Of critical importance to our readers is the knowledge that these disorders are frequently severe and often incapacitating. Also, these disorders may at times be as chronic and long term in the suffering and burden they impose on families and the disablement they cause for those afflicted, as is the case with schizophrenia. A further indicator of the severity of the affective disorders is the recent report by Dr. Ken Wells and colleagues from the very large Medical Outcomes Study carried out by the RAND Corporation. The level of impairment of functioning among persons ill with depression was compared with that produced by such major chronic medical conditions as arthritis, diabetes, hypertension, gastrointestinal and pulmonary disorders. Only chronic heart disease among the eight conditions measured, produced a level of impairment comparable to that which resulted from depressive illness.
Affective disorders are extremely common as well as often severe and disabling.
The essentiality of both a trusted psychotherapeutic relationship and appropriate medication is also convincingly presented. An anonymous wife discloses the limits of human endurance in life with a bipolar spouse-the social and economic as well as emotional ruination which the disease so frequently visits upon the burdened family. Janis Medley reminds us that even the person who to outward appearances has coped successfully with affective illness and holds a responsible position, may have to pay a high price in anguish and pain. Dr. Callaway, with candor rare among mental health professionals, shares with us the painful dilemma of stigma in self-disclosure regarding depressive illness, and Judy Cooperberg shares a poignant event in her life which conveys the power of such stigma to shatter even the most loving of human bonds. Dr. Kay Jamison, one of our leading clinician-scholars of bipolar disorder, documents her own research findings of an extraordinarily high level of affective illness among highly gifted artists and raises the complex issue of the benefits as well as the potential costs to such persons of utilizing medication to regulate their disorders.