Written by Professor Nicole C. Rust 

IS THERE A NEED FOR A NEW GREAT PLAN?

Review by Gunnel Minett

Nicole C. Rust is an American neuroscientist, psychologist, and a Professor of Psychology at the University of Pennsylvania. In this book she explains how she decided to set out to answer the question why treatments and cures for brain disorders have not been developed, as many had expected. 

Thanks in many ways to new technology, brain research has developed fast in recent decades. However, there still appears to be a general strategy of ‘let’s try it and see’ when it comes to addressing new cures for brain disorders, which are one of the biggest challenges in medicine today. This explains why the author is analysing this problem and challenging what she calls the ‘New Great Plan’ for brain research.

So far the approach to curing brain disorders has been more like ‘redirecting a hurricane than triggering some kind of domino chain of cause and effect’. The explanation being, as recent research has shown, that the brain is not like a chain of dominos. In order to progress in treating brain disorders, we need to see the brain as even more complex than we do now.

One problem the author points to is that many brain disorders, such as Alzheimer’s or Parkinson’s disease, have been known for a long time without much progress being made as to cures. Depression is another example where an understanding as to how it occurs is greater than why it occurs.

Rust suggest several ways for researchers in this field to progress. One is to move from seeing the brain as a ‘thing’, to focusing more on it being a ‘process’. Rather than some form of domino cause and effect, the brain works with feedback and feedforward loops in a complex system. 

In order to widen our understanding of the brain’s processing, Rust suggests studying the brain’s plasticity: She writes: “Some of the most promising emerging therapeutic interventions tackle this challenge by extending the brain’s own natural plasticity. The general idea is that the brain becomes entrenched in an unhealthy place and can be restored to health by extending its own remarkable mechanisms for learning and adjusting to new situations. The challenge is to figure out how to enhance those natural mechanisms when innate plasticity falls short. [p 214]

Professor Rust also explores other new techniques to cure brain disorders, such as psychotherapy with psychedelic drugs. A growing number of clinical trials with various mind-altering drugs are being conducted with good results. They deal with addiction, PTSD, depression, psychosis, OCD and even chronic pain. She writes: “In many of these exploratory therapies, the psychedelic is intended to enhance plasticity, but alone, that is not enough – releasing needs to happen as well, and it must be specific to the problem an individual is experiencing.” [p 217]

In summary, professor Rust is promoting a new, expanded understanding of the brain as a way forward, but still within the framework of a strict scientific approach. This is often based on experimentation on mice to safeguard against subjective assumptions and to make sure that the research is carried out in an ethical way that excludes experiments involving human beings. 

Seen from my psychotherapeutic (rather than the neuro-scientific viewpoint adopted in this book) this strict approach may limit the chances of success. For example, adopting the same approach to understanding Parkinson’s disease and depression may be too narrow a neurophysiological approach. As the author points out, some brain disorders may be caused by organic damage to the brain whereas others are caused by events in the environment. This almost certainly means that two different therapeutic approaches may be required. 

In addition, (although this book does not go so far) more awareness of the mind’s influence on the brain could lead to more progress. As an example from my own work as a breathwork therapist, changing the breathing pattern can give the same strong positive effect as drug psychotherapy (and is of course completely free of negative side-effects). As yet there is no explanation as to why changing the breathing pattern can have the same healing effect on the same disorders as psychedelic drugs. Given that a change in the breathing also means a chemical change, this can be objectively studied. (But it may take a bit of convincing to get grants for such studies since much research is funded by pharmaceutical companies).

A final step for brain research may be to go beyond the boundaries of science, which are carefully respected in this book, and move into what today’s scientific paradigm still regards as ‘paranormal’. That is to study the effects of human interaction in therapy. Many forms of psychotherapy focus on creating a good and healing relationship between client and therapist. This is seen as an essential element in curing brain ‘disorders’. However, if brain research is limited to; ‘non-biased’  animal trials, methods which exclude ‘bias’ in the form of personal relationships, and effort to find the right drug, then progress is likely to continue to be very slow. 

Hopefully the Great Plan that the book suggests will lead to a changed attitude as to how to conduct brain research in a way that includes the hitherto ‘un-scientific’ field of human interactions. Let’s hope so since the world really needs to find a way to help the brain stay healthy, given all the positive consequences which that can deliver!

Princeton University Press, USA, 2025, 344 pp, ISBN: 978-0691243054