Understanding the psychological effects of multiple sclerosis

Abstract

Multiple sclerosis is a largely unpredictable progressive disease, with patients accruing many noticeable physical changes during their disease course. However, the compromised cognition and mental health of people with multiple sclerosis typically garner scant attention. This oversight might be understandable, if not excusable, within health services, since health-care professionals consider mobility and other functional signs to be most important for treatment, whereas people with multiple sclerosis regard their mental health symptoms as a higher priority. This difference of opinion could partly occur because information about the assessment and treatment of the neurobehavioural effects of multiple sclerosis is not collated and accessible for many health professionals. In Mind, Mood, and Memory: the Neurobehavioral Consequences of Multiple Sclerosis, Anthony Feinstein—professor of psychiatry at the University of Toronto (ON, Canada)—sets out to remedy this dearth of information. In his book, Feinstein interleaves case exemplars with curated overviews of research relevant to each topic. The cases are fictional but draw on many years of experience of working as a neuropsychiatrist with people with multiple sclerosis. Feinstein writes as a novelist, with the ability to paint a personality and a life convincingly, following a person encountering a diagnosis of multiple sclerosis and their subsequent battles with the disease. The cases are carefully crafted and sequenced to guide the reader gradually through the different mental health effects and sequelae. For readers unfamiliar with multiple sclerosis, Feinstein unpacks and explains the disease according to what patients are told by their neurologists, capturing their understanding and emotional turmoil through the disease journey. To consider how the lives of people with multiple sclerosis can be undermined and curtailed by the neurobehavioural effects of their disease, Feinstein blends typical neuropsychological profiles of patients into individual life circumstances. A detailed description is provided of how a focal and relatively mild reduction in information-processing speed (the primary cognitive impairment in multiple sclerosis) makes high-demand jobs very difficult. Feinstein selects high achievers for these cases, and this choice might reflect his experience working within the Canadian health-care system, or it could indicate that complex employment roles facilitate a detailed explanation of the effects of cognitive deficits on people with multiple sclerosis. Readers from other countries might be surprised at the speed with which Canadian patients access MRI and neurological opinions and diagnoses from the emergency room, although this swiftness could merely reflect a benefit of health care at a leading international neurological centre. Using the case exemplars, Feinstein dissects and explains how individual life circumstances interact with particular cognitive difficulties in multiple sclerosis. For example, a female patient with reduced executive function (ie, reasoning, sequencing, planning) remained competent at work, which was a highly structured and repetitive role in an accounts department, but she was no longer able to enjoy cake-making, which had allowed her to be creative. Every case exemplar is surrounded by a penetrating and lucid literature review, explaining the science behind the relevant assessment and treatment options. Feinstein has a mastery of detail, describing evidence with precision and clarity. He produces a very readable and comprehensive overview of each area, also covering lesser known preliminary findings that are likely to be important in the future. As an example, Feinstein cites a large Italian study that grouped individual cognitive profiles into five cognitive subtypes, highlighting that cognitive dysfunction is also a physical disease. Mind, Mood, and Memory is not a textbook, or if it is, it is a very superior one. The literature in this area includes complex, subtle, and abstract concepts and experiments. Feinstein covers the breadth of cognition and psychiatric presentations in multiple sclerosis with elan. Alongside Feinstein's intellectual authority, the reader might sense his humanity and compassion. Describing a happier outcome, when a man with multiple sclerosis and his adult sons attend a last consultation, Feinstein recounts that he paused momentarily to reflect on this family meeting. There is sensitivity too, and realism. Not all the case exemplars do well, or stay with Feinstein to complete their treatment. Any health professional involved in the care of people with multiple sclerosis should read Feinstein's book, regardless of their specialty. Charity workers and health managers charged with providing services for people with multiple sclerosis might also benefit from the insights and comprehensive coverage. Finally, people with multiple sclerosis—and those who love them—could find some value in an increased understanding from other people's experiences and options.