Neuromind: A Contemporary Approach to Mental Health Paperback – September 29, 2022

Ronald Milestone reviews the organization of neural pathways in the brain and illustrates how they may be shaped by genetics, biology, and social experiences. Milestone then applies his knowledge of these pathways to clinical practice. Neuromind integrates a neuro-scientific understanding of the brain with psychological, social, and experiential underpinnings of the mind. Clinical symptoms are expressions of alterations in these neural pathways. When neural pathways function properly, one sees adaptive behaviors. Symptoms emerge when the pathways are altered. This is a creative, informative, first-class book, which should be of interest to a broad range of mental health professionals. Stan Possick, M.D.

Neuromind: A Contemporary Approach to Mental Health is an ingenious adventure into the mind-body-soul-technology interconnectedness of our brain and central nervous system. Neuromind is part textbook, part case study, and part story-telling. If you have always wanted to truly understand how the brain works, then this is the book for you. Dr. Milestone provides scientific research and clinical cases to support his theories on how the brain processes information that contribute to aspects of our daily lives, including mood, anxiety/fears, socialization, learning, memory, and relationships. He ends the book with an in-depth exploration of biological (and non-biological) interventions and their impact on the emergency mental health crisis in America. This is not a book that you read from cover to cover. Neuromind encourages the reader to reflect, question, and learn, then take time and return to learn more. There’s something of interest for everyone, and I suggest starting with the chapters that interest you most. You will be hooked! Dr. Milestone does an outstanding job of detailing the neural circuitry of the brain and how that circuitry is influenced by biological and environmental factors. He draws parallel connections to other technology circuits and points out the brain’s limitations and adaptability. His use of clinical case examples demonstrates the depth of his professional experience and provides real-life stories to support the scientific processes described in each chapter. If you’re a scientist or medical provider, Dr. Milestone pushes beyond the immense body of knowledge provided in the book by including over 300 pages of reference material to extend your journey. If you’re a layperson interested in the mind-brain labyrinth, you will finish this read intrigued and eager to learn more. Never before have I experienced a scientific body of work that appeals to such a broad audience.Highest praise to Dr. Milestone for the years of research and clinical experience embodied in Neuromind and for sharing his great mind with the world. Dr. Milestone had a tremendous influence as a mentor to me in my early career as a child psychiatrist. He was a great teacher then and continues to teach now.Yolanda Graham, M.D.Chief Medical/Clinical OfficerDevereux Advanced Behavioral Health

Dr. Ronald Milestone, MD, a psychiatrist in the traditional sense, meaning he cares about his patients, makes treatment decisions with them, not for them, and uses psychiatric medications to facilitate treatment, not as treatment, has written a book that very few people could write. Dr. Milestone may be the only person with the time, experience, education, and dedication to our patients and our field to attempt it. What Milestone has produced, comes out of a desire to give back, and gratitude for those who have helped him along the way.NEUROMIND isn’t a book; to call it a book would be like calling Guernica a painting. He has written a self-directed graduate education on the relationship between psychiatry and the mind. Readers who approach this intellectual work of art will miss the point if they do so expecting a leisurely journey through a Foreword, Introduction, Table of Contents, References, and an Index. In fact, there is no index! This is a book with a thousand journeys, each reader choosing his or her own intellectual experience.I found the best way to enter NEUROMIND is by randomly paging through it, stopping at topics of interest, reading a Clinical Example or two, perhaps delving further by exploring his frequent Sidebars, and then either reading the chapter, or going to other sections Milestone recommends, or to the references provided to specific topics of interest. NEUROMIND is 666 pages in length, of which 292 pages are references. I have no idea how many references there are; however, over half have internet links to the recommended articles.You see, this is not a leisurely read, nor a book from which to passively learn. This is an opportunity for active learning, i.e., learning that makes a difference, self-directed by the reader to fit his or her personal, professional, and educational needs. Everyone who reads NEUROMIND will be reading a different book. It will not be reviewed in the New York Times since everyone who reads it is reading a different book and having a different experience.Dr. Milestone is a dedicated clinician with an undergraduate background in neuroscience. I am sure he has never done a 15-minute interview. Nor is he an academic. With sincere apologies to my many friends and colleagues in academic medicine, clinicians know things about people, patients, health and unhealth, and treatment that can’t be taught. With responsibilities for teaching, supervision, administration, and research, academic physicians don’t have the immersion with patient experience that clinical physicians do.In fact, clinicians know as much or more from their interactions with patients than they even know they know. Dr. Milestone was a physician psychiatrist first, a physician being defined as, “a person skilled in the art of healing,” who then taught himself the neuroscience. Thus, his mind was formed by experience, and then informed by his self-education. That is why this author and this person are unique, and how this author has provided a unique intellectual experience.In his preface, Dr. Milestone says, “My greatest debt has been to the patients whose life struggles have revised my approach throughout my career.” That was his first sentence in his paragraph of acknowledgements. An eminent physician’s “greatest debt” isn’t to a department chair, an inspiring professor, or a foundation providing financial support. It is to those patients with whom, in the context of their treatment relationship, have taught him what psychiatrists need to know most.Over the course of his career, Dr. Milestone has taught himself the neuroscience, what he refers to as, “brain pathways that carry messages back and forth, interacting with each other.” In my view, this is the mind, continually modified by genetics, epigenetics, and experience in families, societies, and the greater world. According to my late and dear friend, Walter J. Freeman, III, MD, a physician before becoming the pre-eminent neuroscientist of the 20th century, “The most important function of brains . . . is to interact with each other to form families and societies.”NEUROMIND: A Contemporary Approach to Mental Health, is for any curious person interested in the mind, mental health, and psychiatry, psychology, or social work. In reality, both patients and professionals need this ‘self-directed graduate education,’ because the health insurance companies, the pharmaceutical industry, organized psychiatry, and the psychiatry training programs have completely re-defined psychiatry, limiting it to the prescribing and management of psychiatric medication.I believe the insurance companies will complete that process within five years. Psychiatric prescribing will then be done primarily by physician assistants and clinical nurse practitioners. Who will then understand the mind, the ongoing interaction of the mind with family, society, and the greater environment, and how that ongoing interaction interrelates with the various mental health and addiction disorders? I suppose that function will revert to the philosophers.If mental health professionals, their representative organizations, and their academic training sites do not pursue the mind in context, then patients will need to learn the essence of which Dr. Milestone has written on their own. In my opinion, this ‘self-directed graduate education,’ could provide a resident physician, training in psychiatry today, a better background for the real profession of psychiatry than all the the sterile chapters and journal articles required to become board eligible in the field. More importantly, the active exploration this self-directed program engenders will lead to a lifetime of continuing relevant education.I met Dr. Milestone in Atlanta in 1979. We practiced together for two years there at the same respected psychiatric clinic in the late ‘80s. I then moved to Wisconsin to do graduate study in ethology. He subsequently moved to California to be near his son. We interact occasionally about topics relevant to our mutual professional interests. I am mentioned in the ninth line of his acknowledgements.Douglas A. Kramer, MD, MSEmeritus Clinical Professor of PsychiatryUniversity of Wisconsin School of Medicine