Living Well With Depression and Bipolar Disorder: What Your Doctor Doesn't Tell You … That You Need to Know

As a student, professional, and patient (although without bipolar disorder), I have been a close student of the psychological and psychiatric professions for roughly 30 years. To my mind, patient-aimed literature that even hews to the responsible about bipolar disorder often sounds doctrinaire, sententious, overly systematizing, and even evangelistic. Patient testimony often comes from people who were recently diagnosed and hence has a flavor of the grossly shortsighted "I was lost but now I'm found, and I'll tell you how to live!" attitude.

John McManamy's new guidebook for patients with bipolar disorder and depression is smarter than this. But it is a good example of how, with any serious psychological disorder, a patient should never rely on only one source.

McManamy is a former financial journalist with a law degree who was given a diagnosis of bipolar disorder at age 49. He has run a self-funded Web site and published an e-mail newsletter for several years that reports and comments on studies, conference proceedings, and more. He has developed a fan base.

One would expect an astute patient to have an especially good appreciation for the many complexities of bipolar disorder, regarding everyday life, the range of treatments, and the way current research "speaks to" patients' needs. The book is a lively read and synthesizes a wide array of information. I admire how McManamy chases after, and absorbs, all kinds of studies, looking for the latest scientific findings. Unfortunately, this is organically tied to a big shortcoming: thinking that the only knowledge and wisdom about the illness is in the most recent studies, and accordingly awaiting news of these like a supplicant. One of his few major historical moorings is Emil Kraepelin's diagnostic concepts.

McManamy's book has surprising errors. For example, he notes the DSM-II as from 1980 when it is from 1968. He also liberally quotes from patients' Internet writings on his Web site, which can sound chattery, impulsive, and unvetted.

The book's worst feature is its ignorance of some key medical history that could provide major bearings for its author. A good example is McManamy's treatment of orthomolecular therapy, or megavitamin therapy. He seems to endorse Abram Hoffer's prognostication of 1957 that in 1997 orthomolecular therapy would be accepted. Actually, a well-referenced study published in 1979 critiques megavitamins in a damning scientific assessment. Among many other things, the study condemns megavitamin proponents for their inability or unwillingness to do double-blind studies of megavitamins. This therapy has also been condemned or strongly criticized by numerous other bodies and investigators.

At points like this, McManamy's claim that he is liberally alerting people to the wealth of what's out there may seem to be in good faith but may it be naïve and credulous, or even a con at worst. The book also fails to present the views of those who know very much about themselves from years of nonmedical personal struggle and self-discipline. This book is a useful supplement but by no means is it essential or magisterial.