is a Choice: Winning the Battle Without Drugs
by A. B. Curtiss
Hyperion, New York. 2001.
Reviewed by Christopher Dowrick, Professor of Primary Medical
Care, University of Liverpool, Liverpool L69 3GB, United Kingdom.
is a family therapist and cognitive behavioural therapist. She
also has long personal experience of the condition now known by
psychiatrists as bipolar affective disorder - formerly called
manic-depression - in which periods of intense despair and misery
are interspersed with episodes of highly charged energy and excitement.
This book is a detailed, honest and at times alarming account
of her ongoing struggle with depression, which makes good use
of historical, philosophical, professional and some very personal
books central message concerns the importance of what Curtiss
calls Directed Thinking. She has found that it is
not necessary to become a victim of depressed mood. She argues
that although we cannot get rid of it directly, we do have some
element of choice in the matter. It is possible for us to think
our way out of the depths of despair.
explains the technique of conscious neutral thinking,
whereby we can learn to use simple repetitive thoughts - such
as nursery rhymes - to counter and replace depressive thinking
that can so easily hampers and cripple us. She also explains some
of the cognitive-behavioural techniques used to challenge negative
thinking, which are aimed to help us to see ourselves as not as
failures but as works in progress. In place of the
complex biochemical formulae developed by pharmaceutical companies
to derive antidepressant medication such as Prozac, she presents
us with her own much simpler formula for the cure of depression:
+ (cnt)c = e
+ conscious neutral thinking x concentration = equanimity
describes valuable role models from history and from literature.
At the age of twenty-two Benjamin Franklin decided to embark on
a regimen of acquiring what he considered to be the thirteen important
virtues (including temperance, resolution, chastity and humility)
and kept a diary to record his progress. She finds him a helpful
example of how it is possible deliberately and explicitly to work
on our health and well-being. Greater than this is the importance
of locating ourselves in our life, our roles and responsibilities,
and not seeing our immediate feelings as the arbiters of our fate.
Ishmael, in Melvilles Moby Dick, said that in all
cases man must eventually lower, or at least shift, his conceit
of attainable felicity; not placing it anywhere in the intellect
or the fancy; but in the wife, the heart, the bed, the table,
the saddle, the fire-side, the country.
has devised a morning meditation to use if she wakes and finds
herself depressed. This includes singing childrens songs
and nursery rhymes, fast counting, laughing silently (or out loud
if there is nobody else around), praying for three other people,
and remembering that life can have meaning without the necessity
of happiness. If you cant do it for yourself, do it
for the others.
is strongly anti-medication, particularly antidepressants such
as Prozac, which she sees as taking away our responsibility and
our ability to work things out for ourselves. While I agree with
her concerns about the medicalisation of misery, and the relentless
drive for profit maximisation of major pharmaceutical companies,
I think her position here is unnecessarily antagonistic. In my
experience as a general practitioner - and as the father of a
child who has experienced bipolar affective disorder - I have
found that medication can be a very useful support to the approaches
and techniques that she is advocating in this book. I do not think
that we need to make an either-or choice, but can do best with
a judicious use of all relevant approaches.