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Book Forum: MOOD DISORDERS   |    
A Mood Apart: Depression, Mania, and Other Afflictions of the Self
LAURI R. ROBERTSON, PH.D., M.D.
Am J Psychiatry 1998;155:1291-1291.
View Author and Article Information
New Haven, Conn.

by Peter C. Whybrow, M.D. New York, Basic Books, 1997, 340 pp., $24.00; $13.00 (paper)

Book Forum

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One cannot help joining a chorus of praise—William Styron, Kay Jamison, Peter Kramer, and Maggie Scarf among the members—for this splendid book. The title, which is taken from a Robert Frost poem, sets the stage for a humanistic as well as scientific journey through our most comprehensive understanding of mood. Peter Whybrow, Director of the Neuropsychiatric Institute at the University of California, Los Angeles, is a well-appointed guide. He offers the perspective of a distinguished researcher, never far from that of a classically educated Englishman whose curiosity flows from the nineteenth-century naturalist tradition at its best. Whybrow identifies his approach as "that of the physiologist" (p. xvii). His thoughtfulness and sensitivity as a clinician are also readily apparent.

The text is structured as an essay woven around clinical portraits of five individuals with severe mood disorders (four patients and one former classmate and friend). We are drawn to feel close to Whybrow’s subjects and their families as they speak for themselves and interact with their physician, who also shares brief autobiographical reflections. That these characters are in fact "composites," although their stories are "real," is no impediment to the author’s purpose in this context (p. xix). Historical, scientific, medical, and literary elaborations punctuate and frame the clinical images. Nearly a quarter of the book is devoted to an appendix and notes, which frees the body of the text from academic and technical detail while offering readers the option of further reference and more scholarly pursuit. The writing is lucid and vivid throughout. In moments, however, it strains a bit unsuccessfully toward the prose of a novelist.

Although written for a popular audience, A Mood Apart contains a great deal for all mental health professionals, particularly psychiatrists, to contemplate. Functioning under shifting paradigms, we often find ourselves split into mind and brain camps or giving lip service to biopsychosocial integration. Indeed, I cannot be alone in feeling that in attending to a transference subtlety and prescribing an antidepressant in the same hour, I’ve changed hats, or, regarding a patient’s persistent, vehement complaints, in suddenly wondering if a trial of a mood stabilizer is warranted. How disheartening it is to have a patient repeat the now familiar refrain, "I have a chemical imbalance," when, in fact, he or she seems to be experiencing an unwelcome emotion. It is equally disheartening to have a patient refuse to consider medication, saying, "This is how I am." Yes, there is integration, but it’s hardly seamless.

Employing the central evolutionary biological concepts of homeostasis, adaptation, and attachment, Whybrow presents a logical and rather down-to-earth conception of mind-brain integration. This is extremely helpful in thinking about the amalgam of elements that we call character and self. Although his focus is on severe, diagnostically unequivocal disorders of mood, Whybrow makes it clear that there is a continuum of emotional experience to which his perspective may be applied. He repeatedly emphasizes that nature and nurture are inexorably linked and that both uniquely determine what constitutes stress for a particular individual. Although he recommends concurrent pharmacological and psychotherapeutic treatment, I wish he had said more about the dynamics and resolution of individual conflict in the therapeutic process, especially for patients whose symptoms are less than severe. Such pursuit might inevitably necessitate "reinvention" of psychoanalysis in the twenty-first century.

In summary, A Mood Apart is a superb work, an orienting compendium for colleagues, and perhaps the best overview of mood disorders that psychiatry has to offer a general audience.

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