“Which of the me’s is me?” An Unquiet Mind. A Memoir of Moods and Madness – Kay Redfield Jamison.

Kay Jamison’s story is not of someone who has succeeded despite having a severe disorder, but of someone whose particular triumphs are a consequence of her disorder. She would not have observed what she has if she had not experienced what she did. The fact that she has endured such battles helps her to understand them in others.

“The disease that has, on several occasions, nearly killed me does kill tens of thousands of people every year: most are young, most die unnecessarily, and many are among the most imaginative and gifted that we as a society have. The major clinical problem in treating manic-depressive illness is not that there are not effective medications, there are, but that patients so often refuse to take them. Freedom from the control imposed by medication loses its meaning when the only alternatives are death and insanity.”

Her remarkable achievements are a beacon of hope to those who imagine that they cannot survive their condition, much less thrive with it.

I doubt sometimes whether a quiet & unagitated life would have suited me, yet I sometimes long for it. – Byron.

For centuries, the prevailing wisdom had been that having a mental illness would prevent a doctor from providing competent care, would indicate a vulnerability that would undermine the requisite aura of medical authority, and would kill any patient’s trust. In the face of this intense stigmatization, many bright and compassionate people with mental illness avoided the field of medicine, and many physicians with mental illness lived in secrecy. Kay Redfield Jamison herself led a closeted life for many years, even as she coauthored the standard medical textbook on bipolar illness. She suffered from the anguish inherent in her illness and from the pain that comes of living a lie.

With the publication of An Unquiet Mind, she left that lie behind, revealing her condition not only to her immediate colleagues and patients, but also to the world, and becoming the first clinician ever to describe travails with bipolar illness in a memoir. It was an act of extraordinary courage, a grand risk taking infused with a touch of manic exuberance, and it broke through a firewall of prejudice. You can have bipolar illness and be a brilliant clinician; you can have bipolar illness and be a leading authority on the condition, informed by your experiences rather than blinded by them. You can have bipolar illness and still have a joyful, fruitful, and dignified life.

Kay Jamison’s story is not of someone who has succeeded despite having a severe disorder, but of someone whose particular triumphs are a consequence of her disorder. Ovid said, “The wounded doctor heals best” and Jamison’s open hearted declarations have been a salve for the wounded psyches of untold thousands of people; her unquiet mind has often soothed the minds of others. Her discernments come from a rare combination of observation and experience: she would not have observed what she has if she had not experienced what she did. The fact that she has endured such battles helps her to understand them in others, and her frankness about them offers an antidote to the pervasive shame that Cloisters so many mentally ill people in fretful isolation.

Her remarkable achievements are a beacon of hope to those who imagine that they cannot survive their condition, much less thrive with it. Those who address mental illnesses tend to do so with either rigor or empathy; Jamison attains a rare marriage of the two. Just as her clinical work has been strengthened by her personal experience, her personal experience has been informed by her academic insights.

It is different to go through manic and depressive episodes when you know everything there is to know about your condition than it is to go through them in ignorance, constantly ambushed by the apparently inexplicable.

Like many people with mental illness, Jamison has had to reckon with the impossibility of separating her personality from her condition. “Which of the me’s is me?” she asks rhetorically in these pages. She kept up a nearly willful self-ignorance for years before she succumbed to knowledge; she resisted remedy at first because she feared she might lose some of her essential self to it. It took repeated descents and ascents into torment to instigate a kind of acquiescence. She has become glad of that surrender; it has saved a life that turns out to be well worth living. As this book bleached away her erstwhile denial, it has mediated her readers’ denial, too. As a professor of psychiatry at Johns Hopkins University and in her frequent lectures around the globe, Kay Jamison has taught a younger generation of doctors how to make sense of their patients: not merely how to treat them, but how to help them.

Though An Unquiet Mind does not provide diagnostic criteria or propose specific courses of treatment, it remains very much a book about medicine, with a touchingly fond portrait of science. Jamison expresses enormous gratitude to the doctors who have treated her and to the researchers who established the modes of treatment that have kept her alive. She engages medicine’s resonant clarities, and she tolerates the relative primitivism of our understanding of the brain.

Appreciating the biology of her illness and the mechanisms of its therapies allowed her to achieve a truce with her bipolar illness, and science informed her choice to speak openly about her skirmishes with it. That peace has not entirely precluded further episodes, but it makes them easier to tolerate when they come. Equally, it has given her the courage to stay on medication and the resilience to sustain other forms of self-care.

You can feel in Jamison’s writing a bracing honesty unmarred by self-pity. It seems clear Jamison is not by nature an exhibitionist, and making so much of her private life into public property cannot have been easy for her. On every page, you sense the resolve it has required. Her book differs from much confessional writing in that, although she describes certain experiences in agonizing detail, she maintains a vocabulary of discretion. An Unquiet Mind may have been intended as a book about an illness, not about a life, but it is both. There is satisfaction in making your affliction useful to other people; it redeems what seemed in the instance to be useless experiences. That insistence on making something good out of something bad is the vital force in her writing.

I met Kay Jamison in 1995, shortly after the publication of An Unquiet Mind, when I had first decided to write about depression. I contacted her to request an interview, and she suggested we have lunch; she then invited me to my first serious scientific conference, a suicide symposium she had organized, attended by the leading figures in the field. Her kindness to me in the early stages of my research points to a personal generosity that mirrors the brave generosity of her books. The forbearance that has made her a good clinician and a good writer also makes her a good friend.

In the years since then, Jamison has produced a corpus of work that, in a very different kind of bipolarity, limns the glittering revelations of psychosis only to return to its perilous ordeals. Touched with Fire (1993) had already chronicled the artistic achievements of people with bipolar illness; Night Falls Fast (1999) tackles the impossible subject of suicide; Exuberance (2004) tells us how unipolar mania has generated many intellectual and artistic breakthroughs; and Nothing was the Same (2009) is a closely observed and deeply personal account of losing her second husband to cancer, a journey complicated by her unreliable moods. Her illness runs through these books even when it is not her explicit topic. But that recurrent theme does not narrow the books into ego studies; instead, it makes them startlingly, powerfully intimate.

Jamison consistently evinces a romantic attachment to language itself. Her sentences flow out in an often poetic rapture, and she displays a sustaining love for the poetry of others, quoting it by the apposite yard. Few doctors know poetry so well, and few poets understand so much biology, and Jamison serves as a translator between humanism and science, which are so often disparate vocabularies for the same phenomena. While poetry inflects her literary voice, it sits comfortably beside a sense of humor. Irony is among her best defenses against gloom, and the zing of her comic asides makes reading about unbearable things a great deal more bearable. The crossing point of precision, luminosity, and hilarity may be the safest domain for an inconsistent mind, a nexus of relief for someone whose stoicism cannot fully assuage her distress.

Two decades after its publication, An Unquiet Mind remains fresh. There’s been a bit more science in the field and a great deal of social change regarding mental illness, change this book helped to create: a society in which what was relentlessly shameful is more easily and frequently acknowledged. The book delineates not how to treat the condition, but how to live with the condition and its treatments, and that remains relevant even as actual treatments evolve.

Jamison does not stint on her own despair, but she has constructed meaning and built an identity from it. While she might not have opted for this illness, neither does she entirely regret it; she prefers, as she writes so movingly, a life of passionate turbulence to one of tedious calm. Learning to appreciate the things you also regret makes for a good way forward. If you have bipolar illness, this book will help you to forgive yourself for everything that has gone awry; if you do not, it will perhaps show how a steely tenacity can imbue disasters with value, a capacity that stands to enrich any and every life.

Andrew Solomon

Kay Redfield Jamison

Prologue

When it’s two o’clock in the morning, and you’re manic, even the UCLA Medical Center has a certain appeal. The hospital, ordinarily a cold clotting of uninteresting buildings, became for me, that fall morning not quite twenty years ago, a focus of my finely wired, exquisitely alert nervous system. With vibrissae twinging, antennae perked, eyes fast forwarding and fly faceted, I took in everything around me. I was on the run. Not just on the run but fast and furious on the run, darting back and forth across the hospital parking lot trying to use up a boundless, restless, manic energy. I was running fast, but slowly going mad.

The man I was with, a colleague from the medical school, had stopped running an hour earlier and was, he said impatiently, exhausted. This, to a saner mind, would not have been surprising: the usual distinction between day and night had long since disappeared for the two of us, and the endless hours of scotch, brawling, and fallings about in laughter had taken an obvious, if not final, toll. We should have been sleeping or working, publishing not perishing, reading journals, writing in charts, or drawing tedious scientific graphs that no one would read.

Suddenly a police car pulled up. Even in my less than totally lucid state of mind I could see that the officer had his hand on his gun as he got out of the car. “What in the hell are you doing running around the parking lot at this hour?” he asked. A not unreasonable question. My few remaining islets of judgment reached out to one another and linked up long enough to conclude that this particular situation was going to be hard to explain. My colleague, fortunately, was thinking far better than I was and managed to reach down into some deeply intuitive part of his own and the world’s collective unconscious and said, “We’re both on the faculty in the psychiatry department.” The policeman looked at us, smiled, went back to his squad car, and drove away. Being professors of psychiatry explained everything.

Within a month of signing my appointment papers to become an assistant professor of psychiatry at the University of California, Los Angeles, I was well on my way to madness; it was 1974, and I was twenty-eight years old. Within three months I was manic beyond recognition and just beginning a long, costly personal war against a medication that I would, in a few years’ time, be strongly encouraging others to take. My illness, and my struggles against the drug that ultimately saved my life and restored my sanity, had been years in the making.

For as long as I can remember I was frighteningly, although often wonderfully, beholden to moods. Intensely emotional as a child, mercurial as a young girl, first severely depressed as an adolescent, and then unrelentingly caught up in the cycles of manicdepressive illness by the time I began my professional life, I became, both by necessity and intellectual inclination, a student of moods. It has been the only way I know to understand, indeed to accept, the illness I have; it also has been the only way I know to try and make a difference in the lives of others who also suffer from mood disorders.

The disease that has, on several occasions, nearly killed me does kill tens of thousands of people every year: most are young, most die unnecessarily, and many are among the most imaginative and gifted that we as a society have.

The Chinese believe that before you can conquer a beast you first must make it beautiful. In some strange way, I have tried to do that with manic-depressive illness. It has been a fascinating, albeit deadly, enemy and companion; I have found it to be seductively complicated, a distillation both of what is finest in our natures, and of what is most dangerous. In order to contend with it, I first had to know it in all of its moods and infinite disguises, understand its real and imagined powers. Because my illness seemed at first simply to be an extension of myself, that is to say, of my ordinarily changeable moods, energies, and enthusiasms, I perhaps gave it at times too much quarter. And, because I thought I ought to be able to handle my increasingly violent mood swings by myself, for the first ten years I did not seek any kind of treatment. Even after my condition became a medical emergency, I still intermittently resisted the medications that both my training and clinical research expertise told me were the only sensible way to deal with the illness I had.

My manias, at least in their early and mild forms, were absolutely intoxicating states that gave rise to great personal pleasure, an incomparable flow of thoughts, and a ceaseless energy that allowed the translation of new ideas into papers and projects. Medications not only cut into these fast-flowing, highflying times, they also brought with them seemingly intolerable side effects. it took me far too long to realize that lost years and relationships cannot be recovered, that damage done to oneself and others cannot always be put right again, and that freedom from the control imposed by medication loses its meaning when the only alternatives are death and insanity.

The war that I waged against myself is not an uncommon one. The major clinical problem in treating manic-depressive illness is not that there are not effective medications, there are, but that patients so often refuse to take them. Worse yet, because of a lack of information, poor medical advice, stigma, or fear of personal and professional reprisals, they do not seek treatment at all.

Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide.

I am fortunate that I have not died from my illness, fortunate in having received the best medical care available, and fortunate in having the friends, colleagues, and family that I do. Because of this, I have in turn tried, as best I could, to use my own experiences of the disease to inform my research, teaching, clinical practice, and advocacy work.

Through writing and teaching I have hoped to persuade my colleagues of the paradoxical core of this quicksilver illness that can both kill and create; and, along with many others, have tried to change public attitudes about psychiatric illnesses in general and manic depressive illness in particular. It has been difficult at times to weave together the scientific discipline of my intellectual field with the more compelling realities of my own emotional experiences. And yet it has been from this binding of raw emotion to the more distanced eye of clinical science that I feel I have obtained the freedom to live the kind of life I want, and the human experiences necessary to try and make a difference in public awareness and clinical practice.

I have had many concerns about writing a book that so explicitly describes my own attacks of mania, depression, and psychosis, as well as my problems acknowledging the need for ongoing medication. Clinicians have been, for obvious reasons of licensing and hospital privileges, reluctant to make their psychiatric problems known to others. These concerns are often well warranted.

I have no idea what the longterm effects of discussing such issues so openly will be on my personal and professional life, but, whatever the consequences, they are bound to be better than continuing to be silent. I am tired of hiding, tired of misspent and knotted energies, tired of the hypocrisy, and tired of acting as though I have something to hide.

One is what one is, and the dishonesty of hiding behind a degree, or a title, or any manner and collection of words, is still exactly that: dishonest. Necessary, perhaps, but dishonest. I continue to have concerns about my decision to be public about my illness, but one of the advantages of having had manic-depressive illness for more than thirty years is that very little seems insurmountably difficult. Much like crossing the Bay Bridge when there is a storm over the Chesapeake, one may be terrified to go toward, but there is no question of going back. I find myself somewhat inevitably taking a certain solace in Robert Lowell’s essential question, Yet why not say what happened?

Part One

THE WILD BLUE YONDER

Into the Sun

I was standing with my head back, one pigtail caught between my teeth, listening to the jet overhead. The noise was loud, unusually so, which meant that it was close. My elementary school was near Andrews Air Force Base, just outside Washington; many of us were pilots’ kids, so the sound was a matter of routine. Being routine, however, didn’t take away from the magic, and I instinctively looked up from the playground to wave. I knew, of course, that the pilot couldn’t see me, I always knew that, just as I knew that even if he could see me the odds were that it wasn’t actually my father. But it was one of those things one did, and anyway I loved any and all excuses just to stare up into the skies. My father, a career Air Force officer, was first and foremost a scientist and only secondarily a pilot. But he loved to fly, and, because he was a meteorologist, both his mind and his soul ended up being in the skies. Like my father, I looked up rather more than I looked out.

When I would say to him that the Navy and the Army were so much older than the Air Force, had so much more tradition and legend, he would say, Yes, that’s true, but the Air Force is the future. Then he would always add: And we can fly. This statement of creed would occasionally be followed by an enthusiastic rendering of the Air Force song, fragments of which remain with me to this day, nested together, somewhat improbably, with phrases from Christmas carols, early poems, and bits and pieces of the Book of Common Prayer: all having great mood and meaning from childhood, and all still retaining the power to quicken the pulses.

So I would listen and believe and, when I would hear the words “Off we go into the wild blue yonder,” I would think that “wild” and “yonder” were among the most wonderful words I had ever heard; likewise, I would feel the total exhilaration of the phrase “Climbing high, into the sun” and know instinctively that I was a part of those who loved the vastness of the sky.

The noise of the jet had become louder, and I saw the other children in my second grade class suddenly dart their heads upward. The plane was coming in very low, then it streaked past us, scarcely missing the playground. As we stood there clumped together and absolutely terrified, it flew into the trees, exploding directly in front of us. The ferocity of the crash could be felt and heard in the plane’s awful impact; it also could be seen in the frightening yet terrible lingering loveliness of the flames that followed. Within minutes, it seemed, mothers were pouring onto the playground to reassure children that it was not their fathers; fortunately for my brother and sister and myself, it was not ours either. Over the next few days it became clear, from the release of the young pilot’s final message to the control tower before he died, that he knew he could save his own life by bailing out. He also knew, however, that by doing so he risked that his unaccompanied plane would fall onto the playground and kill those of us who were there.

The dead pilot became a hero, transformed into a scorchingly vivid, completely impossible ideal for what was meant by the concept of duty. It was an impossible ideal, but all the more compelling and haunting because of its very unobtainability. The memory of the crash came back to me many times over the years, as a reminder both of how one aspires after and needs such ideals, and of how killingly difficult it is to achieve them. I never again looked at the sky and saw only vastness and beauty. From that afternoon on I saw that death was also and always there.

Although, like all military families, we moved a lot, by the fifth grade my older brother, sister, and I had attended four different elementary schools, and we had lived in Florida, Puerto Rico, California, Tokyo, and Washington, twice, our parents, especially my mother, kept life as secure, warm, and constant as possible. My brother was the eldest and the steadiest of the three of us children and my staunch ally, despite the three year difference in our ages. I idolized him growing up and often trailed along after him, trying very hard to be inconspicuous, when he and his friends would wander off to play baseball or cruise the neighborhood. He was smart, fair, and self-confident, and I always felt that there was a bit of extra protection coming my way whenever he was around. My relationship with my sister, who was only thirteen months older than me, was more complicated. She was the truly beautiful one in the family, with dark hair and wonderful eyes, who from the earliest times was almost painfully aware of everything around her. She had a charismatic way, a fierce temper, very black and passing moods, and little tolerance for the conservative military lifestyle that she felt imprisoned us all. She led her own life, defiant, and broke out with abandon whenever and wherever she could. She hated high school and, when we were living in Washington, frequently skipped classes to go to the Smithsonian or the Army Medical Museum or just to smoke and drink beer with her friends.

She resented me, feeling that I was, as she mockingly put it, “the fair-haired one”, a sister, she thought, to whom friends and schoolwork came too easily, passing far too effortlessly through life, protected from reality by an absurdly optimistic view of people and life. Sandwiched between my brother, who was a natural athlete and who never seemed to see less-than-perfect marks on his college and graduate admission examinations, and me, who basically loved school and was vigorously involved in sports and friends and class activities, she stood out as the member of the family who fought back and rebelled against what she saw as a harsh and difficult world. She hated military life, hated the constant upheaval and the need to make new friends, and felt the family politeness was hypocrisy.

Perhaps because my own violent struggles with black moods did not occur until I was older, I was given a longer time to inhabit a more benign, less threatening, and, indeed to me, a quite wonderful world of high adventure. This world, I think, was one my sister had never known. The long and important years of childhood and early adolescence were, for the most part, very happy ones for me, and they afforded me a solid base of warmth, friendship, and confidence. They were to be an extremely powerful amulet, a potent and positive countervailing force against future unhappiness. My sister had no such years, no such amulets. Not surprisingly, perhaps, when both she and I had to deal with our respective demons, my sister saw the darkness as being within and part of herself, the family, and the world. I, instead, saw it as a stranger; however lodged within my mind and soul the darkness became, it almost always seemed an outside force that was at war with my natural self.

My sister, like my father, could be vastly charming: fresh, original, and devastatingly witty, she also was blessed with an extraordinary sense of aesthetic design. She was not an easy or untroubled person, and as she grew older her troubles grew with her, but she had an enormous artistic imagination and soul. She also could break your heart and then provoke your temper beyond any reasonable level of endurance. Still, I always felt a bit like pieces of earth to my sister’s fire and flames.

For his part, my father, when involved, was often magically involved: ebullient, funny, curious about almost everything, and able to describe with delight and originality the beauties and phenomena of the natural world. A snowflake was never just a snowflake, nor a cloud just a cloud. They became events and characters, and part of a lively and oddly ordered universe. When times were good and his moods were at high tide, his infectious enthusiasm would touch everything. Music would fill the house, wonderful new pieces of jewelry would appear, a moonstone ring, a delicate bracelet of cabochon rubies, a pendant fashioned from a moody sea, green stone set in a swirl of gold, and we’d all settle into our listening mode, for we knew that soon we would be hearing a very great deal about whatever new enthusiasm had taken him over. Sometimes it would be a discourse based on a passionate conviction that the future and salvation of the world was to be found in windmills; sometimes it was that the three of us children simply had to take Russian lessons because Russian poetry was so inexpressibly beautiful in the original.

*

from

An Unquiet Mind. A Memoir of Moods and Madness

by Kay Redfield Jamison

get it at Amazon.com

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