Bipolar II Disorder. Modelling, Measuring and Managing. Gordon Parker. Cambridge University Press. 2008

Finally, a book devoted to the other bipolar disorder. Bravo! Gordon Parker, the Australian psychiatrist, researcher and head of the venerable Black Dog Institute in Sydney, deserves credit on this basis alone. But this is far from the only virtue of this monograph. Here we get a rich, quirky wonderful assemblage of opinion from the leading authorities on this prevalent and understudied form of manic depression. The combination of being the first publication out of the gate on this important area together with its quality, diversity and depth make this required reading for all clinicians and those patients and significant others thirsty for knowledge of this bipolar subtype. For this group, here’s the bottom line: Read this book!

First, the layout. Eschewing the standard APA format of blandly compiling the accumulated data in an area and striving for a deadening impartiality, Parker chooses an all together different and creative alternative. Rather than draining the lifeblood out of the subject, he makes room for the full cacophony of opinion, debate, agreement and conflict that constitutes the field of research at this time. He specifically includes authors with differing viewpoints and distinct emphases. Even better, he puts forth his own, unique outlook in living color, warts and all. The result is less a compilation than a real-time, streetfight amongst respected colleagues. very real portrait of how medicine exists and evolves.

The second delightful aspect of the book’s format is who and what Parker has chosen to include. Clinicians and patients are given voice alongside of the more typical research-weighted authorship. Chapters reviewing the data on atypical antipsychotics alternate with vivid, first person accounts of disturbed mood states. Clinical experts are given the chance to present compelling arguments based on their treatment experiences. Models of well-being are described from sufferer, physician and research perspectives. Omega 3 fatty acids receive their fair share of attention. And the psychotherapies get equal billing with other psychoactive interventions. Here again, the result is a blooming circus of opinion stretching out in multiple directions.

The book is divided into two main parts. The first section starts with one of the most vivid first-person accounts of this illness that I have ever read. It is followed by a concise but richly detailed history and evolution of ideas about this disorder and where it fits in relation to other psychopathology. The next twelve chapters present short reviews of various points pertaining to diagnosis and treatment. Clinical expert James Phelps reprises his fascinating argument to reverse the default diagnostic bias of affective disorders, making bipolarity the baseline standard and only identifying unipolar illness in the absence of evidence for cyclicity or mixity. Parker then suggests an isomeric model that differentiates bipolar I from bipolar II exclusively on the basis of psychotic symptoms. The reader then gets the chance to see radically different viewpoints on the role of antidepressants in this mood subtype authored by Parker and Joseph Goldberg. Overall, this first section is well-written and the editing gives it a smooth, coherent feel.

The second section, however, is outstanding. Taking the lead, Parker describes a multidimensional treatment package for bipolar type II that emphasizes antidepressants, psychoeducation and well-being plans. And he’s not just talking SSRI’s for bipolar depression; they’re his first line choice for mood-stabilizing agents as well! With this as the set-up, the next twelve chapters allow the leading experts in the field to wrestle with the editor’s contentions.  Among the best responses are those of Post, Ghaemi, Goldberg and Ketter who emphasize the intrinsic recurrence and mixity of bipolarity and the corresponding indication for mood stabilizers over antidepressants. It is here in the noisy and well-reasoned squabbling that the book’s strengths truly shine. Not content to serve up the standard pablum, Parker forces the reader to weigh alternatives, consider the evidence and decide where they stand.

Kudos to this Aussie who has the wherewithal to show our field in all its messy beauty.

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