelve chapters of the book are amalgams of several different patients allowing me to portray a medical detective theme in diagnosis and management of even the most intractable patients and yet answer the basic questions patients and students ask. By dialogue, the mundane becomes interesting: The dialogue portrays the same scientific information as prose, but is based on conversations that may never have occurred with exactly that wording, though the themes have been covered.
 
So what does that do?
The object is to fascinate through these unusual case histories, and to educate by increasing knowledge base.
 
Does this make the book fiction?
I've wrestled with where to classify it but I regard this as a new genre of non-fiction. It is both non-fiction written in a literary style. I regard it as non-fiction because it is a scientific work interwoven into a way of educating and providing scientific knowledge.
 
But there are other aspects of the special literary style, are there not?
Yes. Additionally, the book is written as a play within prose with a series of dialogues based on real-life types of interchanges with patients and students.
 
But what makes this book different?
Most important is the Voyage of Hope -- the subtitle of the book. I try to show how given detailed evaluations even the most ill of patients can usually improve dramatically. This in turn allows hope for the easier conditions as well as assisting patients in understanding their medications better.
 
Surely any psychiatrist could have written this book then?
Yes and no.
 
Yes?
Yes as the book has been an important labor of love. Knowing how it can help thousands of people, it has required the dedication that many physicians exhibit.
 
No?
No, because my own experiences, training and adventures have been so unique.
 
In what way?
I'm a neuropsychiatrist and psychopharmacologist. In other words, I look at all aspects of abnormal brain function ranging from seizures to depression to movement disorders and I link these with aberrant behavior. Using this neuropsychiatric base I apply the principles of the actual brain chemistry and electrical facets to find the most appropriate intervention.
 
And some would say you are uniquely trained in that regard?
Not unique, but certainly unusual enough to have been recruited to establish the first division of neuropsychiatry in a department of psychiatry in the United States.
 
And that was at the University of Washington in Seattle?
Correct. I was on the clinical faculty there, but broadened my frameworks in 1992 when I established the Pacific Neuropsychiatric Institute in Seattle, which is independent of the University of Washington.
 
But you also have another academic appointment?
True. I am also adjunct professor at St Louis University in St Louis Missouri.
 
Isn't this rather unusual?
Yes, it is. I am able to stay in beautiful Seattle and yet maintain an academic as opposed to clinical faculty appointment two thousand miles away.
 
Rather like the concert pianist with appointments to orchestras in New York and Jerusalem?
Possibly.
 
Let me focus a moment on the wonderful title, Cry the Beloved Mind. It reminds me of Alan Paton's book Cry the Beloved Country. Are the two related?
Yes and no. Yes, because both Alan Paton and I shared the common origin of being born in South Africa. Dr. Paton, of course, was a marvelous human being who was a liberal bastion against the political afflictions that beset his country and it is an honor for me to re-evoke his memories in the title Cry the Beloved in my own book. Certainly my book, too, is a beloved cry for help.
 
And why no?
No, because this is not a book on politics or on racial strife but the traumas of real people who can cry out for help and hopefully receive hope from this book.
Paton portrayed predominantly the social and political; I reflect the psychological and the medical.
 
Are your South African origins alluded to in this book?
Indeed. The book begins in South Africa, where I originally trained.
 
How does it begin?
The first chapter begins in South Africa and portrays what could be regarded as a similar discovery to that described in Dr. Oliver Sacks' classic "Awakenings".
 
Who is Dr. Oliver Sacks?
Oliver Sacks is like myself, a neuropsychiatrist, who has recently had his own television program on public TV. He has written a remarkable series of books about unusual brain conditions. For example, in "Awakenings" he described a series of patients who developed a condition called "Encephalitis Lethargica". This produced a condition in which the victims for many years, would sit almost like statues largely unresponsive to their environment. You may remember the remarkable 1990 movie "Awakenings" where the drug levodopa was used to temporarily treat these patients.
 
Tell me more about the similarities and differences?
There is an important learning component portraying information of significant interest in both our writings. Oliver Sacks as the doyen in the area of portraying unusual brain function. I, too, portray uncommon presentations but the object is always to teach about common conditions. Our largest overlap, however, is in my first chapter called "Awakenings re-visited" as I, like Dr. Sacks, describe the use of the very special drug, levodopa. There is a major difference however as in my book, I use this drug for a related but different condition- catatonic stupor- and I describe a "voyage of exploration" that I originally reported in a medical journal in 1988-preceding the movie, Awakenings.
 
So is this the only portrayal of new discoveries?
Indeed, not. This is possibly another aspect of the uniqueness of the book. It literally is at times a voyage of discovery showing my own explorations of sometimes important areas.
 
Are there any that have impacted the world then?
I like to think so but medical science is very much a progression involving many important discoveries one contributing to the other so that my colleagues have, of course, also played important roles.
 
What areas then are pioneering discoveries in your book?
My discoveries with a drug against seizures called Tegretol seemed to spur a revolution in the management of anticonvulsants in psychiatry. Tegretol and other anticonvulsants are now used extremely frequently in many other conditions such as manic-depressive illness, an area I didn't initiate, and explosive anger and non-typical psychoses, therapeutic areas I did pioneer. I describe this work in the book.
 
Any other pioneering contributions?
Possibly. The book ends with a chapter called Curing The Incurable and the reader is able to share the excitement of sciction based as are all chapters on reality. In this instance, we see how the first patient in the world is managed with very high doses of a drug to treat what is often the incurable and disabling condition of tardive dyskinesia.
 
But the book is sciction?
Indeed. Once again, my book involves sciction so I do not describe real patients. I portray the principles, not the patient details.
 
But if this is all "fiction", can we trust the stories?
Yes, you can. The "fiction" is to protect the confidentiality of individuals and to combine real features from many different patients into a more a fascinating whole. But the science is factual.
 
Is there more than just this voyage?
Indeed, yes. Even medical, psychiatric and psychological colleagues have remarked on the education they have received in understanding new approaches to depression, seizures, unusual symptoms, anger, intractable psychosis, anxiety and even drug interactions. I even discuss briefly herbal remedies.
 
You mentioned that the book provides insights into brain medications. But you also alluded to medical social issues.
Indeed. That aspect is very important to me. I wanted this book to be more than a chronicle on brain drugs. I wanted it to express part of me and also reflect the balance of certain areas of medicine that trouble the general reader.
 
For example?
Some intensely personal elements such as:
  • What is normal and what constitutes internal emotional growth?
  • Why should we have gun control and should the psychiatric patient have such access?
  • Is suicide an answer? 
And some not so personal elements?
True. Like should one use generic substitutes? What role do herbal remedies have? How does one approach so-called "shock" treatment. How does one go about informed consent? What roles do regulatory bodies like the FDA have?
 
What about the main characters?
I have tried to show how the student Andrew develops true caring for others over several years of medical training. On the other hand, I have deliberately portrayed the Doctor, who some may interpret as me, as a generic respectful human who greatly wants to help his patients. I believe the characterizations come across. Every chapter has at least one main character, the patient and sometimes there is a supporting cast. My hope has been to respect
 
So is this the second coming of Oliver Sacks?
It would be wonderful if it was. Certainly, I attempt to communicate areas of interest in an enthralling way. However, this book is not directed towards describing the esoteric. I hope to allow people to help themselves. I do not in any way want them to use the book as a substitute for medical care, but the knowledge and insights readers may gain for themselves and their family members should be useful.
 
In summary, then, the book is also a self-help book?
Very much so but always utilizing appropriate professionals. It can best be classified as Non-fiction under Psychology, Medicine and Literature but it certainly has self-help components.
 
And will we see more of such books?
I certainly hope so. This book is the first in a series of Cry the Beloved books. I am in the process of writing Cry the Beloved Brain, then will come Cry the Beloved Patient to be followed by several very special Cry the Beloved books.

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