ACB Publishing LLC, New York, 2013
Reviewed by Barry Blackwell M.A., M.D. (Cantab), M.Phil, FRCPsych.
Frank Berger’s posthumously assembled book of short writings, A Man of Understanding is a lifetime’s treasure trove of wisdom; of truth in action. As he states in its“Personal Views” section, “I have only one prejudice: that there is nothing beyond the inquiry of science. The notion that there is any truth we are not allowed to know is abhorrent to me.”
Readers should realize the who, how and why of the way in which this unusual and unexpected book came to exist. Frank was an eminent member of the half-dozen or so true pioneers who made the break- through discoveries in psychopharmacology in the mid-twentieth century. The drugs they discovered released thousands of patients from asylums into more humane (but still inadequate) community care. Frank Berger’s particular contribution was to develop, beginning with research in animals, the first effective drug for the treatment of anxiety: Meprobamate or “Miltown”. This and other so-called “minor tranquilizers” rapidly became among the most widely used drugs in America, prescribed by physicians of all stripes including family physicians and psychiatrists. In one short year, 1995-1996, Frank’s discovery increased Wallace Laboratories’’ annual revenue from $80.000 to $200 million.
The milestones of Frank’s scientific career spelled out at the beginning of his book appear in more detail in The Oral History of Neuropsychopharmacology(ACNP, 2011: Series Editor Tom Ban), Volume 3, Editor Fridolin Sulser and Volume 9, Editor Barry Blackwell.
Frank’s entry into medical school in Prague was pre-determined by an interest in research and he made his first discovery at age 22 while still a student, a drug treatment for cystitis he sold to a pharmaceutical company. Frank’s long and productive life ended at age 94 in 2008. Throughout this time he kept detailed notes that reflected his philosophical views on life, quite separate from his scientific work. In “Why Write the Book?” he says, “What I have learned is much more important than what I have contributed… (it) is not original and has been taken over intentionally and unintentionally from others. And: “In my immodesty I want to offer a recipe for happiness and success.”
Dr.Berger clearly intended to eventually publish his material with a working title borrowed from Maimonides, Judaism’s medieval physician-philosopher: A Guide for the Perplexed, which is retained as the title of. his introduction. After his death that task fell to his widow, Christine Berger who brought the book to press with its current title and Dr. Berger as author.
Why Frank Berger’s only book for the general public should be about his philosophy of life and not his scientific discovery is revealed by the only allusion he makes to this paradox, quoted on the back cover, “There are misunderstandings about tranquilizers, about what they can do, who should use them, when and how to use them. They may make you feel normal again, able to cope again, but are no substitute for philosophy.”
This honest appraisal is striking and key to understanding Frank’s purpose for his book. In 1970, three years before he retired from industry (but not research); Frank was honored with an award and presented the story of his discovery at a conference in Baltimore that I helped convene with Frank Ayd. The lecture was published in the book we co-edited, Discoveries in Biological Psychiatry (1970). By that time Miltown had been overtaken by the benzodiazepines, Librium and Valium, and controversy was raging in Europe and America over the appropriate and inappropriate use of minor tranquilizers; whether they were panaceas for the vicissitudes of daily life or were more effective treatments for a biological brain disorder. Frank Berger’s position was crystal clear; following a scholarly review of anxiety and its treatment he concluded they were useful for the latter and not the former. With the passage of time his reason for this became clearer and more widely acknowledged: drugs can stifle anxious thoughts, feelings and behaviors but cannot change them; they re-emerge once treatment ends. New improved responses to anxiety-provoking stimuli only arise when learning occurs, based on life experiences and sometimes facilitated by talk therapy.
This is made explicit in the Introduction where Frank describes the book as “an attempt to share some of the things life has taught me.” Further, that they “are not concerned with medicine or science but with “an approach to day-to-day living that has helped me deal more successfully with life’s most vexing problems.” A life-changing experience produced one of those lessons: escaping from his Czech homeland two days after Hitler invaded, being denied passage to America at the last minute and crossing to Britain instead with his wife, no money and unable to find work or speak the language. “There was good reason, one might say, for me to be depressed or downhearted.” So Frank’s response was to “set about doing the best I could in the face of great difficulties”.
This epiphany is translated into four cardinal components of his philosophy that liberate action: tolerating uncertainty and being content with small victories; accepting life’s cultural and spiritual realities while rejecting comforting but ineffectual religious, scientific or philosophical dogma; letting go of unconscious beliefs or fallacies and establishing new beliefs. This last point is driven home by a quotation from Buddha; “The man of understanding makes for himself an island that no flood can overwhelm.” This is prelude to Frank’s benediction: “May this book help you see that it is possible to build such an island without leaving the mainland.”
In the main body of the book Frank Berger’s insights, merged with those of independent philosophers, scientist, authors, politicians and others are stockpiled in alphabetical order in 60 categories the reader can delve among.
Finally, Frank the scientist and empiricist might pose the question, “To what end?” As a philosopher he would be wise enough to know that the answer is beyond the reach of our often crude and error-prone “outcome measures.” It will be up to the reader to seek whatever insights fit their existential predicaments or angst, testing them in real life and sharing them with friends, family, lovers or fellow workers and, perhaps, with a therapist or two. It remains only to quote Anglo-Saxon folk wisdom: “The proof of the pudding will be in the eating thereof.”
August 21, 2014