Malignant Sadness: The Anatomy of Depression, by Lewis Wolpert

London, Faber and Faber, 1999. £9.99 / CAN$22.99 (xii + 196 pages)ISBN 0 571 19172 XDoes the world need another book on depression written for the lay public? Is there anything new still to be said? Are there any topics not yet translated from ‘Scientese’ into English? Are there any niches yet to fill? Perusal of the psychology, self-help, and related sections of any bookstore confirms the subjective impression that there has been a tremendous proliferation of such books since the late 1980s. For instance, the US National Depressive and Manic-Depressive Organization (NDMDA; http://www.ndmda.org) bookstore carries 25 full-length books on depression written for the lay public. Their bookstore committee receives at least two new titles per month to review, and their current backlog runs to several linear feet of shelf space. This is the sea onto which Lewis Wolpert has launched his book.There are two general perspectives on the utility of lay books about depression. The first says that there’s always room for one more, as that new one might speak in some unique, idiosyncratic way to some individual or family member heretofore unreached. The resultant resonance will provide the information or affective ‘click’ that makes them more able to seek appropriate help, or that relieves their suffering just a bit. From this perspective any book, though perhaps quickly remaindered, has done its job. Market forces willing, it will reach out and touch that nth person.The second perspective (take your pick: is it capitalism or managed care that speaks?) asks: of what is the value-added of this specific book? What niche does it fill? While cheering for Wolpert’s book from the first perspective, let us look at it from the second.This book appears geared to the educated – even learned – public. Its author, a research embryologist, has written several lay books on science and has been involved in radio and television programs on various scientific topics. Malignant Sadness is likely to be a comfortable read for those with at least a university education and some interest in the history of scientific thinking about mood and its disorders.There are several important niches that Wolpert’s book does fill. Its extensive attention to cross-cultural issues is a welcome addition to the lay literature. Similarly, the attention to developmental issues, while not unique, is particularly nicely done and clearly benefits from Wolpert’s perspective as a developmental biologist. There also is a wonderful and thought-provoking section on the possible evolutionary significance of sadness and depression.In addition, there are few books, with the exception of Feeling Good1xFeeling Good. Burns, D.D. See all References1, perhaps the grand-daddy of lay books on depression, that discuss cognitive therapy in understandable, non-technical terms. Moreover, Wolpert’s chapter on psychotherapy, though heavily weighted towards cognitive therapy, does cover briefly several other psychotherapies as well, thus putting cognitive therapy in context as one of several psychotherapies used for depression.These aspects, as well as its eminent readability, are clear strengths for Malignant Sadness. Clearly it fills a niche, covers topics insufficiently discussed to date, and does so in a pleasurable and easy manner.There are several weaknesses as well. Overall, while geared to the learned public, it is not exactly clear what Wolpert hopes to convey. Its focus is not a first-person account, though we dip in occasionally to his own experience and that of his family. But we don’t know much about how his depressive episode affected him and how he coped, we certainly do not know enough to be moved or inspired by his struggles – which clearly were great and difficult struggles.On the other hand, the science reviewed is at points somewhat selective or quirkily weighted – although probably not too different from the best Wolpert could expect of me were I to try my hand at the history of science or a personally compelling topic in embryology. For instance, one comes away with the sense that electroconvulsive therapy and psychosurgery are not far apart in terms of acceptability in the scientific and clinical community, and that the efficacy of the former is somehow related to its effects on the hypothalamus and pituitary. Similarly, there are some surprising sweeps of statement that seem more journalistic than translation of science (the report, for instance, that ‘the USA embraced Prozac’ while ‘Germany has… turned to St Johns’ Wort’).There are also a few factual inaccuracies that bear correcting; for example, that venlafaxine is a selective serotonin reuptake inhibitor (it is a mixed serotonin–norepinephrine uptake inhibitor that should be listed with mirtazepine rather than the SSRIs), and that monoamine oxidase inhibitors are less effective than other medications for severe depression. And he promulgates as accepted fact an occasional controversy still being thrashed around in the scientific community (e.g. that serotonin reuptake inhibitors are as cost-effective as tricyclic antidepressants).So it’s not quite the right book to go to for a first-person account of how depression affected a highly intellectual, accomplished scientist and what he did about it. And it’s not quite the right book to go to for a meticulous translation of the current state of the science of mood disorders. It feels more like a rigorous and energetic personal quest, shared with the public, to solve the painful riddle of ‘What happened to me and why?’ Nonetheless, in doing this there is much valuable information conveyed.There are also several delightful surprises in Malignant Sadness. For example, Wolpert artfully enlarges the standard pantheon of who in history was depressed and what they thought about it. In addition to Galen and Burton and a slew of poets, we also hear from the 4th century Christian Church, from Islam, and from Tolstoy. The passing mention of Zen is itself worth expanding into another book.Finally, this is as gorgeously produced a paperback as I have seen for general publication. Its deep-toned purple slip-cover conveys the depth and character of depression, as well as the ethereal nature of this mood that we keep trying, only partially successfully, to capture in exact terms. The stark white inner cover is splattered with excerpts from Wolpert’s account of his own depression in assaultive purple typeface. Perhaps this is meant to convey the harsh nature of depression, or our hard-edged scientific pursuit of its causes and treatment, or even its cognitive aspects that appear so central to Wolpert’s account. The multi-layered contrast works, and the thing of the book itself also teaches us something about this malignant sadness.