The author does a great job making complicated aspects of this biology accessible and understandable. Tiny cells that have been overlooked may in fact take a large part in how our brains function.

Sometimes I am not sure of the total hard science- and I do appreciate her distinction between causation and correlation, which allows to to take some of her other conclusions more seriously.

I enjoyed the book, different sections engaged me in different ways.
It is refreshing and energizing to reimagine how we think things work and hopefully from that, obtain a clearer and more accurate understanding of how things can. and do work.

I recommend.

I had been somewhat under the impression, previous to reading this, that the blood-brain barrier for the most part prevented the body’s immune system from affecting the brain. Turns out all of neuroscience was wrong about this for decades! It’s cool that we know otherwise now!

In my strange combination of science-illiteracy and pop-science-literacy (and extensive reading about mental health and cognitive problems), I had to stop and remind myself that a lot of people probably needed the metaphors more than I did, and that most people probably had not heard of neurofeedback or transcranial magnetic stimulation.

The human interest stories of the three women dealing with serious depression and autoimmune issues were very moving. Obviously I wish none of these specific people ill but it was an interesting narrative choice to have each of them get and stay better at the first treatment profiled (TMS, neurofeedback, and a fasting-mimicking diet.) I guess maybe that’s just how it “really” happened but it feels a little overly utopian. (Did she talk to no one whose depression was still treatment-resistant?) To be fair, the book is careful not to actually suggest that this immunological understanding of microglia and the potential treatment options won’t necessarily be meant to supplant SSRIs, exercise, cognitive behavioral therapy, etc.

I’m a sucker for evolutionary biology sometimes but I thought the theory of microglial inflammation as a social adaption was interesting: depression and anhedonia after an illness as a way to reduce social interaction and therefore dedicate more of the body’s resources to healing.

This excellent piece of medical journalism explores new research on the brain and the immune system. The writing is fresh and interesting, and the author is a born storyteller. She takes you into the lives of several patients suffering neurological malfunctions, following them through their debilitating symptoms, initial consultations, treatment, and their lives after ground-breaking medical procedures.

This book is highly recommended for anyone seeking to understand the underlying causes for psychological and neurological disorders and diseases. Researchers on the cutting edge of brain research are profiled in depth, along with details of their findings and procedures. The book is understandable by intelligent lay people willing to dig deep on a fairly technical topic. Excellent book, highly recommended.

I mostly enjoyed this. The author certainly does a nice job of explaining complicated info, and includes lots of stories and examples to humanize it and help keep it interesting. I found myself skimming some of the stories because I just didn't care. But that's my problem because those experiences kept it from be a boring, data dump. I just wanted to get "the answers/solutions" which don't exist in most cases, yet. This book describes briefly how some info was discovered and where it might lead. Recommended for learners and the curious, not those seeking how to cure or fix inflammatory related health and brain issues. Well done overall.

I really appreciate the ARC for review!!

This book may be divided into thirds. The first third was excellent, the middle third was okay and the final portion was simply awful. The 1st third gets five stars, the 2nd third gets three stars and the final third gets only one star. Thus, the overall average for the entire book is three stars.

Donna Jackson Nakazawa is a favorite nonfiction author of mine. Her book, The Autoimmune Epidemic: Bodies Gone Haywire in a World Out of Balance--and the Cutting-Edge Science that Promises Hope was one of the first books I read after being diagnosed with Rheumatoid Arthritis 10 years ago. And I’ve devoured every one she’s written since.

The Angel and the Assassin: The Tiny Brain Cell That Changed the Course of Medicine is her latest, and publishes in January 2020. It introduces a component of our brains called microglia to the general public. Microglia are cells in the body that don’t get much attention even though scientists are aware of them. But, as Nakazawa explains, some ground-breaking scientists are now intensely researching microglia.

And what they’re learning is stunning. In its simplest form, studying microglia proves that brain, mind, and body are intimately tied together. This seems obvious, but medicine and science don’t treat them as connected. Instead, we focus on the barriers between them. And we assume that the immune system doesn’t exist in the brain, just because we don’t see the same elements as we see in the body.

But Nakazawa explains that this is all old science. Now we know that physical trauma affects the brain, and thus, affects everything about mood, cognition, and brain function. This trauma could be as common as a concussion, all the way up to complicated and traumatic brain injuries.

In addition, diseases that affect the body’s immune system are also likely to affect the brain—a relatively new concept called neuroimmune function. This also changes the way we’ll treat diseases like depression, bipolar disorder, and Alzheimer’s in the future.

Ultimately, the fields of neuroscience, genetics, psychology, psychiatry, medicine, and immunology are all more closely connected than ever.

My conclusions
First, I’m not explaining this as eloquently as Nakazawa does. The science is complex and multi-layered. And yet, she walks readers through the information step by step. The way she integrates stories of real-life patients makes the clinical and research details come to life. Having examples makes everything easier to absorb, and along the way you cheer for the people searching for solutions.

Which leads me to my next point. I particularly like that Nakazawa doesn’t stop at discussing the science. She helps readers understand if and how they can bring these cutting edge concepts into their own lives. Part way through, I was definitely searching online to find specific neuroimmune-related services in my area.

It’s not common to find a book with innovative information that is also so readable. I never felt talked down to, despite my lack of scientific education. Nakazawa is a patient who writes for patients, not researchers. She’s the advocate you’ve always wanted, and by writing books, she helps many more patients than she could do individually.

Read this if you like learning more about how your body, especially your brain, works. You’ll see how the science of microglia is already changing what we know about our brains. Definitely recommended for people with neurological, autoimmune, and mental health conditions of all kinds (and the people in their lives).

Acknowledgements
Many thanks to NetGalley, Random House Publishing Group, Ballantine Books, and the author for the opportunity to read the digital ARC in exchange for this honest review.

Originally published on my book blog, TheBibliophage.com.

Nakazawa has a great writing style, making this complicated topic easily accessible and fascinating. It’s a very personal approach and it works incredibly well in this instance.

I am the type of person who likes to read and learn as much as possible about everything. This book didn’t bore me. I really enjoyed it. It was well written and I learned new things I didn’t know before.

I received this book in exchange for my honest review.

My first thoughts: Illuminating. Startling. Objectively informative. Emotionally and psychologically resonant. Broad conceptually yet personal in context. Explanatory on the whole without crossing the line into yawn-inducing drudgery that slaps research statistic after research statistic, or fact after scientific fact, to the forehead in the hopes that details about microglia will be absorbed into the brain via osmosis then fired from synapse to synapse until it embeds itself there: read but not comprehended, learned but not in a way that warrants more questions or reflection after the last sentence has ended.

Also: Scientifically significant. Balanced between person-focused narration and fact reporting. New knowledge, tailored medical treatments. Surprising connections that send your mind into empathetic overdrive, churning those thinking wheels to exertion so as to induce elbow-under-the-chin musings.

To speak more plainly, this book may be many things but dull and impenetrably dense isn't one of them. It offers a penetrating look into present knowledge and future therapies for inflammatory disorders. Doing so in approachable language, with person-by-person examples, Nakazawa catalogues how microglia, as the white blood cells of the brain, can act as destructive "assassins" that invade healthy cells and cause physical/psychiatric disease or as healing "angels" that already are (or may be) manipulated by scientific intervention someday to reverse damage in the body.

Seeing as how I suffer from multiple autoimmune issues myself, I found this to be instructive as well as intriguing. Relatable, too, given the mental/physical struggles that accompany anything chronic or malignant.

This foray into microglia's role in the body gives the mind/body connection of disease concrete validity. Something definitive, observable, and testable in laboratories around the world. Nakazawa lays out research and interviews with experts who discuss how microglial cells are the main culprits of inflammation in the brain because they "were/are mistakenly eating away synapses that shouldn't be pruned away," thereby contributing to neuropsychiatric or neurodevelopmental disorders like depression, Alzheimers, glaucoma, lupus etc. The author also personalizes the science by weaving in her own trials with Guillain-Barré syndrome, by chronicling treatments that Katie Harrison, Heather Somers, and Lila Chen all try to alleviate their symptoms. Doing so allows readers to bounce back and forth between the faceless objectivity of science and the human subjectivity of what it means to suffer from a persistent illness.

I am so glad I picked this up! It demolished my meager expectations. It was amazing to ponder the idea that science has uncovered a specific underlier of inflammatory disease. A cellular bridge between mind and body--finally!

Thanks so much to NetGalley and Ballantine Books for the ARC!