An Unquiet Mind

by Kay Redfield Jamison

My mind would race from subject to subject,...

being filled with the exuberant and cosmic thoughts that had been associated with earlier periods of rapid thinking, it would be drenched in awful sounds and images of decay and dying: dead bodies on the beach, charred remains of animals, toe-tagged corpses in morgues. During these agitated periods I became exceedingly restless, angry, and irritable, and the only way I could dilute the agitation was to run along the beach or pace back and forth across my room like a polar bear at the zoo. I had no idea what was going on...

psychiatrist. I got as far as the stairwell just outside the clinic but was only able to sit there, paralyzed with fear and shame, unable to go in and unable to leave. I must have sat there, head in my hands, sobbing, for more than an hour. Then I left and never went back. Eventually, the depression went away of its own accord, but only long enough for it to regroup and mobilize for the next attack.

My mind was flying high that day, courtesy of whatever witches’ brew of neurotransmitters God had programmed into my genes,

He pointed out the university regulations stating that I was not allowed to be taking his course, as it was for juniors and seniors only, and I said that I knew that, but it looked interesting and the rule seemed completely arbitrary.

the write-up ended with “Due to a misunderstanding of instructions, and a general lack of knowledge about what was going on, a broader range of pitch stimulation was not tested and, by the time the misunderstanding was understood, the auditory nerve was fatigued. So was

It had become clear to me over time that my mercurial temperament and physical restlessness were going to make medical school—especially the first two years, which required sitting still in lecture

halls for hours at a time—an unlikely proposition. I found it difficult to stay put for long and found that I learned best on my own. I loved research and writing, and the thought of being chained to the kind of schedule that medical school required was increasingly repugnant.

he was immensely creative, curious, and open-minded; difficult but fair in his intellectual demands; and exceptionally kind in understanding my own fluctuating moods and attentiveness.

me on a scale ranging from -3 (paralytic and entirely despairing) to +3 (magnificent mood and vitality),

Somehow, like so many people who get depressed, we felt our depressions were more complicated and existentially based than they actually were. Antidepressants might be indicated for psychiatric patients, for those of weaker stock, but not for us. It was a costly attitude; our upbringing and pride held us hostage.

I decided early in graduate school that I needed to do something about my moods. It quickly came down to a choice between seeing a psychiatrist or buying a horse.

a sort of equine Woody Allen, but without the entertainment value.

In the clouds-and-silver-linings department, however, whenever I rode him I was generally too terrified to be depressed, and when I was manic I had no judgment anyway,

so maniacal riding was well suited to the mood.

Looking back over those years with the cool clinical perspective acquired much later, I realize that I was experiencing what is so coldly and prosaically known as a remission—common in the early years of manic-depressive illness and a deceptive respite from the savagely recurrent course that the untreated illness ultimately takes—but I assumed I was just

back to my normal self.

Graduate school was not only relative freedom for me from my illness, but it was also freedom from the highly structured existence of undergraduate studies. Although I skipped more than half of my formal lectures, it didn’t really matter; as long as one ultimately performed, the erratic ways that one took to get there were considerably less important.

My hair, like my moods, went up and

down: long for a time, until an I-look-like-a-toad mood would sweep over me; thinking a radical change might help, I then would have it cut to

Feelings of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one’s marrow. 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. You never knew those caves were there. It will never end, for madness carves its own reality.

Who is being too polite to say what? Who knows what? What did I do? Why? And most hauntingly, when will it happen again?

Which of my feelings are real? Which of the me’s is me? The wild, impulsive, chaotic, energetic, and crazy one? Or the shy, withdrawn, desperate, suicidal, doomed, and tired one? Probably a bit of both, hopefully much that

neither. Virginia Woolf, in her dives and

climbs, said it all: “How far do our feelings take their colour from the dive underground? I mean, what i...

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

Summer, a lack of sleep, a deluge of work, and exquisitely vulnerable genes eventually took me to the back of beyond, past my familiar levels of exuberance and into florid madness.

He says he remembers having thought to himself, Kay looks manic. I, on the other hand, had thought I was splendid.

I was increasingly restless, irritable, and I craved excitement; all of a sudden, I found myself rebelling against the very things I most loved about my husband: his kindness, stability, warmth, and love.

But then back on lithium and rotating on the planet at the same pace as everyone else, you find your credit is decimated, your mortification complete: mania is not a luxury one can easily afford.

So after mania, when most depressed, you’re given excellent reason to be even more so.

At one point I was determined that if my mind—by which I made my living and whose stability I had assumed for so many years—did not stop racing and begin working normally again, I would kill myself by jumping from a nearby twelve-story building. I gave it twenty-four hours.

could feel my mind being reined in, slowed

down, and put on hold. But it was a very long time until I recognized my mind again, and much longer until I trusted it.

unnerving to realize how confusing it was to be a patient.

all the same I was relieved: relieved to hear a diagnosis that I knew in my mind of minds to be true. Still, I flailed against the sentence I felt he had handed me.

Moods are such an essential part of the substance of life, of one’s notion of oneself, that even psychotic extremes in mood and behavior somehow can be seen as temporary, even understandable, reactions to what life has dealt. In my case, I had a horrible sense of loss for who I had been and where I had been. It was difficult to give up the high flights of mind and mood, even though the depressions that inevitably followed nearly cost me my

But I compare myself with my former self, not with others. Not only that, I tend to compare my current self with the best I have been, which is when I have been mildly manic.

In a small minority of patients, including myself, the therapeutic level of lithium, the level at which it works, is perilously close to the toxic level.

Nausea and vomiting and occasional toxicity, while upsetting and embarrassing at times, were far less important to me than lithium’s effect on my ability to read, comprehend, and remember what I read. In rare instances, lithium causes problems of visual accommodation, which can, in turn, lead to a form of blurred vision. It also can impair concentration and attention span and affect memory. Reading, which had been at the heart of my intellectual and emotional existence, was suddenly beyond my grasp.

did not read a serious work of literature or nonfiction, cover to cover, for more than ten years.

missed my home, my mind, my life of books and “friendly things,” my world where most things were in their place, and where nothing awful could

come in to wreck havoc. Now I had no choice but to live in the broken world that my mind had forced upon me. I longed for the days that I had known before madness and medication had insinuated their way into every aspect of my existence.

Try not to let the fact that you can’t read without effort annoy you. Be philosophical. Even if you could read, you probably wouldn’t remember most of it anyway.

could not afford to be too near someone representing, as she did, the temptations residing in my unmedicated mind; the voice of upbringing that said one should be able to handle everything by oneself; the catnip allure

I believe, without doubt, that manic-depressive illness is a medical illness; I also believe that, with rare exception, it is malpractice to treat it without medication.

medication as a promise of a cure, and a means of suicide if it doesn’t work. She fears that by taking it she will risk her last resort.

The endless questioning finally ended. My psychiatrist looked at me, there was no uncertainty in his voice. “Manic-depressive illness. ” I admired his bluntness. I wished him locusts on his lands and a pox upon his house. Silent, unbelievable rage. I smiled pleasantly. He smiled back. The war had just begun.

Over and over and over I would say to myself, If I can’t feel, if I can’t move, if I can’t think, and