The Book

This book is an autobiographical account of 15 years of serious ongoing but partly remitted depressive illness-specifically manic depression, or as it’s more usually called nowadays bipolar disorder. It is also an introduction to the science of depression-the biology behind what we know about its causes and the drugs we use to treat it. The style therefore varies from part to part: the science is concentrated in the middle, and the autobiography and other personal matters like the interaction of depression and personality surround it. There is also a chapter on the problem of suicide, which is integral to any discussion of depression. In addition I gather together a lot of information (not easily available in one place) on the actions and side-effect profiles of the major drugs on the market – not just antidepressants, but drugs used to treat accompanying conditions like anxiety, mood-cycling and insomnia.

There is also some discussion of a topic that seems at first to belong rather to philosophy: the ‘mind/body problem’, the issue of whether there is such a thing as a non-material mind separate from the physical body. I take the view that there isn’t: the brain is as much a ‘physical’ organ of the body as the liver, and the ‘mind’ is simply one of the things that the brain does. The mind is therefore as material as the rest of the body, and its diseases are matters for conventional medicine. This means drugs in the first instance; though given this view psychotherapy is also a kind of drug, since it is an interaction of material minds. This materialism is important, because it means I fully espouse the ‘medical model’ of mood disorders (depression and manic depression), and claim that there is no significant difference between ‘mental illness’ and any other kind, since they are all dysfunctions of the body. This means that mood disorders are no more worthy of stigmatization than diabetes or cancer. One is no more justified telling a depressive to pull his socks up than telling a diabetic to put his pancreas in order.

I write for anybody interested in the phenomenon of mood disorder-in the first instance for depressives themselves. It is often comforting in an odd way to see the awfulnesses of others’ suffering and the possibilities of improvement: to discover that you are not uniquely disordered, but in some ways even typical and might get better. I also write for the carers, loved ones and friends of the seriously depressed. This includes general practitioners, psychiatrists and psychologists who might find a detailed and carefully observed account of the phenomenology of depression useful. Perhaps the elaborate descriptions I give of dysregulated states of mind can help cultivate greater empathy and understanding. My third audience is the general educated reader with an interest in some of the things that the mind can do and medicine can do with it, and how disease and personality may intersect.