Abstract
The beautiful city of Sydney is associated with many things in the popular imagination but rarely with depressive illness. However, it is the site of a world-renowned centre for research into mood disorders: The Black Dog Institute. The term is usually attributed to Winston Churchill, but he may have borrowed it from the poet, William Cowper. The authors of this guide are both associated with the Black Dog Institute. Professor Gordon Parker is its executive director and Dr Manicavasagar is a senior research fellow. Together they have produced an erudite, informative and thought-provoking volume that ranges from the conceptual bases upon which our thinking about depressive disorders rests to the clinical management of these extremely challenging conditions.
As the authors point out, both the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association and the International Classification of Disease of the World Health Organization define depression as essentially a single condition varying only by severity. There are of course major problems with this approach. Parker and Manicavasagar expose the weaknesses in these existing models and describe a new approach to subtyping and managing depression based on specific subtypes. They argue that depression may exist as a disease, a disorder or syndrome and therefore requires a multi-modal approach to conceptualization and management.
The authors are to be applauded for returning to what in the past has been a difficult battlefield. Many will recall the essentially unresolved clash between the Maudsley School of Dimensionalists and the Newcastle School of Dichotomists with regard to the classification of depression. Of course, common and heterogeneous disorders such as depression must be no more than a taxonomic label for a variety of ills. The authors have made a brave attempt to advance the field; inevitably, however, this will not be the last word on the classification of depression but, at the moment, it is a useful, practical and extremely valuable summary of where we are at present, including our current uncertainties and the potential ways forward. What I found particularly refreshing about this book was the brio with which it was written, again, to quote Winston Churchill, ‘attitude is a little thing that makes a big difference’. The attitude and approach displayed by the authors of this volume are surely a hopeful prognostic sign for future research in depression.
Allan H. Young
Vancouver, Canada