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Book Reviews |
Key Words: Books Reviewed
A Mood Apart is a book about mood, human emotions, and their function in everyday living. It is particularly focused on mania, depression, and the way these illnesses affect the lives, families, and environment of those who suffer from them. Dr. Whybrow has been able to produce a compendium of up-to-date knowledge with a wide source of reference. His approach to mood disorders, as he points out, is that of a physiologist who pays attention to molecular detail and behavior of the entire organism, in this case the human being. The book is his attempt to document what he has learned through his training, education, and many years of experience with the men and women who suffer from mood disorders.
As the author notes, he has witnessed a revolution through his professional lifetime. We have learned more about the molecular structure of the brain in the past 30 years than we learned throughout the previous 2,000 years. We have gained an understanding of how brain chemistry is altered in people who suffer from mood disorders, and we have applied this knowledge to the development of new drugs and effective treatments. Whybrow engagingly writes, however, that human behavior is not a manifestation of biologically programmed and genetically predetermined anatomical structures, neurotransmitters, and receptors. At the same time, he objects to those who believe human destiny is entirely determined by one's experience with the environment and can be changed by personal will and new corrective experiences.
The author makes it clear that he rejects the voices of reductionism and believes in a comprehensive and intelligent integration of biological, psychological, and social factors—the biopsychosocial model. He favors a dynamic and integrative approach, one that combines objective science with an understanding of the personal experience of people who suffer from these illnesses. To highlight the importance of such an integration, the author communicates his clinical and basic-science knowledge of the brain and its function while also relating a series of personal stories that are interwoven with the scientific data.
The book describes the clinical manifestation of mood disorders, as well as the underlying structures of the brain and the environmental stresses that may trigger the cycles of mania and depression in genetically predisposed individuals. Each chapter is written with great sensitivity to the personal experience of the individuals who have suffered severe depression, mania, or a combination of both. The first chapter begins with an account of the author's loss of his father and the grief experience following this loss.
The book is skillfully written and filled with lively descriptions. It reads like a novel and is so delightfully engaging that it was difficult for me to put it aside once I had started reading. The author takes complex concepts of the brain and human behavior and simplifies them by the use of metaphors, examples from world literature, and his personal experience. For example, a chapter that deals with the development of the emotional self is entitled "A Mind of One's Own." It begins with a quotation from anatomist John Zachary Young's Programs of the Brain, communicating that "all life depends on the flow of information," and another from Tolstoy's The Death of Ivan Illych, affirming that each person is unique in having a mind of his own. I found of particular interest the author's definition of the concept of mind: "What we experience as mind is the orderly activity of the brain. Mind is the subjective awareness of the continuous processing of information among the many neurons that make up the brain's organic parts." The author explains how states of mind change in our very dependence on external influences, whether chemical (such as alcohol) or environmental and social (such as sudden news of a loss).
The chapter "The Legacy of the Lizard," which focuses on the anatomy of the emotional brain, begins with a quote from Paul D. MacLean's The Triune Brain in Evolution.1 MacLean emphasizes that the human brain has evolved and expanded to its great size while retaining the features of three basic evolutionary formations that reflect an ancestral relationship to the reptiles, early mammals, and recent mammals. Thus the three neural assemblies constitute a triune brain, a hierarchy of three brains in one. In this context Whybrow explains wonderfully the various functions of the brainstem, the limbic system, and the neocortex and how they interact with each other in health and disease. However, since he is so thorough in his use of sources, I was rather surprised that he has omitted the important contributions of the English neurologist John Hughlings Jackson, who more than a hundred years ago laid the foundation for MacLean's concept of the triune brain.2–4
Another example of the author's method is the chapter about the adaptation and care of the self, "Thoughtful Reconstruction." The information is beautifully presented in the context of a chess game between the author and his friend Dr. Stephen Szabo. The author presents the idea of treating the extreme states of mania and depression on the principles of "perturbation, facilitation, and modification." He then notes that Dr. Szabo, who himself has experienced manic-depressive illness, suggested changing these terms to "prodding, assistance, and modification." Adding his personal experience, the author creatively communicates how these three phases serve as a structured map to the care and treatment of patients who suffer from manic-depressive mood disorder.
In sum, A Mood Apart is truly a classic and unique contribution, offering a comprehensive and in-depth review of scientific information based on an integrative biopsychosocial model.
Footnotes
Dr. Torem is founder and Medical Director of the Center for Mind-Body Medicine, Akron, OH, and Professor of Psychiatry, Northeastern Ohio Universities College of Medicine, Rootstown, OH.
References
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