DEALING WITH DEPRESSION by Gordon Parker

Depression is an illness that is oft misunderstood and, despite growing public awareness, is still very much stigmatised. Dealing with depression is a book that coves new ground in understanding the different types of depression, how it affects people, and offers suggestions for management systems through both psychotherapy and medications.

The author, Gordon Parker, is a leading international expert on depression and mood disorders, a Scientia Professor of Psychiatry, and also the Executive Director of the Black Dog Institute. The Black Dog Institute, based in Sydney, Australia, is a not-for-profit organisation and world leader in the diagnosis, treatment and prevention of mood disorders such as depression and bipolar disorder.

The difference between Dealing with depression and other books about depression that I have read is that this book goes beyond the general outlook of categorising people as suffering from either major or minor depression. Instead, Gordon Parker argues for an alternative model, one that is more complex than a time frame. He and his researchers believe that personality types predispose people to developing the various depressive conditions, which are all markedly different. They also suggest that “personality style shapes the clinical depressive pattern, and perhaps more importantly, influences the chance of responding to differing treatments”.

So, rather than advocating a “horses for courses” generalised approach to depression, this book takes a more holistic approach, which considers life events, biological factors and personality style, and then formulates suggestions for treatments. Instead of following the “major” and “minor” diagnosis, common in North America, which Parker states are simply too vague and do not do enough to describe the actual problem that the person is experiencing, he classifies clinical depression disorders into three categories:

• non-melancholic
• melancholic and
• psychotic melancholia.

 

Each of these forms of depression and their subtypes requires different considerations for treatment.

Non-melancholic depression is caused by excessive stress or a major life event combined with personality style and displays a lack in psychomotor disturbance (PSD). There is often has a high spontaneous remission rate whereby suffers get better naturally, without intervention or help from therapists or medications.

Melancholic depression is much more severe, PMD is evident, but there is a low rate of spontaneous remission. This form of depression is believed to be biological in nature, and as such responds well to antidepressant medications but treatments such as counselling and psychotherapy have little impact.

Psychotic melancholia features severe depression, PMD, hallucinations and delusions, and pathological feelings of guilt. The only treatment that works is antidepressant medications.

Bipolar disorder and its classifications of bipolar I and bipolar II are also closely discussed. Dealing with depression also lists the general features of depressive and bipolar disorders, which highlight the differences in behaviour, thought processes, and emotions experienced by suffers of these disorders. Parker also presents in-depth information on personality styles and behavioural traits; what a medical assessment for determining depression might cover; what patients should be told; and various antidepressant drug treatments that are available and their effectiveness on the depressive subtypes.

What I found particularly interesting is that Parker does not advocate staying on one medication for an extensive time period to see if it works. He argues that not all medications are equal, that this is a myth, and that some antidepressants are “far more powerful than others in helping certain types of depression”. If a medication does not work, he recommends changing it, trying another medication, until the person finds one that works for them and their condition. Parker writes that some sign of improvement should occur with the first 10 days, and that if no improvement has been seen within 2 weeks then reassessment of dosage levels, or change to another drug may be required.

 

“It’s important to challenge the myth that antidepressants need to be trialled for many weeks or months so as to ensure that patients are not left on an antidepressant for an extended period with the view that it might start working after two or three months.”

 

I found this advice exciting and refreshing as it challenged what many GPs advise. I have a close family member who suffers from depression. They asked their GP to change their medication because they weren’t noticing any changes, weren’t feeling any better after 3 months on the medication. The GP refused to change the medication, revise the dosage or alternative options claiming that they needed to be on the medication for another 3 months before any real improvement could be seen.

Dealing with depression contains a lot of useful information and clearly explains the different types and subtypes of depression in easy to understand language. Real life examples are used to support the research and claims. The exploration and reclassifying of depression using the Black Dog Institute’s categories was stimulating and encouraging to read and certainly made more sense than the major/minor depression classification system that is so predominant in the health care system.

This book is an excellent resource for anyone suffering from depression; for family and friends of suffers; or for anyone interested in learning more about the complexities of what it means to suffer from a depressive disorder.

Dealing with depression: A common sense guide to mood disorders – 2nd edition (Allen & Unwin 2004)                                                                                                ISBN: 1741142148

 

AN UNQUIET MIND by Kay Redfield Jamison

An Unquiet Mind provides a unique and no-holds barred insight into the euphoria that can escalate to terror, combined with the deep, dark depths of despair that bipolar sufferers experience on a regular basis.

This brilliant autobiography, written by Kay Redfield Jamison, delves into the dark and oft misunderstood world of bipolar disorder, once know as manic-depression*. Jamison is a Professor of Psychiatry, has worked extensively in clinical practice with people who suffer from mood disorders, and was for many years a director of the UCLA Affective Disorders Clinic, which was a large teaching and research facility. She also suffers from severe bipolar episodes. All of these elements put her in the unique position of being able to write about bipolar disorder from both a clinical perspective and personal experience.

Jamison describes bipolar disorder as:

“an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide.” (p.6)

Jamison recounts her early experiences with bipolar as a teenager, and then moves on to her college years where the illness progresses to much stronger episodes with more increasingly dire consequences. As she frantically attempts to keep up with her university course load studying medicine, and then post-graduate studies, her life is torn apart by manic episodes followed by soul-destroying bouts of depression that last months and even years.

Jamison writes with candour and brutal honesty about her manic-depressive episodes, her denial to admit that the mood disorder is destructive and dangerous not only to herself but others around her, and her long, slow path to healing and sanity. After many years of denial, and one particularly psychotic manic episode, she finally agrees to take medication: lithium. The use of lithium was still in its infancy, had only been approved for clinical use four years earlier, and as such she is reluctant to take the medication, concerned about side effects, and long term use. She points out that treating mood disorders requires not just medications but also psychiatric treatment, which focuses on “developmental issues, personality structure, conflict and emotional and unconscious thought”.

Bipolar disorder is a deceptive illness in that the manic highs bring about periods of intense activity and creativity; there is a wondrous and intoxicating rush of elated emotions, and the seductive nature of having gifted insights to problems. It is these elements that people with bipolar are reluctant to part with, as the rush is ecstatic. However, the shift from ecstasy to psychotic is dangerous and uncontrollable, after which sufferers are often plunged into black, despairing depression. It is an illness that kills thousands of creative and imaginative people each year.

Jamieson writes with clarity about the highs and lows, the confusion and despair, and madness that she experienced:

“When you’re high, it’s tremendous. The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find brighter ones… Sensuality is pervasive and the desire to seduce and be seduced is irresistible. Feelings of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one’s marrow… now… you are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of your mind. You never knew those caves were there. It will never end, for madness creates its own reality… It goes on and on, and finally others’ recollections of your behavior – your bizarre, frenetic, aimless behaviors… All those incredible feelings to sort through… Which of my feelings are real? Which of the me’s is me? The wild, impulsive, chaotic, energetic, and crazy one? Or the shy, withdrawn, desperate, suicidal, doomed, and tired one?” (p.64-67)

She discusses her own struggles and the great lengths to which she would go to avoid dealing with her illness, often injecting humour into a serious subject. One example of this is when she realises in graduate school that she has a serious problem and needs either psychiatric help or needs to buy a horse. She explains her decision this way:

“Since almost everyone I knew was seeing a psychiatrist, and since I had an absolute belief that I should be able to handle my own problems, I naturally bought a horse. Not just any horse, but an unrelentingly stubborn and blindingly neurotic one, a sort of equine Woody Allen, but without the entertainment value.” (p.54)

She had created romantic notions of being best friends with this horse, of the horse running happily up to her in search of a carrot or sugar cube. The reality proved somewhat different:

“What I got instead was a wildly anxious, frequently lame, and not terribly bright creature who was terrified of snakes, people, lizards, dogs, and other horses – in short terrified of anything he might reasonable be expected to encounter in life – thus causing him to rear up on his hind legs and bolt madly about in completely random directions.” (p.55)

An Unquiet Mind is filled with reflections, chaotic events, the negative impacts of not being willing to accept that she needed medication, and even when she did take medication the resulting the episodes of despair and destruction that ensued every time she went off her meds, seeking the thrill and rush of the inspiring ‘high’ episodes. The book also combines scientific and clinical analysis of mood disorders. These medical approaches add balance and credibility to Jamison’s story and highlight the conflicts that she faced when trying to act in a medical capacity, how the mania and depression severely impacted upon her study, her work and personal life, and yet those same things informed her work, gave her insights into bipolar disorder, and inspired her to dedicate her life to understanding mood disorders and help others who also suffer from the illness.

The frankness of the writing, and Jamieson’s ability to include humour, and story telling techniques, made this an incredibly fascinating book to read. Her obvious pain and confusion, her distress and frustration are palpable. A singularly compelling read, and by the end of it I had a renewed sense of respect for people who suffer from bipolar disorder and the minefield of problems that they need to navigate every day.

 

* Jamison preferred the term manic-depression as she felt that it more adequately described the illness a she experienced it.

 

An Unquiet Mind: A memoir of Moods and Madness (Picador 2011) – eBook.      ISBN 9781447204040 EPUB                                                                                          First published in 1995 as a Borzoi Book by Alfred A. Knopf Inc. in New York.

ISABELLE OF THE MOON AND STARS by S.A Jones

“It’s a Monday morning and the train is thick with lassitude. Wherever you look heads loll onto shoulders and eyes are glazed. Only a young woman in the middle carriage seems immune to the warm treacle atmosphere. She sits, straight-backed, intent on the scene scrolling by. It is high summer. The sky is candy-hard and cloudless with the roofs of the houses cut stark against it. The lines are so sharp you might slice your finger if you traced them on the window. She breathes in the lavender and fresh laundry scent of her home town in January and smiles.”

From the moment I read this opening paragraph, I was irresistibly drawn into this remarkable novel written by S.A Jones. The descriptions of places and events are well-crafted resulting in vivid imagery that accompanies a bold and beautiful story about love, relationships, pain, confusion, and what it takes to face the dark places of depression.

Isabelle of the Moon and Stars tells the story of Isabelle, a young woman who works in mundane government position as a data analyst where, after the ‘incident’, she is relegated to making statistical reports that no one ever reads. She knows this because she has started substituting ridiculous material into her reports such as “Sucking up to management: good or bad for building ventilation?” and “ Gonorrhoea and P3: a comparative analysis” and Jack, her boss, hasn’t mentioned a thing about it. Out of boredom and meaningless direction, Isabelle starts ignoring her work and using work time for her own personal projects, namely to plan an Australia Day party on the rooftop of her apartment complex, and to research her favourite topic: Prague.

The unspoken ‘incident’ was an anxiety attack that lead to a serious bout of depression, during which time Isabelle’s boyfriend Karl heartlessly ditched her for another woman. This pushed Isabelle to the darkest of places and almost to the edge of her life. Isabelle hates the words ‘depression’ and ‘anxiety’. They are ‘blank, nothing words’ that do nothing to describe the pain, the fear, and torture that she feels when The Black Place comes for her. She loathes that her torment and trauma is diminished to terms such as ‘the incident’ and wishes that her Black Place could come with a splint or cast to prove how real her pain is.

It is only because of her best friend Evan’s support and love that Isabelle managed to claw her way back to sanity and control. Evan is celibate, having made a promise to God to cherish his virginity but has neglected to set a reason or time as to when he can be released from this promise. Isabelle has gone to great lengths to control her life and keep The Dark Place at bay. But things start to unravel when she develops a sexual attraction for her middle-aged boss Jack, and Evan confesses his desires for Isabelle herself. Jack’s wife, Kate, is not going to give him up without a fight. She is well aware that her husband has a wandering eye but she’s no pushover and has a few tricks up her sleeve to tempt him back. In the midst of this chaos Isabelle is preparing to throw an Australia Day party, something she has never done before, and has invited all of the people in her apartment block, many of whom she doesn’t even know, to attend. This gesture brings her into the life of her dear, sweet, elderly neighbour, Mrs Graham, and the relationship that develops between them is one of gentle tenderness and deep affection.

The tension within the novel builds to a sizzling point, and as the summer heat escalates so does the risky game that Isabelle is playing with Jack. Frictions overflow, and a moment of unrestrained passion sees Isabelle doing what she does best: running away. To Prague. Running from Evan, running from her own demons.

I was first heard about Isabelle of the Moon and Stars through an interview with the author, S.A Jones, which featured on Amanda Curtin’s blog, looking up/looking down. The concept of a story that attempts to express through its main character a realistic look at how depression and anxiety are experienced intrigued me. Jones mentioned that she was inspired by ‘a dissatisfaction with the way mental illness is often portrayed in popular culture’. Depression is often still very much misunderstood with sufferers enduring a ‘get over it’ attitude by people in their lives, and society at large. It is a difficult topic to base a novel around but Jones has managed to not only construct a convincing narrative, she has created a main character that is so life-like, so engaging and flawed that I cared deeply for Isabelle, felt her pain acutely.

Jones doesn’t stereotype Isabelle. Instead we are given an insight into the daily struggle that Isabelle faces in trying to keep the threads of her life together, keep the façade of wellness in place while desperately fearful of failure, of her world falling apart, of losing the fight to keep The Dark Place from consuming her. Isabelle experiences intense panic attacks, which are her Dark Place. The intensity of these attacks, the sense of being at the mercy of her own body and mind, which seem to have conspired to kill her, are scenes that have been composed with skill and grace, they are raw and confronting, completely believable, and reflect real depressive experiences.

Depression is often viewed as a dark topic but that doesn’t mean that Isabelle of the Moon and Stars is a dark, depressing novel. The opposite in fact. It is a novel that explores what it means to have depression with sensitivity and insight coupled with humour, strength, courage, resolve, love and friendship. There are wonderful moments of tenderness and developing trust in Isabelle’s friendship with Mrs Graham; there is passion, desire, disappointment and mortification in her relationship with Jack; there is a deep solid friendship and blossoming love with Evan; and there is reflection and unification within herself.

Isabelle of the Moon and Stars was a joyous book to read. The prose was beautiful, heartfelt and kept a steady pace. I was immediately drawn into Isabelle’s life from the first delightfully written paragraph right through to the last. It is an immensely satisfying novel from a very talented Australian author, and I highly recommend you put it on your reading list for 2015.

Isabelle of the Moon and Stars (UWA Publishing 2014)                                                                    ISBN: 9781742586038