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Monday, 27.05.2019

Janusz Rybakowski: The Faces of Manic-Depressive Illness
Donald F.Klein’s comments

 

         Some time ago, I agreed with Tom Ban to review (comment) on the book by Janusz Rybakowski: The Faces of Manic-Depressive Illness

            After reading this slim volume I uncharacteristically found myself procrastinating and could not figure out why.

            My first reading acquainted me with Prof. Rybakowski’s impressive career and contributions. Unfortunately for Anglophones he has published almost exclusively in Polish. 

            Prof. Rybakowski made my job much easier by posting a detailed outline of his book in the INHN Book Section, followed by a well-balanced Author’s Statement. I am taking the liberty of quoting it completely:

 

“INFORMATION ON CONTENTS: Chapter 1 presents a fascinating illness, the symptoms of which are the manifestation of very basic as well as unusually sublime aspect of existence and human experience. Chapter 2 describes ancient and modern history of the illness, from Hippocrates and Areteus of Cappadocia up to the contemporary classification of Emil Kraepelin and a separation from recurrent depression by Jules Angst and Carlo Perris. Chapter 3 characterizes mania when nothing is impossible and Chapter 4 describes depression when life has no sense. Chapter 5 presents mania and depression in various configurations and Chapter 5 defines what is the risk of becoming ill. Chapter 7 describes what is going on in the brain during the illness, Chapter 8 presents the past and present of the illness genetics and Chapter 9 shows the illness from the evolutionary perspective. Chapter 10 raises an issue of a connection between bipolar disorder and creativity. Lithium remains the most specific drug for the illness what is discussed in chapter 11. Chapter 12 further elaborates the management of the illness with special focus on mood-stabilizing drugs, mentioning also psychotherapeutic approaches. In Chapter 13, an attempt is made for using the illness as a metaphor of the American society. Finally, Chapter 14 put forward the research and treatment perspectives.

 

“AUTHOR’S STATEMENT: The book was based on my 40 years’ experience with mood disorders and lithium treatment. My interest in bipolar illness extends from epidemiology and clinics, to neurobiology, genetics and psychopharmacological treatment. I was in charge of two epidemiological Polish projects: DEP-BI and TRES-DEP. In the first, which included 880 patients with depression remaining in ambulatory treatment by Polish psychiatrists, we demonstrated that in more than 60% of them, some kind of bipolar disorder can be diagnosed. In the second, covering 1,051 patients with diagnosed unipolar depression, in one third of them the features of bipolarity were found, as assessed by the Hypomania Checklist (HCL-32). Furthermore, patients with bipolar features were more resistant to treatment with antidepressant drugs than the remaining ones. My enterprise with lithium started in 1971 and has been going on until now. I am the author of more than 100 papers on different aspects of lithium treatment. Recently, we have reported on five patients being the excellent lithium responders, receiving the drug for 40 years or more. In 2012, I received the Lifetime Achievement Award from the European Bipolar Forum and in 2015 – the Lifetime Achievement Award of the World Federation of Biological Psychiatry.” (October 12, 2017)

 

            On reflection, one problem with this book is that Prof. Rybakowski does not go into far greater detail regarding his lithium expertise. My wish to know more about his experiencecomes from my enthusiasm for this medication combined with the recognition that many American psychiatrists have never used it except as a last resort. A lengthy,clinically-rich description of its use would be very welcome. It is also not clear if Polish psychiatry has replaced lithium with anticonvulsants (which have their place).

            There are two chapters with which I had clear problems: Chapter 7 is about what is going wrong with the brain during bipolar illness. Although you would not know it from this book, Prof. Rybakowski’s extensive bibliography has brain biochemistry and its disorder a central concern. Chapter 13 attempts to use manic-depressive illness as a metaphor for American society. I thought that glib. 

            Probably none of INHN’s readership will ever read this book which, mysteriously, Amazon sells for  $471 and refers to it as a 2009 volume. However, Amazon lists several other recently translated books at far more reasonable prices by Prof. Rybakowski

 

January 10, 2019