Books: Prodding for the depressed

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The Independent Culture
A MOOD APART: A Thinker's Guide to Emotion and its Disorder by Peter C Whybrow, Picador pounds 17.99

BOOKS ON the brain are currently raining into the stores so thick and fast, it is hard to delve into anything that is not a self proclaimed "brilliant" new expose of how our grey matter works - usually under the Big Brother control of omnipotent genes, natural selection processes and computation. Whybrow's "compendium" is a welcome exception.

As a practising psychiatrist, Whybrow is fascinated by depression and mania in real human beings. He has distilled his insights and knowledge on these truly crippling conditions into a highly readable digest that will be compelling reading to anyone suffering from emotional disorders, or indeed merely fascinated by what emotions are, and how they steer and reflect our daily life.

Each chapter tells a story, and each could be read alone. Starting with a graphic account of his own grief at his father's death, Whybrow uses case studies to illustrate melancholic depression, and then mania. Depression emerges as a consistent and clear syndrome, difficult to diagnose in the early stages because of the varied lifestyles and personalities of the sufferers. But as time goes on, the consistency of signs and symptoms unmasks the problem, not just as one of emotion - of feeling distant and numb - but as a thought disorder too, along with a body "housekeeping" problem of eating and sleeping appropriately. We see how depression slowly distorts the entire mind-set and hence lifestyle of each individual, sometimes to such extremes that oblivion seems the only palliative.

Mania, by contrast, comes across as a highly desirable condition characterised, in the early stages, by leaps of imagination and boundless energy. Sadly however, the cases of two particular manias illustrate a progressive loss of judgement leading to antisocial behaviour subsequently tail-spinning into deep depression. For the first time, notwithstanding the endless entries on mania in medical and neuropharmacological textbooks I've read, it seemed that I really understood what the condition actually felt like.

Whybrow cleverly mixes human interest with facts so that the narrative sustains pace. I noted that brain diagrams, along with more mechanistic explanations of how the chemical messengers - transmitters - work within the brain, and indeed how they are manipulated by drugs, were all very sensibly left tucked away in an appendix for the reader to pass up or pore over, according to their degree of curiosity or depth of knowledge. The fact that the main text at least, contains not one figure, also distinguishes it fundamentally from even the remotest resemblance to any type of pedagogic offering.

Although Whybrow does not attempt a simplistic neuro-reductionist list of reasons for depression, he does, nonetheless, give a near-exhaustive account of the important influences. For example, his admirably wise view of genes is as mere risk factors, not direct causes, for depression and mania. The chapters on genetic disposition to certain types of temperament and emotional profiles, combined with intelligent and unhysterical arguments in favour of electroconvulsive therapy (ECT), all make for an absorbing and balanced account, along with descriptions of aberrant neuronal reactions to the seasons, or the hormonal imbalances that can follow childbirth.

The storyline therefore races along, encompassing the basic material without too much distraction. Perhaps however, the very strength of this work - that it does not chase a sensationalist theory of consciousness or mind - is also a weakness: the conclusions are reassuring rather than stimulating. The most constructive element of Whybrow's stance is that, over time, he favours a triple assault in treating depression and mania. In the short-term, the immediate acute phase, he dubs the ideal strategy "perturbation", or as his ex-manic friend favours, "prodding", for example with a short course of ECT. Secondly comes the longer-term approach, a slower acting therapy of anti-depressant drugs. A very important point here is that drug therapy is given a place, yet a limited one, in an ordered sequence of other treatments: hence the reader will see that a depressed patient need not necessarily rely on a lifetime of medication. Instead, as the longer term end-point Whybrow advocates "modification" through more "cognitive" therapies - a change of mind-set through re-evaluation and self-education rather than by the blunter (albeit more direct) instruments of electrical jolts or drug marinades.

Another drawback from the neuroscience platform, is that the anatomy of the brain is divvied up a little too easily into specific functions. Although it is undoubtedly true that damage to certain regions does result in certain dysfunctions, it does not always follow as readily as Whybrow implies that one area for example (the amygdala) is the "emotional sentinel", whilst another (the prefrontal cortex), is the "depository of emotional meaning". Each brain region is not an autonomous mini-brain, as this kind of scenario implies: instead, it is merely miniaturising the problem of relating brain anatomy to holistic brain functions and disorders.

But Whybrow writes primarily as a clinician, not as a scientist. As such he offers insights into the complexity of the human condition without any trite or reductionist attempts to "solve" the more academic and abstracted problem posed by the nature of consciousness. This book could offer enormous help to those whose lives fall under the shadow of mood disorders, as well as reminding the more reductionist neuroscientists, especially those turning to silicon circuits, and genetic dictums - just how complex and multi-layered the real brain is, and just how pivotal are the subjective feelings it generates.