by Peter C. Whybrow
Review by Deborah A. Hill on Jan 4th 2001
This is a collection of essays on various aspects of mood disorders by a renowned psychiatrist. It is a combination of reflection over his life of clinical practice, conversations with friends and patients and analysis of the background of mental illness diagnoses. His particular focus is on depression in its most profound form, melancholy, and its variant, manic-depression. He seeks to elucidate the varieties of how mood disorders present in a wide variety of patients and how mental illness workers can help them. He differentiates the terms emotion and mood by declaring that emotion is "usually transient and responsive to the thoughts, activities, and social situation of the day." Mood "is the consistent extension of emotion in time."
The basic premise that informs his discussion is that we as biological animals always return to homeostasis. "Emotion is the homeostat of life, an instrument of social self-correction--and when we are happy or sad it has meaning." Melancholy and mania are disorders of this homeostasis. He develops this from a physiological perspective by describing the basic workings of the brain and its effect on various systems in the body. But he also emphasizes that behavior, and therefore emotions and moods, "is an amalgam of biology and experience." "Change occurring in any one brain center will influence the activity of the whole limbic alliance. Furthermore, anything that distorts the harmonious interaction can result in the appearance of unstable emotional expression--as in the mood disorders--and, commonly, a loss of the usual patterns of the body's housekeeping homeostats controlling sleep, appetite, energy, and the hormonal rhythms." Such elements of stress, genetics, our sense of control, grief, social contacts, experience, hormones, personal responsibility, self-knowledge, evolution and medications are brought to bear on the issue of how depression develops, recurs and is stabilized.
In spite of the more casual approach of an essay, he does not skip the current research. Instead of makings lists, charts, and formal diagnoses, he uses the essay form to elucidate how one becomes/is depressed, how it colors that person's world and how the practitioner can enter into that world in order to minimize its deleterious effects on her or his life. His topics range from the basics of psychological and psychodynamic theory to the history of the relationship between medicine and religion to the continuing stigma that mental illness is a failure of the will, all illustrated by several case studies. So, the reader is brought up to date on research but in a conversational style rather than a formal paper.
Whybrow's book is relevant for professionals and lay alike, as it describes what it is really like to be deeply depressed from several important perspectives. Mental illness workers might learn more about what it is like from the client's perspective, thereby aiding in their practice, and the clients themselves could increase their self-knowledge that is so important to an effective treatment.