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THE LANCET Neurology Vol 1 November 2002 http://neurology.thelancet.com454

The Synaptic Self Joseph Le Doux Macmillan, 2002£20, 406 ppISBN 0 333 78187 2

Do you believe that you are your synapses?Do we really only use 10% of our grey

matter? Will you need more than 10% of your brain to get togrips with The Synaptic Self? Perhaps.

Theories of consciousness and notions of self leave many ofus in a quantum pickle and we are left to conclude that at leastit’s good to know why we don’t understand something. In hislatest offering, Le Doux takes us again through the shadowychasms between sensation and experience into the workings ofthe brain, the conscious mind, and how we become the peoplewe are. According to LeDoux, the key to everything the braindoes lies in our synapses. He writes with personal andcharming humility, and sometimes humorous turns.

The scope of LeDoux’s horizon makes for an engagingand accessible read. From Kant to Kandel, Locke to LouReed, and Buddha to Bunuel, he is looking for the essence ofa person in the brain, the self that Paul Klee described as “adramatic ensemble”. Le Doux’s exposition is nothing less.He sets out his questions with clarity and quickly puts“consciousness” in its place as an overvalued problem inmodern neuroscience. And yet he sympathises with thebelief that one day neuroscience will come to explain it.

LeDoux links a fairly detailed idea of selfhood to neuralfunctions with a model of self he feels to be compatible withcurrent understanding of brain function. There is the clearmessage that philosophy will not give us the kind offoundation we need to pursue the relationship between “thesoul’s frail dwelling” and “the totality of the livingorganism”. We are taken on an intriguing tour of the“unruly mob of brain systems” with emphasis on thecontribution of synapses in development, learning andmemory, cognition, emotion, motivation, and psychiatricillness. The synaptic organisation of self is set up indevelopment, modified by life experiences, and maintained,moment to moment, by coordinated learning that occurssimultaneously in diverse synaptically linked systems.

Le Doux insists his view deals with the way the mindtypically works in most of us, as well as the way it worksuniquely in any one of us. Although, synapses themselvesdon’t account for everything the brain does, he points out,they participate crucially in all acts and thoughts, in everyemotion we experience. They are the key to the brain’s manyfunctions, and thus to the self.

For some, these mysteries originate much further back indeep time before the brain evolved. What’s the reason for auniverse containing the raw stardust materials of the braincoming into existance at all? Both Sartre’s Roquentin and Ifeel very nauseous about this indeed. But as an antiemetic toexistential angst, Le Doux’s work is therapeutic. Jon Sen

The Newborn BrainEdited by Lagercrantz H, Hanson M, Evrard P, Rodeck CCambridge University Press, 2002£95, 550 ppISBN 0 521 79338 6

This review volume tries to bridge the notinconsiderable gap between basic neurobiology of thedeveloping brain and the more clinical aspects ofmonitoring, imaging, and management. A book of twohalves, it largely succeeds in giving a basic scienceunderpinning for the more clinical functions, but also servesto starkly remind the reader of the increasing gulf betweenthe phenomenal complexity of the developing CNS at amolecular, cellular, and pathway level, and the relativelycrude tools that are currently available for clinicalinvestigation.

None of the above should in any way reduce the value ofthis book, which pulls together learning from many differentareas of neurobiology and focuses on a comprehensiveexposition of current knowledge of the developing brain.

This book is worth reading solely for its first chapter byJean-Pierre Changeux who reflects on the origin of thehuman brain and confirms his reputation as a polymath whoweaves a tapestry of science from many different disciplinesinto his chapter. The next 11 chapters provide acomprehensive framework for all aspects of early braindevelopment; together, they highlight the complexity of the

brain and the astounding rapidity with which it develops.For instance, the young human brain contains far in excessof 50 billion neurons before apoptosis starts to occur, andprior to birth 40 000 new synapses are formed every secondin the striate cortex. The speed of neurodevelopment in thefirst year of life underlines the awesome nature of thedeveloping human brain.

The second half of the book deals with more clinicalaspects of early brain development of interest to theobstetrician, neonatologist, and neuropaediatrician. Thesechapters are written in an authoritative and clear manner.However, clinical neuroscience is shown to lag far behindneurobiology. This is no criticism of the book, but anobservation of the frustration that many clinicians feel whenfaced with problems in fetal and neonatal life that affectfunctional outcome in the baby. Hopefully, in years to come,the gap between these two areas of the science will close tothe benefit of children and their families.

This book provides as much easily digestible informationas any short text on the subject, it is well presented, clearlywritten, and extremely authoritative. An additional joy ofthis book is the historical vignettes of individuals who havewon Nobel Prizes for their contribution to developmentalneuroscience. These are extremely informative and relatewell to the text that they follow. I would very stronglyrecommend this book to any student of neurobiology,and any clinician who has a serious interest in thedeveloping brain.Malcolm Levene

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