I got delayed in reading Gordon Parker's book on bipolar II by Melvyn Bragg's Remember Me, a novel based on his relationship with his first wife. This woman is an artist who has at least two periods of depression culminating in her suicide as the marriage relationship breaks down in the maelstrom of the 1960s social change. As you might expect her depression is combined with personal attractiveness, creative talent and periods of high productivity. She undergoes a long period of psychoanalytical treatment in the 1960s and even insists that her husband does the same.
She never enters the asylum system which was still going strong in the 1960s and in which Kraepelin's manic depressive insanity was born a century before. The extreme form that Kraepelin described was rebranded in the 1960s as bipolar disorder and has been the subject of a substantial body of research. However, the illness described by Bragg has attracted much less interest and study until recently. Parker sets out in his book to summarize and extend our knowledge of this illness which has come to be called bipolar II.
How do you write a book about a disorder that is ill defined and little researched? You could just outline the depth of ignorance and point out potentially useful paths but Parker has instead given readers the benefit of experience combined with what evidence is available. The book begins with chapters by a dozen authors that review the evidence, often by extrapolation from bipolar I data. The conclusions are generally that the data is very limited and that even the limits that define the disorder are unclear. But the more unique parts are the chapters that follow which consist of Parker's views and research about both defining and treating the condition.
He is not afraid to let his clinical experience guide him, for example in the use of antidepressants in bipolar II. Rather than just push forward his view on this (and other approaches) he seeks criticism and sets out the ways that he has tried to define and research the problem. He has not just sought the view of one friendly critic but gathered a dozen to express their disparate views on his approach.
If you are looking for a book that gives you the way to understand and treat bipolar II then Dr Parker's regimen may well be what you are looking for. His approach is described in detail and accompanied by advice from his clinical colleagues on broader psychological and lifestyle approaches. However, it is likely that most specialists reading this book will value more the exposure to a range of diverse ideas, some of which are plainly contradictory.
It is possible there is one approach that is right to help those with bipolar II disorder and that systematic research will reveal it. However, the research on bipolar I seems to be telling us that each individual treatment can be beneficial but for a small (and different) proportion of the patient group. This may also be why combinations are often proving more effective than monotherapies in medication trials. We are still hopeful that differentiating between patients and defining subgroups could prove very useful. Whether defining groups around the features of mania and hypomania is the best route has yet to be proven.
The tragic suicide at the end of Remember Me appears to stem from the breakdown of the marriage but the way that her analytical treatment proceeds and the abrupt end is clearly important. The quality and experience of the people giving advice and care to those with bipolar II is a vital issue, particularly at this time when a nice recipe book is not available. Dr Parker clearly demonstrates that he is in touch with this vital issue.
