Irwin, Cait with Evans, Dwight & Andrews, Linda. (2007). Monochrome Days: A firsthand account of one teenager's experience with depression. Reviewed by Robbie J. Steward, Michigan State University

Irwin, Cait with Evans, Dwight & Andrews, Linda. (2007). Monochrome Days: A firsthand account of one teenager’s experience with depression. N.Y.: Oxford University Press, Inc. Pp. v + 160         ISBN 978-0-19-531005-4 Reviewed by Robbie J. Steward Michigan State University September 26, 2007 Monochrome Days should be on the required reading list in every high school psychology class and noted for discussion within curriculum in every graduate program in counseling, psychology, and social work. The inclusion of this text is a curriculum imperative given than most adolescents having symptoms of depression and anxiety, (particularly those from families having lower socio-economic status), do not seek help. There remains a dire need in general society to reach students and parents alike in an attempt to educate them about the disease and the resources around them (Bailey, 2007), in addition, to better preparing novice professionals in disseminating the necessary information to the public that will facilitate prevention and early diagnosis and intervention. This collaborative effort among one diagnosed with depression (Cait Irwin), a psychiatrist (Dwight Evans, M.D.), and a free-lance health and psychology writer (Linda Wasmer Andrews), accomplishes these objectives. The chapters flow easily and effectively set the stage for the presentation of an engaging, personal, and heart-wrenching story that also serves as an easy-read textbook that informs laypersons and budding professionals of the language associated with diagnosis, treatment, and management of depression. The legitimacy of its utility and meaningfulness in education and psychology is validated by advance acclaim by the directors of three of the leading national organizations that have the charge for improving the lives of children and adults living with serious mental illnesses and their families: the National Alliance on Mental Illness Child & Adolescent Action Center (NAMI), Active minds, Inc., and the suicide Prevention Action Network (SPAN USA). The case description component of the book presents a teen’s autobiographical journey through the struggles of depression, which is a major negative cause of engagement in at-risk behaviors (i.e., substance abuse, anorexia, etc.), academic failure, suicidal ideation, and potential death. Written in retrospect and after extensive trial and error efforts in treatment over time, the content uniquely not only presents an in-depth description of internal and interpersonal struggles associated with the ongoing vacillation between hope and despair, but also provides well-defined guidelines for self-assessment (pp. 29-38), help-seeking strategies for successful intervention (i.e., pp. 30, 65), and personal day-to-day management of symptoms associated with this particular diagnosis (i.e., Chapter 7). In many ways, the text has the qualities of a traditional casebook in that it does describe psychological-emotional experiences from onset of the disease and throughout treatment and management interventions in addition to family members’, friends’ and acquaintances’ responses. Life before and after onset of the symptoms are addressed, signs and symptoms of how and when things went wrong, suicidal ideation, hospitalization, tried and failed attempts at therapeutic interventions, medications, and coping, as well as family heart-break and disconnect are presented as realities that may occur during and after recovery. However, this is not the traditional casebook, which typically has linear successes and the happy ending of full recovery with a resulting cohesive and stable family system. The authors sensitively address the negative influence of the disease on the family system, relaying some understanding and forgiving interpretation of others’ detachment and awkwardness, during a time of greatness need of the one diagnosed. However, in doing so, these words are balanced with descriptions of behaviors from others that were found to be most helpful and supportive even though actions might not have been received positively at the time or may not have resulted in immediate positive responses. This work shares the knotholes and flaws that are so often missing in other caseworks. The presence of the identified “patient” as an author in collaboration with professionals allows the evolution of a portrait of one whose insight about their influence on others as well as others’ influence on them is well-documented. Monochrome Days extends the description beyond one individual’s personal story of success to infuse the many faces of significant others’ responses, the effect of the disease on those around them, an abbreviated overview of the literature addressing diagnosis and treatment, and the need for the ongoing inclusion of personal responsibility in monitoring the disease as essential to recovery and management. This is a hard-hitting story of confusion and deep psychological hurt that is not quickly resolved through attention from family and friends, or introspection about the irrationality of thinking. Mainstream ideas about depression resulting solely from an absence of love, social support, and an accommodating environment are refuted. The frightening reality presented is one in which a prevailing negative emotional state of despair and sadness may suddenly occur for no clearly identifiable reason and persist over long periods of time in spite of all personal, family, and school system efforts for correction and healing. Ms. Irwin’s evolving and resilient spirit exhibited throughout her experiences of hopelessness, haplessness, and a non-reality based sense of social isolation are detailed in a manner that is simultaneously unsettling, and inspiring in spite of the pervasiveness and complexity of the collective set of symptoms and effects. Nevertheless, this book is by far much more than a casebook with the primary objective of provoking empathy and understanding of mental illness and depression as a disease. The carefully crafted organized words of the authors and the artwork aptly portray the emotional emptiness and hopelessness associated with depression. However, there are additional qualities that make his work a significant contribution to the literature and an educational tool that heightens sensitivity and awareness, and provides critical knowledge as well. The attention to gender differences increases readers’ awareness of the varying faces of depression based on socialization within our general social structure (pp. 14, 16, 87). Differences between characteristics associated with normal development during adolescence and those associated with depression are noted. The authors help readers better distinguish between what is considered ‘normal’ and what is not at this stage of development. Additional distinguishing points that further enhance knowledge and awareness about the disease include: a 61-word glossary that covers the most relevant nosology associated with diagnosis and pharmacological (i.e., pp. 81-86), various modalities of treatment of the disease (i.e., cognitive-behavioral therapy—pp. 86-88, interpersonal therapy—p. 88, family therapy—pp. 88-89, group therapy—pp. 89, 92-93; a section answering the most frequently asked questions related to understanding depression (pp. 127-136), strategies for battling stereotypes and stigma and effective transitioning into adulthood (Chapters 6 & 7); and, lists of organizational resources (21) (pp. 141-144), books categorized by reading level, first person accounts, and biographical accounts (15), hotlines (2), and websites (2). This book represents one example of a one-stop primer that is guaranteed to lead to increased sensitivity to the perils of the experience and knowledge about exactly what to expect and do once a formal diagnosis of clinical depression occurs. Readers who are mental health professionals or who are in training in this capacity will be left with greater empathy for the impact of depression during this sensitive developmental stage and a better understanding of the world through the eyes of those with whom they work. Teachers, parents, and adolescents are offered a glimpse into the personal and interpersonal tensions and dilemmas experienced by sufferers of depression and those around them. Consequently, they, likewise, will be better prepared to identify and intervene when symptoms present within themselves, within families and within social networks. Depression is presented as a disease, with well-defined signs and symptoms (i.e., changes in eating habits, changes in sleeping habits, changes in activity levels, changes in energy levels, feelings of worthlessness, changes in thinking ability, and thoughts of suicide) (pp.31-34), and having various types (i.e., Dysthymia, Bipolar disorder) (p. 13), which require immediate and ongoing attention. In highlighting these points, the work is stellar and makes a meaningful contribution to our understanding of that which has been identified as one of the most prevalent mental illness diagnoses in this country today and that 14% of teens report experiencing some associated symptoms by age 18 (p. 13). However, what is equally important to understanding depression, but not directly addressed in the case highlighted, was apparent implicitly in the manner in which etiology was addressed. Those who are depressed may not be able to clearly identify the points of etiology of the disease, only the prevailing sense of hopelessness. Although the authors took care to identify multiple possible explanations for the origins of the depressed mood (i.e., genetics, biology, psychology, environment) (pp. 15-21), they suddenly become less forthcoming about offering readers some insight about the etiology of the depression of the case described. The explanation was limited to a reaction of seemingly having no idea at all about the causes, to trying to fit in at school, to the genetic contribution from her father, who reportedly suffered from similar symptoms. This absence of expressed insight about reasons for onset and triggers is somewhat noteworthy given reported multiple contacts with therapists and hospitalizations. Nevertheless, individuals do have the right to share or not share pieces of their own personal stories, but this void in the text omits volumes of key information that might have informed readers of the most important factors, which would have provided some insight regarding intervention. For example, a description of how her family system and personality might have specifically contributed to the onset and how changes that occurred during treatment led to more positive outcomes would have been beneficial in completing the picture for laypersons and practitioners. Targeting a specific combination of triggers may engender some hopefulness about individuals’ sense of control, even if limited, over the process and outcome of the recovery experience. The content in the present state reinforces for some a potentially most terrifying conclusion that depression occurs suddenly with no precipitating event or set of events. Providing this information would also have added to the literature addressing prevention, which would certainly benefit readers as well as the profession overall. Regardless of the reasons for the omission, readers must be cautioned in drawing conclusions resulting solely from a disease or medical model perspective without some direction or sense of causality attached that extends beyond the genetic and biological explanations. References Bailey, L. (2007). Students with symptoms of mental illness often don’t seek help. The PsychwatchNewsletter, 10. Retrieved June 30, 2007, from http://www.psychwatch.com/news.htm About the Reviewer Robbie J. Steward is Director of the MA Counseling program and Professor in the Department of Counseling and Educational Psychology & Special Education at Michigan State University. She is currently examining the influence of counselor-trainees’ cognitive-psychological-emotional characteristics on their development of counseling competence. Her research interests include multicultural counseling training, counseling supervision, and the identification of non-cognitive variables that influence academic success in K-12 and undergraduate university student populations.