Mood Apart: Depression, Mania and Other Afflictions of the Selfby Peter C. Whybrow
Mania and depression fascinate and haunt us, even if we do not suffer from them, because they are exaggerated expressions of usual mood states, the essential barometer of our everyday life. Unlike other brain disorders, mood disorders magnify the emotional swings that all of us experience. We all know our physical boundaries, where our corporeal selves begin and end but that knowledge does not extend to our emotional lives. How does one separate a mood from "personality"? How can we distinguish our state of mind from the concept of our own selfhood?
In A Mood Apart, Dr. Peter Whybrow examines mood disorder as "an affliction of the self," exploring the human being within the diagnosis. He minimizes the artificial separation between physical and mental life, to reconcile the physiological basis of our emotional state with the essential idea of our selfhood.
Our culture stigmatizes and romanticizes mental illness, confusing it with questions of will power, personal weakness or creative impetuosity. Dr. Whybrow helps us to think of emotions rationally and not judgmentally, by situating the true self somewhere within the continuum of radical feelings. Dr. Whybrow teaches us that we live our lives by systems of regulation and control -- a process he calls "emotional homeostasis." The primary goal of treatment, using a combination of psychopharmacology and talk therapy, is to restore to the patient a new understanding of and healthy master over mood disorders.
Like Peter D. Kramers' Listening to Prozac, and Kaye Jamisons' An Unquiet Mind, this elegant and authoritative book consoles by combining the intimacy of case studies with the objectivity of a lifetimes scientific research and clinical experience. It is essential reading for all those curious about how our brains "work" and our lives "feel," for those suffering from mood disorders and those who care about them.
The popular and controversial antidepressant Prozac has made serotonin and other mood-related neurotransmitters in the brain familiar to many. But Whybrow (coauthor, The Hibernation Response, 1988), chairman of psychiatry at the University of Pennsylvania, shows how these messenger chemicals fit into the larger structure of the brain, and in particular of the limbic alliance, which includes the amygdala and the thalamus, and which governs our emotions. Whybrow defines mood disorders as a disruption of the limbic alliance's homeostasisits self-regulating powerwhich in turn disrupts three areas of activity: thinking (such as memory), feeling (which becomes dominated by negativity), and "housekeeping" (such as sleeping and eating patterns). Sometimes the highly detailed scientific discussion becomes a little convoluted, a little redundant, and a little too full of gee-whizzing about the wonders of the human brain. But overall his presentation is illuminating, and the case histories demonstrate his sensitivity and skill as a clinician. In particular, the story of John Moorehead, a Jesuit academic with a generally optimistic and intellectually curious nature who suddenly plunged into a profound depression, illustrates the tortured and complex nature of manic-depression. His case also demonstrates one of Whybrow's most emphatic points: that experence, especially human attachment, is as important as biology in causing mood disorders. Thus, while Moorehead had a genetic predisposition to his illness, it flared up only after the breakup of a profound friendship. Whybrow therefore stresses that however effective drugs such as Prozac may be, they must be combined with psychotherapy.
Because of its emphasis on complicated neurobiology, this is not the place to begin learning about mood disorders. But for those already familiar with the subject, Whybrow's presentation offers a deeper understanding of, along with a humane and wise approach to, these very troubling illnesses.
- Basic Books
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- 6.49(w) x 9.55(h) x 1.23(d)
Read an Excerpt
A Glimpse of Melancholy
Grief, Emotional Homeostasis,
and Disorders of Mood
No one ever told me that grief felt so like fear.
C. S. Lewis
A Grief Observed (1961)
After the mind has suffered from an acute paroxysm of grief, and the cause still continues, we fall into a state of low spirits.
The Expression of the Emotions in Man and Animals (1872)
We buried my father according to his instructions, under the tree he had chosen in the little country churchyard. The weather that day was unsettled, in step, it seemed, with my inner feeling. All morning storm clouds had threatened, with gray hammerheads rising in the warm summer air. Then at noon, just as we gathered together, the heavens parted with a thunderous crack, and rain cascaded down in soaking sheets upon our bowed heads and the open ground.
My father had suffered a long and painful illness, so there had been ample time to come to terms with his death. The long transatlantic flights on the many visits back to England from my new home in America offered time for reflection during those final months. The visible shrinking of his person and his world, our discussions about life in the face of death, all gave me time to prepare. After all, as a doctor I had seen death creep up on people before. And as a psychiatrist I knew something about grief; I had counseled those for whom grief lingered, those for whom it had lapsed into a melancholic mood.
But this time it was different.
Being the elder son, I had fashioned a testimonial of sorts, something that reflected my love and esteem for the man. But at the funeral, when it came time for me to speak, my words dissolved in aflood of tears. Language was abandoned. I learned, as had generations of men and women before me, that for some losses there is no preparation. Faced with the stark reality not of any death, but of my father's death, I was once again a primal emotional being. For a moment, amidst the storm and turmoil of that day in June, I caught a glimpse of melancholy.
Over the natural life span grief touches everyone. It is a profound and numbing experience, and none of us will escape its twisting pain. When it strikes, the raw intensity of the feeling comes as a surprise. Life is rolled on its head, and we find ourselves off balance. Routine patterns and familiar assumptions are called into question. Social attachments of love and friendship that gave meaning and purpose are fundamentally changed. Inevitably we are confronted with the challenge of finding for ourselves a new fit with the world, for that which was once a stable and accustomed part of life's routine has been irretrievably lost. The external world has changed and with it the inner world of personal meaning.
The experience of grief is intrusive and primitive. "No one told me that grief felt so like fear," wrote C. S. Lewis in A Grief Observed, after the death of his wife. "I am not afraid but the sensation is like being afraid. The same fluttering in the stomach, the same restlessness, the yawning. I keep on swallowing." In grief there is an uneasiness, an urge to pace, an inability to concentrate that is difficult to explain. That summer of my father's death I felt sad but also strangely tense and anxious, as if in the presence of some primal danger. As a doctor I knew of that feeling, from the many vivid descriptions of my patients. It is the protest stage, the earliest and most obvious phase of grieving.
In protest's wake comes emotional withdrawal. Slowly the sense of disbeliefthe denial that the world has really changedgives way to a mental numbness and profound sadness. In breathing, the chest feels heavy; it takes a conscious effort to fill it with air. To this simple, fundamental act of living, there is added a sense of burden. Favorite interests and familiar appetites are lost. There is a distancing from the daily commerce of the world; a preoccupation with one's own thoughts and a preference for being alone. "I find it hard to take in what anyone says," wrote Lewis. "It is so uninteresting. If only they would talk to one another and not to me." This was the man who had enchanted both children and adults with The Lion, the Witch, and the Wardrobe, and other wonderful stories from the mythical kingdom of Narniaa man who loved storytelling, teaching, students, argument, and the world of ideasand yet his publisher insisted that A Grief Observed be released under an assumed name. "It is a fragmentary work," noted his biographer A. N. Wilson, "lacking any cohesion compared to his other books, it's an example of just what people speak of in bereavement, a shattering of his usual style. Its shooting stabs of pain, its yelps of despair, its tears, its emotional zig-zagging, all bear testimony to such a shattering."
"Shattering" catches the essence of grief. For me the word conjures up a broken mirror, a useful metaphor. In a cracked looking glass it is often difficult to recognize one's self because of the distortion of the image. So it is with grief. Sadness is just a small part of what happens, for there are other distorted reflections in the mirror. We find ourselves stumbling in the management of a familiar existence. Nothing works as it should. Insomnia drains the day's supply of energy. Routine habits become a burden, future planning is neglected, thinking is slowed, and concentration scattered by intrusive memories. Through the looking glass of grief one is reintroduced to oneself as a disorganized stranger, a person apart from the accustomed self.
These fragmented reflections provide a glimpse of what "disordered mood" really meansof what can happen to human beings who suffer depression and melancholic despair, a severe and crippling extension of depression. Although we call depression and melancholia mood disorders, they actually involve mental processes that extend well beyond mood and also beyond the emotional awareness that sustains social communication.
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