BY WILLIAM POLKOWSKI
Both an authority on manic-depressive illness (Bipolar Disorder) and one who has experienced it first hand in its various dimensions, Kay Redfield Jamison has written prolifically about manic depression. She has had several books published. In 1990 “Manic Depressive Illness,” a comprehensive textbook of some 900 pages coauthored with Frederick Goodwin, M.D., was published. In 1993 “Touched with Fire: Manic Depressive Illness and the Artistic Temperament” came out; and in 1995 her personal memoir, “An Unquiet Mind,” became available. It describes her family background, her childhood, the various manifestations of her illness, her struggles and her loves.
The subtitle of the book is “A Memoir of Moods and Madness.” That she refers to her illness as involving episodes of insanity and madness reflects her own disabling and severe experience of both the manias and the depressions. At times her thoughts became utterly distorted and fragmented, and once she attempted suicide. Her experiences include mixed episodes, where symptoms of both mania and depression co-occur. Her life is a testimony that a serious mental illness can be treated successfully and is compatible with great achievement, even in medicine and psychiatry.
Kay, obviously an intelligent and rather willful girl, had a brilliant and mercurial father — he was a career air force officer, a pilot and a scientist — and a warm, stable mother. Though they moved frequently, and in spite of the disruptions that accompany such a life, she appears to have had a reasonably happy childhood. She always liked school, did well, enjoyed sports and readily made friends. When Kay was 15, her father retired from the Air Force and took a job as a scientist with the Rand Corporation, which could not tolerate his idiosyncratic thinking and grandiosity. He lost his job. Soon thereafter her parents became estranged.
Highly heritable, manic depression is evident in her family. She was the youngest of three children — her brother, three years older, she describes as intelligent and steady; her sister, thirteen months older, was an unstable rebel who had trouble adjusting in life. And at age 17, while a senior in high school, Kay experienced her first manic episode.
At age 20 Kay interrupted the turmoil of her undergraduate life at UCLA by a year at St. Andrews in Scotland, where she indulged her interest in zoology and literature. Then she returned to UCLA. She had the good fortune to be able to do research and write under the direction of an extraordinary professor, who himself was inclined to rapid and profound mood swings. She thoroughly enjoyed graduate school, not realizing that she was enjoying a typical remission of symptoms. She married during this time, her first marriage. Even in her medical studies and her clinical work in psychiatry, where she learned diagnosis, she failed to connect her own experience with the manic depressive illness described in her textbooks.
Shortly after her appointment as an assistant professor of psychiatry at UCLA, she experienced a severe manic episode, more dangerous and psychotic than she had ever experienced. She wrote, “There is a particular kind of pain, elation, loneliness, and terror involved in this kind of madness. When you’re high it’s tremendous. The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the power to captivate others a felt certainty. There are interests found in uninteresting people. Sensuality is pervasive and the desire to seduce and be seduced irresistible. Feelings of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one’s marrow.”
But then the severity of her symptoms got even worse: “But, somewhere, this changes. The fast ideas are far too fast, and there are far too many; overwhelming confusion replaces clarity. Memory goes. Humor and absorption on friends’ faces are replaced by fear and concern. Everything previously moving with the grain is now against—you are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind.”
Kay wrote of her struggles with lithium, which she regarded as a lifesaver, but also was her chosen instrument of death. She swallowed a highly toxic dose and had even taken an antiemetic so that she would not vomit it up. But she answered a phone call and a physician friend recognized that she was in crisis and acted immediately to save her. For her, lithium controlled her manic moods, but it also interfered with her emotional range and liveliness. Finally, she opted for a lesser dosage that still would allow her to experience a halfway normal emotional life at the risk of having exaggerated emotional responses.
For a long time Dr. Jamison struggled with revealing to others her manic depression, fearing that this would lead to canceling her hospital admitting privileges and licensing to do clinical work. She was fortunate enough to have knowledgeable medical friends and expert psychiatrists who supported her and could check on her well-being. Also they could monitor her mental states to ensure that she was not compromising her ability to help her patients.
Kay Jamison poses the question whether, if it could be determined in utero that a fetus has the likelihood of developing manic depressive illness, parents would choose abortion. If so, this would eliminate an important source of creativity in society. She points out that most parents have claimed that they would never make this choice. She also responds to the question of whether she would have preferred not to have had manic depression. She says that, if there were no way to control the illness, she never would have wished it on herself or others; but it is controllable and she is glad that she has had the accompanying experiences, even if a number of them have been horrible to endure.
“An Unquiet Mind” is written well, illustrates some of the typical experiences of mania and depression, as well as extraordinarily severe symptoms. It gives the reader insight into how such experiences impact the manic depressive’s life — vocation, friendships and love. Dr. Jamison’s life shows how life’s struggles can be used to advantage to increase well-being, satisfaction and accomplishment. Every life includes many gifts as well as limitations, and her life illustrates how we can work with both to achieve our life’s goals.