Abstract
As we well know, mood disorders exact a massive toll in human life and suffering. Much research has concluded that subjective quality of life is overwhelmingly determined by prevailing mood. With the development of the concept of disease burden, the real impact of major psychiatric disorders on human populations is finally being given due recognition. It is with these implications for quality of life that editors Peter Joyce and Philip Mitchell begin and end their multi-author textbook on classification, diagnosis, treatment and correlates of depression and bipolar disorder. There are 53 contributors to 40 chapters, mostly psychiatrists from Australia and New Zealand. But among others are nurses, medical students, bioscientists, lawyers and politicians.
Mania and melancholia were first described by Hippocrates, and linked together as a syndrome by Aretaeus of Cappadocia in antiquity. Yet with respect to modern diagnosis Gordon Parker suggests that our current DSM-dominated dimensional approach ‘should embarrass the profession’. The validity of the major depression concept is rarely questioned despite overwhelming evidence of its heterogeneity. In a chapter which defines the book, Parker suggests that depression needs to be subclassified into psychotic, melancholic and non-melancholic types, the latter being further subcategorized on life event and personality dimensions. It is refreshing to read a textbook not afraid to challenge unsustainable orthodoxy.
One of the outstanding features of this monograph is that in contrast to many others, bipolar illness is not added as a virtual afterthought to depression; it is a key focus throughout the text. As with depression there is also a challenge to orthodoxy in excellent descriptions and discussion of the bipolar spectrum (one scheme involves eight subtypes including bipolar III1/2). The enormous benefit for many patients in early diagnosis and treatment of bipolar spectrum disorders is being increasingly recognized by clinicians.
Boundary issues with schizoaffective disorder and schizophrenia are covered more briefly. This is understandable in a book on mood disorders but a pity as the Kraepelinian dichotomy of 1896, alive and well in the DSM, is yet another orthodoxy way past its use-by date, and we are very overdue for a paradigm shift in the classification of psychoses.
Management is well covered and again in contrast to other sources, is specific for bipolar illness as well as depression, including chapters on psychotherapies. Content is up to date, comprehensive and presented without bias: psychodynamic psychotherapy and interpersonal therapy receive comparable attention to the ubiquitous cognitive behaviour therapy.
Another strength of the book is excellent chapters on comorbidities, particularly personality and alcohol/substance abuse. Chapters also address depression and bipolar disorder across the life cycle and in various contexts. I found the many first person descriptions, and especially Neil Cole's story of ‘surviving bipolar disorder’, deeply moving.
In my view, this textbook should be required reading for anyone working in psychiatry. It is a useful resource for General Practitioners and other health professionals. Most chapters are accessible to any interested reader, and should prove informative to patients and their families.
Once in a while, Australian and New Zealand psychiatry kicks a big goal on the global scale. In mood disorders, John Cade and lithium immediately come to mind. There is no doubt in my mind that this superlative work edited by Peter Joyce and Phillip Mitchell will prove a landmark Australasian contribution to the world psychiatric literature.