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January 22, 1992

Mania and Depression: A Classification of Syndrome and Disease

Author Affiliations

Northwestern University Medical School Chicago, Ill

JAMA. 1992;267(4):579-580. doi:10.1001/jama.1992.03480040131049

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Winokur's book represents the achievement of a professional lifetime of thinking about how to separate types of affective disorders based upon such factors as clinical syndrome descriptions, epidemiology, premorbid personality, course of illness (including age at onset), family history of psychiatric illness, laboratory findings, response to treatment, and genetic studies. It also has the benefit of being written in straightforward, unpretentious prose.

The approach is strictly according to the medical model of psychiatric illness; consequently, anyone primarily involved with psychoanalytic approaches will not find this text of much interest. Nevertheless, as a psychoanalytic reviewer, I am powerfully impressed by the author's scholarship. Any models, including both psychodynamic and medical, if employed in isolation, will have serious limitations; however, it is fascinating how Winokur ends up convincingly dividing the category affective disorders into four specific affective disorders: (1) organic affective syndrome (dysfunction in the brain or bodily metabolic disease); (2) bipolar