jo's Reviews > An Unquiet Mind: A Memoir of Moods and Madness

An Unquiet Mind by Kay Redfield Jamison
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Aug 09, 2007

it was amazing
bookshelves: psychic-pain, memoir, books-i-teach, psychiatry-ugh
Recommended for: people with bipolar disorder
Read in March, 2011 , read count: 2

just re-read this for class. maybe i'll post a a review later. for now, though, i raised my four-star rating to five. the ways in which KRJ thinks about mental illness are not always congenial with mine, but this is a brave, beautifully written, and still very powerful book, many such memoirs later.

REVIEW 3/12/11

i'm not going to research this, but i think this was one of the first candid memoirs of mental disorder coming from someone famous/mainstream in the US and published by a major publisher. it was especially noteworthy because the author was (is) a mental health professional, a teaching and practicing clinician who had written what was probably the most authoritative textbook on bipolar disorder at the time (maybe it still is). that this woman who had climbed so high in a world of men would come out and say candidly that she had the very disorder she was considered an expert at treating was fairly shocking. bipolar people were and are not supposed to be able to think critically about their disorder (or much of anything), much less to treat it in others. i am not going to research this but i think this book became a bestseller.

although not herself a psychiatrist (her degree is in psychology), KRJ is a professor of psychiatry and her narrative of madness hinges on the unquestioned premise that bipolar disorder is a biological illness (she doesn't like the word "bipolar disorder," which had already been introduced in the DSM at the time of the book's writing, and prefers to refer to the condition as manic-depressive illness). this means that she embraces what is now referred to as the medical model of (this, at least) mental illness, according to which (this) mental illness is due solely to genetic factors which are responsible for a certain kind of malfunctioning of the brain. humbly, and wisely, KRJ sticks closely to her own disorder, never generalizing about mental illness in general.

this biological narrative is the backbone of the book. it allows KRJ to exonerate herself and her history for the terrible lows she experienced and believe that if it weren't for her illness she would perfectly fine.

this is incredibly complicated. it hits the core of the concept of illness in general, and identity, and, also, the fraught field of disability studies. if i am blind, am i perfectly fine except for the fact of being blind? do disabilities attach to the body in ways that leave the self intact?

i am not even sure that KRJ would agree with my pushing her premises to this conclusion. she definitely does not feel intact. her illness as she describes it affects her life so profoundly, i am not sure she feels that she is entirely separate from it. yet, a certain separateness between the self and the illness is a consequence, it seems to me, of an extreme view of the medical model and of certain conceptions of disability.

needless to say, i don't find the medical model convincing. for one, there is to this day no hard evidence of any kind that mental illness is biologically based. there is some anecdotal evidence based on heredity, brain scans, and the sometime effectiveness of drugs, but just about all of the above can be explained in other ways, too. more damningly, there is the fact that mentally "ill" people have lively and rich inner lives that we can explain away through biology only by denying some of the most fundamental tenets of humanness. according to a strong medical model, distorted thoughts, hallucinations, obsessions, phobias and dreams are all the result of misfiring neurons and have no significance at all. as such, they don't lend themselves to more then the 15 mins conversation required to decide what drug treatment to adopt.

the reality is that drug treatment decisions are so arbitrary and themselves anecdotal, there is no single drug that is guaranteed to solve a particular mental disorder, the way, say, antibiotics are guaranteed (well, less and less) to cure infection or insulin to keep diabetics alive.

it seems at the very least perplexing to me that some thought patterns should be granted credibility and some shouldn't. if you rule out the meaningfulness of the bizarre thoughts of a schizophrenic, why should i lend credence, say, to the thought process that leads you to such ruling out? what makes your thoughts more valid than those of a schizophrenic?

etc.

so this was always my reservation with respect to this book. having just reread it, though, and seen its impact on my students, i have come to appreciate its complexity and value. first of all, it is remarkably and even outrageously candid. this woman's courage in risking her professional standing to tell an extremely uncomfortable truth about mental illness deserves great admiration. i believe that this book has done much to remove some of the stigma that attaches to mental illness.

secondly, it is written passionately and lyrically, and some passages (especially in the last part) are deeply moving. this is a woman who knows pain, despair, and abject suicidality, and if you know them too you will find in her a fellow traveler and a beacon of hope.

what i like best, though, lies at the meta-level. when pain hits us harder than we can bear it, we desperately need a narrative that makes sense of it and, in doing so, allows us to survive. in Unquiet Mind KRJ may or may not be telling something informative about bipolar disorder, but she is certainly giving us the narrative she created for herself in order to survive the intolerable pain she was experiencing and even thrive in spite of it. This seems to me of tremendous value. If even one person found in this book a story that helped her carry on and succeed in putting together a satisfactory life, the book would be worth its ink in gold.

when KRJ wrote Unquiet Mind the capacity of lithium to stabilize mood had just been ascertained. since then, lithium has been proven to be also very dangerous, so if you read this and your (uninformed) psychiatrist puts you on a gigantic lithium regimen, read up on the internet what lithium can do to your body. there are a number of people who have lost kidney function to the miraculous curative powers of lithium. on the other hand, maybe lithium works for you in small amounts, or other drugs do, and that's great. or maybe you are one of those people who prefer to live their bipolar lives medication-free, and if so more power to you (and the best of luck: you are going to to need a lot of resources to keep out of a very coercive pro-medication mental health system).

i have my own personal narrative of mental illness and it works for me. i think it's the right one and i am quite wedded to it. it is based on the so-called trauma model of mental pain and tends to be quite wary of the medical model. at the same time, i appreciate the well-being psychodrugs have brought to countless people, just as i appreciate the well-being people derive from: love, friendship, therapy, good food, yoga, exercise, comfort, compassion, and immoderate amount of chocolate.

there is no magic bullet when it comes to inner pain. we do well to keep this in mind at all times.
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Comments (showing 1-12 of 12) (12 new)

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message 1: by Hazel (new) - added it

Hazel Me, too. This has been on my list for a while. I liked Night Falls Fast a great deal.


Msmurphybylaw I would love to read your review. Thanks for bringing this book to my attention.


Msmurphybylaw Very well put. Thank you.


message 4: by Hazel (new) - added it

Hazel Thank you, jo. I sometimes find these memoirs difficult to read, but I'm encouraged by your thoughtful review. I want to compile a collection of books I can recommend to patients and others. I think this might do very well for some people. Of course, I have to read it first. :-)

We seem to have different perceptions of the medical model. the medical model of (this, at least) mental illness, according to which (this) mental illness is due solely to genetic factors which are responsible for a certain kind of malfunctioning of the brain I don't remember ever being taught that genetics could be a sole factor in any mental illness. On the contrary, our understanding is that genetic factors, together with environmental factors (including stress) seem to increase the likelihood of someone getting some conditions. There's a fair amount of evidence for genetic factors, e. g. in twin studies, where identical twins separated at birth are more likely to get the same illness. I wouldn't call this kind of stuff anecdotal.

according to a strong medical model, distorted thoughts, hallucinations, obsessions, phobias and dreams are all the result of misfiring neurons and have no significance at all. as such, they don't lend themselves to more then the 15 mins conversation required to decide what drug treatment to adopt

Again, my understanding is very different. One of the reasons we use different psychotherapeutic approaches to help people manage their distressing symptoms, in addition to and sometimes instead of medication, is that we recognise these illnesses as being multifactorial. Any British-trained psychiatrist will spend an hour beginning the assessment of a patient. Our follow up appointments in the public sector are usually limited to half hour sessions, but I think we would all be horrified by a 15 min assessment , except in a triage-type situation. And I agree, the content and form of 'abnormal' thoughts/perceptions is very meaningful. I find it hard to imagine a psychiatrist wouldn't recognise that. Many of us will develop a 'formulation' which includes the emotional, social, cultural factors contributing to the person's problems. By the way, we don't use lithium carbonate much here, either, because of its toxicity. But I remember it working very well for some people. It's been around for 50 years or more.

Last week I attended a conference on transcultural cognitive behaviour therapy, where most of the presenters were psychiatrists who as researchers and psychotherapists, use CBT to help people cope with psychotic illnesses.

I wonder if there are cultural differences in the practice of psychiatry, which contribute to our different perceptions? I found that when I moved from the West Indies to the UK.

Your personal narrative sounds like just the kind of approach I recommend. Lots of us look instead for a magic bullet.

just as i appreciate the well-being people derive from: love, friendship, therapy, good food, yoga, exercise, comfort, compassion, and immoderate amount of chocolate.

Wish I could come up with a pill for this. :-)


message 5: by jo (new) - rated it 5 stars

jo hey hazel, thanks for the thoughtful comments. i should have mentioned the twin studies. those are good and, you're right, not anecdotal. i am of course entirely receptive to the predisposition idea; it would be foolish not to be, given the evidence. truthfully, though, in the US, partly because of the turn to managed care and the almost complete control of insurance companies on medical care (including mental health), and partly because of the enormous power of pharmaceutical companies, a way of thinking about the (diseased) mind solely in biological terms is vastly preponderant.

by the way, KRJ does repeat, over and over, that medication without therapy is not enough, but her experience with therapy seems, from her scant description of it, to be more about managing bad moments than about solving deep-seated issues. in other words, the disease is biological but of course sometimes you're going to feel shitty, and in those times a good therapist will help you get through. this does not seem enough to me.

since bipolar and schizophrenic people get better without drugs all the time, it seems to me time to start considering that we really don't know much at all about the way the brain or the mind work and that the best way to learn about them is by talking and listening to patients. which, i assure you, it's not done much in the US. don't know about the UK.

this scandalous article was in the new york times last week. be amazed. http://nyti.ms/fxnVtv you guys will do well to fight for the NHS, flawed as it is, tooth and nail.


message 6: by jo (new) - rated it 5 stars

jo hazel, two litte clarifications: i make a point of saying that what i decry is the "strong" medical model. also, lithium was just being approved by the FDA when KRJ started taking it, not when she wrote the book.


message 7: by Hazel (new) - added it

Hazel jo wrote: "hey hazel, thanks for the thoughtful comments. i should have mentioned the twin studies. those are good and, you're right, not anecdotal. i am of course entirely receptive to the predisposition ide..."

Hard to believe, jo! Scandalous indeed. That's so sad. I feel for that doctor, who can't care for his patients according to his conscience. We complain lots about the NHS, but it is worth fighting for. And I agree with the one who says the medication can help, but it's the doctor-patient relationship that heals.

And I agree with you, that we really don't know much at all about the way the brain or the mind work. I think clinical and research psychiatrists know this very well. Perhaps the pharmaceutical companies have a vested interest in pretending otherwise, hmm?


message 8: by jo (new) - rated it 5 stars

jo Hazel wrote: "Perhaps the pharmaceutical companies have a vested interest in pretending otherwise, hmm?"

i wonder. :)

as for that doctor (i assume you are talking about the nyt guy), he's bring home some 200K/year, so i wouldn't feel too sorry for him.


message 9: by Hazel (new) - added it

Hazel jo wrote: "Hazel wrote: "Perhaps the pharmaceutical companies have a vested interest in pretending otherwise, hmm?"

i wonder. :)

as for that doctor (i assume you are talking about the nyt guy), he's bring h..."


Yeah, but it's too easy for me to be morally superior and say I'd never do such a thing. :-)

And he sounds as though he's in pain, don't you think? Or am I projecting?


message 10: by jo (new) - rated it 5 stars

jo hahaha. i'm happy you are seeing his side of the story. my compassion for him fails me when i think of the patients he processes like loaves of bread out of a mill. it's a fault in me. i'll try to rectify.


Jab843 Excellent review, I also realized that the book is on of the first in its field. I had hoped that she would write a follow up afterwards, but to no avail. I guess the final book will be after 10 or so more years discussing how she dealt with it being public and taking medication.


message 12: by jo (new) - rated it 5 stars

jo thank you, jab843!


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