‘Trains of Thought: A Natural History of the Mind’ Review

Rebecca Wallersteiner takes a look at ‘Trains of Thought: A Natural History of the Mind’, a new book by clinical psychologist James Brennan about where the human mind has come from within our natural history as a species, how they work, how they develop over the course of our lives, and how we adjust to change.

In this thought-provoking, stimulating and engaging book, clinical psychologist James Brennan draws on personal, clinical and academic experiences to explore the human mind, as distinct from the brain. Trains of Thought blends scientific insight with real-life experience to offer a clear and accessible understanding of how we think, feel and adjust to change. Brennan combines psychology, neuroscience, and decades of clinical experience to show how consciousness is built from our senses, bodies, and memories – not a mystical process, but nonetheless beautifully constructed.

Judiciously referenced, with helpful reading lists at the end of each chapter, the book initially takes the reader on a journey through the evolutionary origins of the human brain and its leap in development around 50,000 years ago, to the mental-modelling creatures we are today. He clearly explains the processes of thinking, learning, memory and emotions, differentiating between different types of thought and memory and how these can sometimes be disrupted, (or heightened) by our emotion).

Brennan writes vividly with empathy and insight regarding the patients he has helped over the years. His intriguing case vignettes include Nell, a thirty-six year old doctor, training in endocrinology, who was dying from cancer. “The referral had suggested that we were meeting because Nell could not accept that she was going to die and would become furious whenever other people implied that this could happen,” he writes. In their first meeting, Nell made it clear that this would be the case for him too. She had risen out of an extremely deprived childhood to train to be a nurse and soon after she qualified applied for medical school. A very private and reserved person, Nell had few friends although she did seem to have close work colleagues who liked her and enjoyed her witty jokes. Before her diagnosis of fatal cancer, she had never seriously thought about being alive. “She was both horrified and regretful at how much she had taken for granted, how much she had missed. Nell’s questions were not entirely new to me. When I began working in oncology twenty-four years earlier there had been almost no clinical psychologists working in cancer in the UK’s National Health Service.”

Brennan was appointed to the first full-time clinical psychology post in cancer services in the NHS by Dr Liz Whipp, a clinical oncologist working at Bristol Oncology Centre. They worked together for twenty years. He went on to develop the first clinical psychology department in NHS cancer services.

Another fascinating case, described by Brennan, was that of a woman in her late twenties called Jane, the mother of two young children, who had recently been treated for cervical cancer. “In our first session she told me that, as far as she was concerned, her cancer was a punishment for having been sexually promiscuous earlier in her life. Jane had made the link between cervical cancer and the human papilloma virus, which is sexually transmitted, and from this had concluded that she was responsible for her predicament, and she was feeling guilty about it.” What she described was familiar to Dr Brennan as he had previously encountered patients who believed their cancer was a form of punishment. Digging deep into a patient’s story would enable them to understand a bigger story. As a child Jane had witnessed her fifteen year old sister’s death, after accidentally shooting herself with their father’s shotgun. It was a freak accident. Terrible grief followed of course and left Jane with the feeling that terrible catastrophes can happen out of the blue, when you least expect them. Getting cervical cancer re-triggered a feeling that she was somehow to blame, having been the daughter that had survived and that she had brought her illness upon herself. “Jane’s memories engendered such emotional distress for her that they had distorted her life, and until she was able to disinter her memories with me, and reflect upon her assumptions, she was a helpless victim to their power over her.” Talking therapies help people make sense of the things that have happened to them over the course of their lives and the assumptions, residual emotions and behaviour they have developed as the result.

My favourite chapter deals with how people adapt to change. “A world devoid of change becomes stagnant, and for us mentally active humans it is best avoided,” writes Brennan. People often avoid change as it is stressful, but new experiences are necessary to avoid us becoming stagnant and bored. However, rapid change, such as that experienced by Nell, can be overwhelming and even traumatic. “Most people are comfortable somewhere between these extremes, but there remains a tension between a wish to be stimulated, preferably by one’s own curiosity, and a wish to avoid the stress of the unpredictable, the uncontrollable, and the unknown,” explains Brennan. Travelling to places they have never been before and encountering new people and situations may be thrilling for some people and alarming for others. This chapter seems particularly topical at this time of year with all the changes and upheavals such new resident doctors inductions, starting a different hospital role and children returning to school.

A final chapter considers the end of life. Brennan reflects: “Almost regardless of where the trajectory of their illness takes them, most people come to deeply value the time they have left in this world. They tell me that this new appreciation of life is an insight that they vow to cherish, a lesson they never want to forget. They tell me that any wealth they have acquired resides in the relationships they have had with other people, and not in the material ‘stuff’ that perhaps they once believed was so important to acquire.”
I thoroughly enjoyed this book. It is a fascinating, scholarly read that encourages us to reflect on what makes up human and our relationships with each other, nature and the world around us and should appeal to practitioners and non-medics alike.

Dr James Brennan has been a clinical psychologist for over forty years, supporting a wide range of mentally ill patients, especially those with cancer. He trained at the Institute of Psychiatry in London, and subsequently taught medical students and doctoral clinical psychology trainees for most of his career. While at the University of Bristol’s Department of Palliative Medicine he published several academic papers and lectured internationally on cancer and palliative care. His previous book Cancer in Context (2004) has been reprinted four times.

Trains of Thought: A Natural History of the Mind by James Brennan, published in quality paperback, by Modernity Press, Bristol, available via Amazon and to order in all good bookshops, June 2025, priced at £16.00