Outskirts Press, INC.

Rethinking Mental Health

Neuromind tells a new story about mental health, not about illness and symptoms, but about how the individual adapts effectively to everyday life, which includes awareness and intention, agency, for selecting actions. New research on the brain reveals how this occurs. Separate brain information pathways carry messages from inside and outside the body to decision centers to guide actions. These pathways are organized by genetics, life events, and social situations. They are continually modified by the social experiences of everyday life, unless they become “stuck” and dysfunctional. Each is described in a separate chapter with current research and selected clinical relationships. Neuromind offers an approach to providers from multiple disciplines, with chapters on assessment, and biological and information therapies. It is not a “self help” book, but can be read by non-professional readers with an appreciation for neuroscience. Much still needs to be learned, and questions are posed for future research.
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milestone305@zohomail.com

Reviews:
I finished reading your book Neuromind, and I think it is a first class piece of work. You’ve synthesized an enormous amount of material from a variety of different types of sources, and your synthesis is quite masterful. --S Possick MD

Because Ron is a real clinician, was a full-time clinician working in multiple settings, he is probably the only person I know or know about who could write the real book about good psychiatry, i.e., real psychiatry.  You don’t learn this in residency or fellowship.  You don’t learn this from part-time clinicians working and teaching in an academic environment.  I don’t think you learn this from academics.  You learn this from smart, effective psychiatrists whose career succeeds or fails based on their clinical abilities. As the title and blurbs suggest, what he does do is bring the science to the clinical work, not try to fit the clinical work into a scientific theory. ---Doug Kramer MD

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.
Yolanda Graham, M.D.Chief Medical/Clinical OfficerDevereux Advanced Behavioral Health


I worked with Dr. Milestone at Inner Harbour Hospital in the 90’’s and early 2000’s. He was not only the medical director of the hospital but headed several treatment teams, supervised and conducted inservice training and staffed cases regularly with the therapists and direct staff . I am certain that his contributions include much more than mentioned here. I am an LPC and at that time I was on staff as a therapist. I was fortunate to directly benefit from Dr Milestone’s leadership, teaching, expertise, and wisdom.  Dr Milestone stands out as a brilliant, creative, and dynamic leader at every level. 

This book’s scope of distilled information is staggering.  The most delightful surprise for me was to find embedded clinical applications and examples and stories. I still remember some of his engaging, therapeutic stories and metaphors.      

I appreciate the visual organization of the book. The text is visually “ chunked” into sidebars that can easily be enjoyed on their own. I can easily peruse the short clips identified as clinical examples, a summary of pertinent research, historical reference, and clinical intervention. All of the research is cited in the second half of the book. It is easy to look at websites and other references.  Dense information is presented in a clear, succinct fashion. I found myself perusing at times as well as reading for depth. I will continue to pick up this book that I’m sure will continue to provide more gems and insights. Every turn of the page reveals more.  
The book takes a panoramic and focused view of an interactive path toward mental health. Each chapter explores a vector that impacts a person’s capability to ‘ interact with’ and ’adapt to’ the community.  As a psychotherapist this vast distilled information helps me to better identify what impedes a client’s efforts to adapt and how to facilitate a client's agency in this process?  

This book is an ongoing adventure. Dr Milestone suggests that ideas not currently popular in our field might not only be coming back but might be essential for all us in going forward. Taking in the current chaotic complexities and casualties of the social structures in which we live is foreboding. We need to find a better way forward.      

Because I have worked as a psychotherapist for most of my professional life, I particularly direct my reading attention towards “Chapter 12 : Information Interventions   “ …”  In today’s world a therapist's task can be overwhelming particularly in light of the amount of information available combined with the challenge of maintaining a clear and direct focus.  This book offers me an in depth, clear, well organized resource that sparks agency for me as a clinician.   

Thank you Dr. Milestone. This book brings back so many good memories of times spent at Inner Harbor with the extraordinary staff, and most of all, the patients. Being a mental health provider  is daunting but engaging and challenging. You have created a treasure chest that can benefit the whole spectrum of Mental Health professionals. 
You not only brought your ferocious intellect to NEUROMIND : you obviously brought your humanity.  Bravo!


Gaetana (Tana) Del Prete LPC BCN
Licensed Professional Counselor 
Board Certified in Neurotherapy

KEY CHAPTER INSIGHTS

Chapter one: The brain is a biological information processing system, sending messages from region to region over defined pathways which produce, among other actions, social adaptation.
 
Chapter two: Many regions of the brain participate in social interaction, but areas containing “mirror neurons” are particularly important for mimicry and the ability to differentiate self and other.  Emotions are messages created by the social brain for group communication.
 
Chapter three: The interactions between body and brain occur in the tegmental-hypothalamic region, which regulates bodily functions,  and coordinates them with external social demands.  The interactions are often difficult to define, as in post partum syndrome.
 
Chapter four: The significance,linking sensory data with rewards, is stored in the Papez pathway through hippocampus.  Disturbances by various etiologies produce the “schizophrenias”. 
 
Chapter five: The “locking-on” process of sustained attention uses “working memory” to experience subjective awareness (also called  consciousness) to focus brain activities.  Psychosis occurs when focus is disturbed, and meditation and hypnosis are methods that use the process for repair.
 
Chapter six: The executive choice system includes both attention processes in chapter five and the prefrontal regions, where multiple pathways converge to select behaviors.  The “choice” of behavior is transmitted through basal ganglia nuclei that have previously learned and stored sequences to be activated.
 
Personality is the pattern of learned social interactions,  (the analogy to posture in response to gravity),  stored in basal ganglia pathways,  which may be altered by experience. 
 
Chapter seven: The two primary social learning experiences are primary attachment  and sexuality.  Detailed studies of attachment have been performed and related to borderline syndrome
.  The factors regulating the patterns of sexual identity and behavior have been poorly researched, and are not understood.
 
Chapter eight:  The response to danger is organized over pathways from amygdala to other brain regions, similar to the hippocampal papez circuit.  The five aspects of amygdala response can be related to five clinical patterns seen in anxiety disorders, including PTSD.  Aggression also originates in amygdala but its control is poorly understood.
 
Chapter nine: Addiction is the “hijacking” of the motivation system by non survival motivation.  This was traditionally focused on chemical substances, but other behaviors may also result in maladaptive motivation.  Multiple factors contribute to the vulnerability.
 
Chapter ten: The revised diagnostic system is based on the function of the pathways responsible for adaptive behavior,  and the disturbances, called etiologies, that alter them, including social factors.  Illness is measured by the severity of impaired adaptation, not the presence of symptoms.  Adaptation is bidirectional both superior and impaired adaptation.
 
Chapter eleven:  Psychopharmacology, the preferred intervention at present,  involves three decisions: Does the medication work (and how?)?  What is the balance of intended and other effects?  When should the medication be discontinued?  There is confusion in dealing with each one.
 
Chapter twelve: Altering pathways by input of information (psychotherapy, etc) involves five factors:  the level of interpersonal interaction, the balance of verbal and non-verbal information,  the channels of communication, the balance of cognitive and emotional focus,  and the extend of control of process (agency) by the client or programmer.  No current system of treatments attempts to balance these in therapist and client, and evaluate the results.