Main description:

In this book we present a conceptually integrated approach to disorders of mood. These disorders are defined narrowly as the clinical syndromes of mania and melancholia. The latter is our particular focus, for the simple reason that it is more common and thus more is known about it. Our approach owes much to Adolf Meyer, who first used the term psychobiology. It was he who emphasized in a practical way the importance of the clinician consider ing the joint contribution of psychosocial and biological factors in the genesis of mental disorders. However, until the 1960s, our relative ignorance of basic mechanisms that link brain and behavior prevented the development of a genuine psychobiological perspective. Thus Meyer's work was concerned largely with teaching the importance of the personal biography and a consideration of social history in the development of mental disorder. We feel that sufficiently rigorous data have now emerged in psychia try to permit tentative but real psychobiological integration. Affective illness is proba bly the most promising area for an attempt at such a synthesis. It is our belief that the theory and clinical practice of psychiatry now can be woven into a coherent theme, integrating insights and evidence generated by the psychodynamic, biological, and behavioral methods; hence in part we review the emerging psychobiology of mood disorders with the hope that it can serve as a generic paradigm for other psychiatric syndromes.

Contents:

I. Overview, History, and Classification of Mood Disorders.- 1. Mood Disorders: An Introduction.- Two Case Histories.- Melancholia.- Mania.- The Semantics of Mood and Its Disorder.- The Clinical Manifestations of Mood Disorder.- Who Suffers Mood Disorders?.- The Distinction between Mood Change and Clinical Episode.- The Subjective Experience of Depressed Mood.- The Affective Experience: Teleological and Literary Reflections.- References.- 2. Mood Disorders: Historical Perspective and Current Models of Explanation.- Early Struggles: The Empirical and the Supernatural.- Introspection and the Comfort of Metaphysics.- The Cartesian Dualism of Mind and Body.- The Rise of Humanism and Objective Observation.- The Progenitors of Current Understanding: Freud, Kraepelin, and Meyer.- The Common-Sense Psychobiology of Adolf Meyer.- Current Concepts of Mood Disorder.- Intrapsychic Models of Depression.- Behavioral Models of Depression.- Biological Models of Affective Disorder.- In Conclusion.- References.- 3. Clinical and Familial Subtypes of Mood Disorders: Observation, Opinion, and Purpose.- Why Classify?.- Phenomenology and Pathogenesis: Confusion and Debate.- Symptomatology and the Classification of Mood Disorders.- The Need to Be Practical.- A Primary-Secondary Distinction.- Classifying Primary Mood Disorder: Dimensional and Axial Techniques.- Family Studies and the Unipolar/Bipolar Distinction.- Other Specific Disorders: Variants of the Major Affective Disorders.- Toward a Practical Nosology: DSM-III.- Outcome Studies of the Diagnostic Criteria.- References.- II. Elements of Present Knowledge.- 4. Attachment and Loss.- The Experience of Grief.- Bereavement and Its Sequelae.- Attachment and Its Formation.- Attachment as a Primary Drive.- Failure to Develop Primary Attachment.- Behavior following Separation in Human and Monkey Infants.- Separation and the Precipitation of Mood Disorders.- Sensitization to Adult Depression by Loss in Childhood.- Some Conclusions and Comment.- References.- 5. The Meaning of Loss: Psychoanalytic Explorations.- The Roots of Psychoanalysis.- Early Psychoanalytic Concepts of Melancholia.- Structural Analytic Approaches.- The Mother-Child Relationship and the Depressive Position.- The Evolution of Analytic Concepts.- Self-Esteem, the Ego, and Depression.- Theories of Manic-Depressive Oscillation.- Reality Distortion in Depression.- Some Conclusions and Comment.- References.- 6. The Neurobiological Foundations of Behavior: Environmental Challenge and Response.- Illustrations from Endocrinology.- Chemical Signaling Systems.- Homeostatic Control Mechanisms.- Orchestrated and Dual Systems of Control.- Marking Time with Neurophysiology.- A Neuroanatomy of Function.- Neurochemical Mapping.- The Neuroanatomic Chemistry of Emotion.- The Importance of Technology.- The Life Cycle of the Biogenic Amines.- Manufacture.- Events at the Synapse.- Subsequent Metabolism.- The Interface between Neurochemical and Neuroendocrine Mechanisms.- The Neuroendocrine Response to Environmental Challenge.- Early Studies.- Individual Differences in Response.- Some Conclusions and Comment.- References.- 7. The Emerging Neurobiology of Mood Disorder.- The Nature of the Evidence.- Serendipity: New Drug Treatments and the Pharmacological Bridge.- Biochemical Correlates of the Affective Syndromes.- Studies of Urinary Metabolites.- Investigation of the Cerebrospinal Fluid.- Studies of Brains of Suicide Victims and Postmortem Material.- Neuropsychopharmacology and Biogenic Amine Metabolism.- Influencing the Manufacture of Biogenic Amines.- Influencing the Dynamics of Release of Biogenic Amines.- Influencing the Receptor Site at the Postsynaptic Neuron.- Decreasing the Destruction of Monoamines.- The Evidence in Summary.- The Prediction of Pharmacological Response.- The Affective Syndromes and Hypotheses of Amine Interdependence.- Neurophysiological Arousal States in Melancholia and Mania.- Electrolyte Studies.- Sleep Studies.- Changes in Endocrine Function and Physiological Mechanisms of Defense.- The Brain-Corticosteroid Axis.- The Brain-Thyroid Axis: An Adaptive Mechanism?.- The Role of Receptor Sensitivity in Affective Illness and the "Switch Mechanism" of Bipolar Illness.- Some Conclusions and Comment.- References.- III. Toward a Synthesis.- 8. Theoretical Aspects of Living Systems: Philosophical Pitfalls and Dynamic Constructs.- The Philosophical Pitfall of the Mind-Body Dichotomy.- Living Organisms as Open Systems: Dynamic Stability through Regulation and Control.- Analogy with the Mechanical World.- Rhythmic Behavior and Temporal Organization in Biology.- Human Biological Clocks.- Light as a Zeitgeber in Human Beings.- The Changing Photoperiod and Seasonal Depressions.- Evidence for Temporal Disorder in the Final Common Path of Affective Illness.- Dynamic Mechanisms Which Serve Stability and Flexibility.- Dynamic Systems and Subsystems: Some Definitions.- Describing the Behavior of Complex Systems: Mathematics as a Potential Common Language.- Conclusion and a Review of Dynamic Constructs.- References.- 9. Toward a Psychobiological Integration: Affective Illness as a Final Common Path to Adaptive Failure.- The Evidence for a Final Common Path to Disorder.- The Predisposition to Disorder.- Genetic Vulnerability.- Predisposing Temperament.- The Modulating Influence of Age and Sex.- Physical Illness and Its Treatment.- Loss of Attachment in Childhood.- Predisposing Character Traits.- Precipitating Factors That Initiate the Path to Dysfunction.- Psychosocial Variables as Precipitants.- Precipitating Factors in Mania and Hypomania.- Intermediary Mechanisms to Adaptive Dysfunction.- Appraisal, Response, and Pathway Initiation.- Biological Mediation of the Arousal Response.- The Importance of the Diencephalon.- An Integrative Model of Depression.- Conclusions.- References.- 10. Implications for Clinical Practice, Training, and Research.- Implications for Clinical Practice.- The Importance of Diagnosis.- Principles of Comprehensive Clinical Care.- Mood Clinics and Affective Disorder Units.- Implications for Training.- In General.- Post-Residency Fellowships.- Implications for Research.- Epilogue: The Case for Optimism.- References.- Author Index.