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A Mood Apart: Depression, Mania and Other Afflictions of the Self
This is not a conventional self-help book; rather, it is a compendium in the classical sense. It is a digest of what I know and what intrigues me as a practicing physician, about emotion, mood, and the emotional brain, about how the emotional self can become disordered, and about the treatment of those disordered states.... It is my hope that A Mood Apart will be particularly helpful to those who themselves suffer from depression or manic depression, or who have experienced the illnesses through someone close to them. --- excerpts from book's Prologue
363 pages, Paperback
First published January 1, 1997
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Displaying 1 - 15 of 15 reviews
October 13, 2013
Once I started this book I couldn't help wanting to finish it.
It's far from perfect: the author isn't Oliver Sacks but wishes he were, and is a little too keen to extoll the virtues of modern medicine while downplaying the perfectly good reasons why many patients have a hard time with psych meds, hospitalization, and other forms of treatment.
But overall: very good, insightful, and lyrical. Good balance of history, philosophy, personal stories, neuroscience, and practical advice-- all relating to the wide spectrum of depressive disorders. And as someone who suffers from a mood disorder, it has been incredible to see all the experiences that baffle and frustrate me laid out on paper as if they weren't incomprehensible at all.
Quotes:
"It is one of the great ironies of Western culture that we revere and socially applaud sustained creativity, drive, and infectious enthusiasm but fail to recognize these qualities as close cousins of the disorganization and suspicion that accompany them in mania and are stigmatized as maniacal madness."
p. i
"Eleven to fifteen million people in the United States are afflicted with mood disorders of some description, and of these, over two million suffer the severe form of manic-depressive illness. However, fewer than one-third of these millions ever receive treatment or even recognize that their misery could be relieved.... Moods develop from our emotions, and because emotional life lies at the very core of being a person, to accept that emotion and mood can be 'dis-ordered' calls into question the very experience that most of us take for granted-- the presence of a defined, predictable, and unique subjective entity that we fondly refer to as the intuitive 'self.'"
p. 7
In depression: "Attachments to family and friends become meaningless; one no longer eats with appetite, if one eats at all; sex is a forgotten pleasure. Memory and decision-making become impaired. A preoccupation with minutiae and past failure steals away normal concentration, driving out any sense of joy. The skills to adapt to changing circumstance are lost. In their place exist painfully diminished energy and negative self-perception. Social responsibilities are forgotten or excused, Life becomes a burden.... The experience that the sufferer describes has only distant relevance to the real events of the world. What may have started as an appropriate response to a tragic moment extends into some sort of behavioral cancer, a malignant mood that invades and distorts the very nature of the self."
p. 15
"Emmett [who had manic-depression and committed suicide] was killed not only by his own hand but by the social stigma that surrounds depression and manic depression. While we may aspire to the energy and vivacity of early mania as a form of life enhancement, at the other end of the continuum depression is still commonly considered evidence of failure and a lack of moral fiber. This will not change until we can speak openly about these illnesses and publicly recognize them for what they are-- human suffering driven by dysregulation of the human brain."
p. 64
"Our coherent image of the world is a unique interactive process between our brain's biology and what we experience. Each can change the other."
p. 68
John, a patient, said: "'In depression, your normal self shrinks and you have little time for others... The territory of the self gets smaller and smaller until it's totally occupied. So when you talk to anyone you're not really interested in what they have to say because there's no room for them anymore.'"
p. 146
"Selye proposed three phases of his general adapatation [response to stress] syndrome-- alarm, resistance,and exhaustion. The first two, taken together, equate essentially to what I have described as reactive homeostasis-- the autonomic arousal and hormone release of healthy adaptation. The third phase, exhaustion, corresponds to the kindling of chronic arousal and adaptive failure. Under these chronic conditions, the feelings of foreboding, increased vigilance, and being 'wired' that occur during acute stress evolve into anxiety, insomnia, loss of sexual interest, and reduced appetite-- all symptoms experienced during melancholia."
p. 171
"John's experience, where a decline in mood is not the first sign of oncoming depression, is not unique. In fact, some 5 or 10 percent of individuals never experience obvious sadness, but progress through a period of increasing anxiety and disorganization-- which they find difficult to pin down as a mood disturbance-- directly to anhedonia and the syndrome of melancholia. Sometimes it is sleep that is first impaired, or they find themselves increasingly tense and fatigued, with vague aches and pains similar to the early stages of flu."
p. 182
"We find this same rigidity [referring to the abnormally inflexible rhythms that precede epiletic seizures and heart attacks] in bipolar illness. In mania, and in melancholia, a healthy responsiveness to ongoing events becomes replaced by a terrifying determinism. At the height of Melanie's mania, her sleep, thought, and action proceeded as dictated by her demons and the underlying molecular disturbance that had given them life.... Moods stand apart from the requirements of the day, and the accustomed balance of life's rhythm disappears."
p. 219
"The choice of an appropriate antidepressant requires of the phycisian a familiarity with psychopharmacology, a certain empiricism, and an alliance, ideally of mutal trust, with the patient. The pharmacology of mood, and expecially the treatment of depression, has become a complicated subject... There are now many antidepressant drugs from which the physician may choose. However, what is still frustrating and painful to those who are melancholic, and to their family members, is that none of the medications, new or old, improves depressed mood immediately. And the first medication chosen is not always the one that reverses the depressed mood. Thus, in the alleviation of depression by antidepressant drugs, confidence is required between doctor and patient. While success is ultimately achieved in over three-quarters of those treated, it is not something instantly attained."
p. 224
"...because of the idiosyncrasy of brain chemistry and our ignorance of the specific regulatory defect that drives bipolar illness, for each individual the pharmacological treatment of depressed mood remains a miniseries of empirical scientific experiments, through which the doctor and patient, working together, discover the best fit between pill and person."
p. 227-8
"Margaret's angry reaction [saying that she never wanted to see her brother again after a very disruptive and frightening visit while he was manic], born out of frustration and love, is a common experience for the family members of those who suffer manic depression and melancholia. Even when the difficult behaviors and accusations are recognized as illness, the pain and emotional chaos that they breed is real, destroying intimacy and caring. The subtle distortions of communication and the irritable blame, which so often occur in smoldering chronic depression, are frequently more difficult for families to bear than acute, bizarre episodes such as the one Margaret describes. The tragedy of these disrupted attachemtns is reflected in the statistics about those who suffer these illnesses, with evidence of frequent divorce, poor job performance, social isolation, and even criminal acts being commonplace.
"What is often most difficult from the standpoint of family members is the fright, apprehension, and sheer frustration of not knowing how to help. Tolerance cannot always be sustained and inevitably tempers flare and battles rage."
p. 239-240
Stephan, a patient, recalls: "'During those early months I couldn't see anything objectively. I was jaded and pessimistic one day, and unreasonable and demanding the next. My relationships with my friends and family were in tatters.'"
p. 244
"Several time-limited therapies, including interpersonal psychotherapy and supportive-expressive psychotherapy [in contrast to classic psychoanalysis], have been developed. Each focuses upon problems of self-distortion and how these distoritions, through conflicted relationships, can initiate a vicious circle of depression and disturbed behavior."
p. 246
"Cognitive therapy is more actively structured, time limited, and goal directed than synamic therapy, with the therapist seeking an active intellectual collaboration with the patient. The basic proposition is that specific ideas-- the now-familiar schema-- have been adopted as we learn about ourselves and the way the world is organized. Some of these ideas are inaccurate, distorted by the circumstances under which they were acquired. Nevertheless, they become automatic representations of what we believe the world to be...
"These automatic thoughts are in many cases the prelude to depressed mood, fostering negative thinking about ourselves, others, and the world in general."
p. 247
It's far from perfect: the author isn't Oliver Sacks but wishes he were, and is a little too keen to extoll the virtues of modern medicine while downplaying the perfectly good reasons why many patients have a hard time with psych meds, hospitalization, and other forms of treatment.
But overall: very good, insightful, and lyrical. Good balance of history, philosophy, personal stories, neuroscience, and practical advice-- all relating to the wide spectrum of depressive disorders. And as someone who suffers from a mood disorder, it has been incredible to see all the experiences that baffle and frustrate me laid out on paper as if they weren't incomprehensible at all.
Quotes:
"It is one of the great ironies of Western culture that we revere and socially applaud sustained creativity, drive, and infectious enthusiasm but fail to recognize these qualities as close cousins of the disorganization and suspicion that accompany them in mania and are stigmatized as maniacal madness."
p. i
"Eleven to fifteen million people in the United States are afflicted with mood disorders of some description, and of these, over two million suffer the severe form of manic-depressive illness. However, fewer than one-third of these millions ever receive treatment or even recognize that their misery could be relieved.... Moods develop from our emotions, and because emotional life lies at the very core of being a person, to accept that emotion and mood can be 'dis-ordered' calls into question the very experience that most of us take for granted-- the presence of a defined, predictable, and unique subjective entity that we fondly refer to as the intuitive 'self.'"
p. 7
In depression: "Attachments to family and friends become meaningless; one no longer eats with appetite, if one eats at all; sex is a forgotten pleasure. Memory and decision-making become impaired. A preoccupation with minutiae and past failure steals away normal concentration, driving out any sense of joy. The skills to adapt to changing circumstance are lost. In their place exist painfully diminished energy and negative self-perception. Social responsibilities are forgotten or excused, Life becomes a burden.... The experience that the sufferer describes has only distant relevance to the real events of the world. What may have started as an appropriate response to a tragic moment extends into some sort of behavioral cancer, a malignant mood that invades and distorts the very nature of the self."
p. 15
"Emmett [who had manic-depression and committed suicide] was killed not only by his own hand but by the social stigma that surrounds depression and manic depression. While we may aspire to the energy and vivacity of early mania as a form of life enhancement, at the other end of the continuum depression is still commonly considered evidence of failure and a lack of moral fiber. This will not change until we can speak openly about these illnesses and publicly recognize them for what they are-- human suffering driven by dysregulation of the human brain."
p. 64
"Our coherent image of the world is a unique interactive process between our brain's biology and what we experience. Each can change the other."
p. 68
John, a patient, said: "'In depression, your normal self shrinks and you have little time for others... The territory of the self gets smaller and smaller until it's totally occupied. So when you talk to anyone you're not really interested in what they have to say because there's no room for them anymore.'"
p. 146
"Selye proposed three phases of his general adapatation [response to stress] syndrome-- alarm, resistance,and exhaustion. The first two, taken together, equate essentially to what I have described as reactive homeostasis-- the autonomic arousal and hormone release of healthy adaptation. The third phase, exhaustion, corresponds to the kindling of chronic arousal and adaptive failure. Under these chronic conditions, the feelings of foreboding, increased vigilance, and being 'wired' that occur during acute stress evolve into anxiety, insomnia, loss of sexual interest, and reduced appetite-- all symptoms experienced during melancholia."
p. 171
"John's experience, where a decline in mood is not the first sign of oncoming depression, is not unique. In fact, some 5 or 10 percent of individuals never experience obvious sadness, but progress through a period of increasing anxiety and disorganization-- which they find difficult to pin down as a mood disturbance-- directly to anhedonia and the syndrome of melancholia. Sometimes it is sleep that is first impaired, or they find themselves increasingly tense and fatigued, with vague aches and pains similar to the early stages of flu."
p. 182
"We find this same rigidity [referring to the abnormally inflexible rhythms that precede epiletic seizures and heart attacks] in bipolar illness. In mania, and in melancholia, a healthy responsiveness to ongoing events becomes replaced by a terrifying determinism. At the height of Melanie's mania, her sleep, thought, and action proceeded as dictated by her demons and the underlying molecular disturbance that had given them life.... Moods stand apart from the requirements of the day, and the accustomed balance of life's rhythm disappears."
p. 219
"The choice of an appropriate antidepressant requires of the phycisian a familiarity with psychopharmacology, a certain empiricism, and an alliance, ideally of mutal trust, with the patient. The pharmacology of mood, and expecially the treatment of depression, has become a complicated subject... There are now many antidepressant drugs from which the physician may choose. However, what is still frustrating and painful to those who are melancholic, and to their family members, is that none of the medications, new or old, improves depressed mood immediately. And the first medication chosen is not always the one that reverses the depressed mood. Thus, in the alleviation of depression by antidepressant drugs, confidence is required between doctor and patient. While success is ultimately achieved in over three-quarters of those treated, it is not something instantly attained."
p. 224
"...because of the idiosyncrasy of brain chemistry and our ignorance of the specific regulatory defect that drives bipolar illness, for each individual the pharmacological treatment of depressed mood remains a miniseries of empirical scientific experiments, through which the doctor and patient, working together, discover the best fit between pill and person."
p. 227-8
"Margaret's angry reaction [saying that she never wanted to see her brother again after a very disruptive and frightening visit while he was manic], born out of frustration and love, is a common experience for the family members of those who suffer manic depression and melancholia. Even when the difficult behaviors and accusations are recognized as illness, the pain and emotional chaos that they breed is real, destroying intimacy and caring. The subtle distortions of communication and the irritable blame, which so often occur in smoldering chronic depression, are frequently more difficult for families to bear than acute, bizarre episodes such as the one Margaret describes. The tragedy of these disrupted attachemtns is reflected in the statistics about those who suffer these illnesses, with evidence of frequent divorce, poor job performance, social isolation, and even criminal acts being commonplace.
"What is often most difficult from the standpoint of family members is the fright, apprehension, and sheer frustration of not knowing how to help. Tolerance cannot always be sustained and inevitably tempers flare and battles rage."
p. 239-240
Stephan, a patient, recalls: "'During those early months I couldn't see anything objectively. I was jaded and pessimistic one day, and unreasonable and demanding the next. My relationships with my friends and family were in tatters.'"
p. 244
"Several time-limited therapies, including interpersonal psychotherapy and supportive-expressive psychotherapy [in contrast to classic psychoanalysis], have been developed. Each focuses upon problems of self-distortion and how these distoritions, through conflicted relationships, can initiate a vicious circle of depression and disturbed behavior."
p. 246
"Cognitive therapy is more actively structured, time limited, and goal directed than synamic therapy, with the therapist seeking an active intellectual collaboration with the patient. The basic proposition is that specific ideas-- the now-familiar schema-- have been adopted as we learn about ourselves and the way the world is organized. Some of these ideas are inaccurate, distorted by the circumstances under which they were acquired. Nevertheless, they become automatic representations of what we believe the world to be...
"These automatic thoughts are in many cases the prelude to depressed mood, fostering negative thinking about ourselves, others, and the world in general."
p. 247
June 29, 2008
The author, a psychiatrist, attempts to explain to the lay person the physical causes of depression and mania and the way psychiatric drugs such as Prozac and Lithium work to keep these illnesses under control. He uses real-life examples of depressed and bipolar people to help the reader's understanding.
Considering that much of this book concerned brain chemistry, I thought it was reasonably understandable, and the style of writing mostly managed to avoid the denseness of a textbook. Whybrow addresses some of the various forms of talk therapies as well as medications, and he includes some helpful tables in the back of the book of anti-depressant drugs and mood stabilizers and their side effects. This is a good resource for people suffering from depression or bipolar disorder, or any other person who wants to learn about these illnesses.
Considering that much of this book concerned brain chemistry, I thought it was reasonably understandable, and the style of writing mostly managed to avoid the denseness of a textbook. Whybrow addresses some of the various forms of talk therapies as well as medications, and he includes some helpful tables in the back of the book of anti-depressant drugs and mood stabilizers and their side effects. This is a good resource for people suffering from depression or bipolar disorder, or any other person who wants to learn about these illnesses.
March 13, 2015
I've been reading this book on and off for a long, long time, the subject requiring a very specific state of mind and often hitting rather close to home (not so much the parts about mania, but the descriptions of depression definitely felt familiar). It feels somewhat dated, but I actually found it interesting to learn about the earlier days of modern psychiatry (i.e. since the 70s) and the book covers a wide range of topics around mood disorders. The author has been working the field for decades, and what made this book especially appealing was the genuine liking and respect for the people whose stories are told.
March 13, 2010
Reading for added knowledge for the diagnoses etc. that I come across at work- it is incredibly well written and articulate. And fascinating. For anyone who wants to know more about mood disorders, depression and wants to write a truly literary book about such subjects.
Read
May 7, 2020didn't finish
December 9, 2011
Having lived with someone with bipolar (who was a poster child for keeping the disorder in check) and having met Peter Whybrow, this is a great book to read. It provides invaluable insight into the disease as well as other mental illnesses and how to navigate them. The most important thing to take away is that mental disorders require a three pronged approach. 1) self awareness and acknowledgement that you have the disease 2) therapy 3) consistent medication. If people don't embrace all three, they will forever be plagued with the highs and lows that go hand in hand with most mental illness. Definitely a good read.
August 24, 2013
The science and research that informs treatment for mood disorders, manic depression in particular. Made me realize how specific some of the interventions are...and that the best outcome is from a combination of correctly chosen drugs, sometimes shock therapy, and talk therapy. This was published in 1997. I'm guessing there have been advances in treatment since then. My copy from 1997 had a different subtitle: "Depression, Mania, and Other Afflictions of the Self." I wonder why the change for the 1998 edition. Sales? He quotes from Kay Redfield Jamison's memoir (An Unquiet Mind, 1995): "...madness carves its own reality."
August 28, 2007
An excellent book for anyone who has ever been forced to ask, "why?" This is one of the best books I've ever read on mood disorders. It's heart-felt, terrifying, and compassionate. It beautifully combines explanations of the science behind these disorders with the emotional impact they have on the sufferers and the people who love them.
February 7, 2008
This is a very good discussion of depression and mania and the ways they intersect. It's slightly dated now in terms of some of the theories regarding the causes of depression and bipolar disorder, but it's still a good treatment of the subject and gave me a lot to think about.
May 27, 2014
I read almost 200 pages of this highly technical tome, and then I just couldn't go any farther. Not particularly enjoyable or informative for people who are well-versed in bipolar disorder. 1.5 stars.
February 2, 2008
an excellent book that explains the processes of two very misunderstood diseases. i think this should be mandatory reading for everyone
Currently reading
April 9, 2008Helping me understand normal...
August 8, 2010
A dense book that discusses the chemical aspects of depression and manic depression (bipolarism).
April 3, 2011
Compassionate and clinical, a recommended resource for survivors of a loved one's suicide.
February 25, 2013
Deeply informative and empathetic book about bipolar illness. Beautiful writing.
Displaying 1 - 15 of 15 reviews