An Unquiet Mind

by Kay Redfield Jamison

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.

As has been true a thousand times since, my curiosity and temperament had taken me to places I was not really able to handle emotionally, but the same curiosity, and the scientific side of my mind, generated enough distance and structure to allow me to manage, deflect, reflect, and move on.

despite the fact I had no obvious reason to believe that I was anything else but passably sane, irrational fears began to poke away at my mind. I had a terrible temper, after all, and though it rarely erupted, when it did it frightened me and anyone near its epicenter. It was the only crack, but a disturbing one, in the otherwise vacuum-sealed casing of my behavior.

it is only now that I really begin to understand how desperately important it was to both my intellectual and emotional life to have had my thoughts and enthusiasms given not only respect but active encouragement. An ardent temperament makes one very vulnerable to dreamkillers, and I was more lucky than I knew in having been brought up around enthusiasts, and lovers of enthusiasts.

also had left behind a life that had been filled with good friends, family closeness, great quantities of warmth and laughter, traditions I knew and loved, and a city that was home.

California, or at least Pacific Palisades, seemed to me to be rather cold and flashy. I lost my moorings almost entirely, and despite ostensibly adjusting rapidly to a new school and acquiring new friends—both of which were made relatively easy by countless previous changes in schools that had, in turn, bred a hail-fellow-well-met sort of outgoingness—I was deeply unhappy.

Once I got over the initial shocks, I found most of my remaining experiences in high school a remarkable sort of education. Some of it was even in the classroom. I found the highly explicit conversations of my new classmates spellbinding.

The past was indeed the past.

I waited and waited for the return of the laughter and high moods and awesome enthusiasms, but, except for rare appearances, they had given way to anger, despair, and bleak emotional withdrawal.

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. You never knew those caves were there. It will never end, for madness carves its own reality.

Feeling normal for any extended period of time raises hopes that turn out, almost invariably, to be writ on water.

I had been mildly manic many times before, but these had never been frightening experiences—ecstatic at best, confusing at worst. I had learned to accommodate quite well to them. I had developed mechanisms of self-control, to keep down the peals of singularly inappropriate laughter, and set rigid limits on my irritability. I avoided situations that might otherwise trip or jangle my hypersensitive wiring, and I learned to pretend I was paying attention or following a logical point when my mind was off chasing rabbits in a thousand directions. My work and professional life flowed. But nowhere did this, or my upbringing, or my intellect, or my character, prepare me for insanity.

character building, no doubt, but I was beginning to tire of all the opportunities to build character at the expense of peace, predictability, and a normal life.

doubted, completely, my ability to do anything well. It seemed as though my mind had slowed down and burned out to the point of being virtually useless. The wretched, convoluted, and pathetically confused mass of gray worked only well enough to torment me with a dreary litany of my inadequacies and shortcomings in character, and to taunt me with the total, the desperate, hopelessness of it all.

I can’t think, I can’t calm this murderous cauldron, my grand ideas of an hour ago seem absurd and pathetic, my life is in ruins and—worse still—ruinous; my body is uninhabitable.

Inflammability, however, always lay just the other side of exaltation.

Depression, somehow, is much more in line with society’s notions of what women are all about: passive, sensitive, hopeless, helpless, stricken, dependent, confused, rather tiresome, and with limited aspirations. Manic states, on the other hand, seem to be more the provenance of men; restless, fiery, aggressive, volatile, energetic, risk taking, grandiose and visionary, and impatient with the status quo.

Manic-depression is a disease that both kills and gives life. Fire, by its nature, both creates and destroys.

Like everything else in my life, the grim was usually set off by the grand; the grand, in turn, would yet again be canceled out by the grim. It was a loopy but intense life: marvelous, ghastly, dreadful, indescribably difficult, gloriously and unexpectedly easy, complicated, great fun, and a no-exit nightmare.

Manic-depressive illness forces one to deal with many aspects of growing old—with its physical and mental infirmities—many decades in advance of age itself.

Robert Lowell, often crazy but rarely stupid, knew better than to assume a straight shot at happiness: If we see a light at the end of the tunnel, he said, it’s the light of an oncoming train.

I found that asking questions, tracking down answers as best I could, and then asking yet more questions was the best way to provide a distance from anxiety and a framework for understanding.

If I asked him what he was thinking, it was never about death, the human condition, relationships, or us; it was, instead, almost always about a scientific problem or, occasionally, about a patient. He pursued his science and the practice of medicine with the same romantic intensity that was integral to the way I pursued the rest of life.

Our common intellectual interests—medicine, science, and psychiatry—are very strong ones, and our differences in both substance and style have allowed each of us a great deal of independence, which has been essential and which, ultimately, has bound us very close to one another over the years.

These groups—and the scientists and clinicians who make treatment possible-—have made life easier for all of us who have psychiatric illnesses, whether we call ourselves mad or write letters of protest to those who do. Because of them, we now have the luxury of being able to debate the fine points of language about our own and the human condition.