The first (shorter) half of this book is a riveting account of the author’s depressive episode, his anxiety and his manic depression, whereas the second half is a more conventional discussion (from his experience as a psychologist) of the therapies available, including the background, speaking therapies and drugs. Originally written in 1974 (about 3 years after the first episode), the account is supplemented by updates in 1987 and 1997, giving the reader a perspective which was obviously not available to Sutherland when he wrote his first account, while also giving the immediacy of the original version. Sexual jealousy of his wife’s lover and on-going arguments are a gripping part of the story, which gives it a gossipy and bitchy character that is mesmerising. Sutherland doesn’t spare himself, and some of his behaviour is hardly excusable. But he conjures up the way that his mania and depression completely changed his perspective on self and the world.

Although the lunacy and humour of the manic phases are described with verve, the account is valuable for its depiction of the hopelessness of Sutherland’s subsequent depressions. There is a priceless description of the despondency, isolation and ‘mental agony’ of the condition. It also gets across the way in which life is never quite the same again, as though the person who has experienced a psychotic episode has gone through a door, and the world can never be lived in the previous uncomplicated way it was before.

There are some excellent depictions of life in an acute psychiatric unit, and of the psychiatrists working there. Group therapy sessions are described acutely, focussing on how different clinicians led them in different ways and for their own purposes.

Sutherland is clear that drug therapy was useful in a way that group therapy was not. However, he also has considerable time for some of the talking therapies that he has used, and also appreciates the space given by the time on the acute psychiatric ward.

This is a vivid picture of how someone becomes unhinged, as the combination of brain chemistry and circuitry force a rebellion against the way they are living life. If you are a clinician working in mental health, this book should not be missed.

Stuart Sutherland (1998) Breakdown: a personal crisis and a medical dilemma, 2nd ed, Oxford, Oxford University Press

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