An Unquiet Mind

by Kay Redfield Jamison

can’t care, then what conceivable point is there in living?

The morbidity of my mind was astonishing: Death and its kin were constant companions. I saw Death everywhere, and I saw winding sheets and toe tags and body bags in my mind’s eye. Everything was a reminder that everything ended at the charnel house. My memory always took the black line of the mind’s underground system; thoughts would go from one tormented moment of my past to the next. Each stop along the way was worse than the pr...

afterward; filling the ice-cube tray was beyond my capacity, and I occasionally slept in the same clothes I had worn during the day b...

“Patient reluctant to be with people when depressed because she feels her depression is such an intolerable burden on others”;

“I can’t help it. I can’t help it,” I chant to myself, but I can’t say it; the words won’t come out, and the thoughts are going by far too fast. I bang my head over and over against the door. God make it stop, I can’t stand it, I know I’m insane again. He really cares, I think, but within ten minutes he too is screaming, and his eyes have a wild look from contagious madness, from the lightning adrenaline between the two of us. “I can’t leave you like this,” but I say a few truly awful things and then go for his throat in a more literal way, and he does leave me,

provoked beyond endurance and unable to see the devastation and despair inside. I can’t convey it and he can’t see it; there’s nothing to be done. 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.

I understand why Jekyll killed himself before Hyde had taken over completely. I took a massive overdose of lithium with no regrets.

Suicidal depression, I decided in the midst of my indescribably awful, eighteen-month bout of it, is God’s way of keeping manics in their place. It works. Profound melancholia is a day-in, day-out, night-in, night-out, almost arterial level of agony. It is a pitiless, unrelenting pain that affords no window of hope, no alternative to a grim and brackish existence, and no respite from the cold undercurrents of thought and feeling that dominate the horribly

restless nights of despair.

One would put an animal to death for far less suffering.

When I was ill, it was simply overwhelming: for days and weeks at a time, I would put up the DO NOT DISTURB sign on my door, stare mindlessly out the window, sleep, contemplate suicide, or watch my guinea pig—a memento of one of my manic buying sprees—furiously scurrying around in his cage. During those times I could not imagine writing another paper, and I was incapable of comprehending any of the journal articles that I would try to read. Supervising and teaching were ordeals. But it was a tidal existence: When I was depressed, nothing came to me,

and nothing came out of me. When manic, or mildly so, I would write a paper in a day, ideas would flow, I would design new studies, catch up on my patient charts and correspondence, and chip away at the mindless mounds of bureaucratic paper-work that defined the job of a clinic director.

was a loopy but intense life: marvelous, ghastly, dreadful, indescribably difficult, gloriously and unexpectedly easy, complicated, great fun, and a no-exit nightmare.

Because manic-depressive illness had brought such misery and uncertainty in its wake, I presumed life should therefore be kinder to me in other, more balancing ways. But then I also had believed that I could fly through starfields and slide along the rings of Saturn. Perhaps my judgment left something to be desired.

Moment by moment, with infinite patience and tact, his gentleness—and his belief in me, in who I was, and in my basic health-—pushed back the nightmare fears of unpredictable moods and violence.

But grief, fortunately, is very different from depression: it is sad, it is awful, but it is not without hope.

Since that day, whenever possible, I fly British Airways. And, each time, I am reminded of the importance of small kindnesses.

when I realized that my steps were literally bouncier than they had been and that I was taking in sights and sounds that previously had been filtered through thick layers of gauze.

Lowering my lithium level had allowed not only a clarity of thinking, but also a vividness and intensity of experience, back into my life; these elements had once formed the core of my normal temperament, and their absence had left gaping hollows in the way in which I could respond to the world.

The too rigid structuring of my moods and temperament, which had resulted from

a higher dose of lithium, made me less resilient to stress...

As I gradually entered into the world of more stable moods and more predictable life, I began to realize that I knew very little about it and had no real idea of what it would be like to live in such a place. In many ways, I was a stranger to the normal world.

It was true that much got done during the days and weeks of flying high, but it was also true that one generated new projects and made new commitments, which then had to be completed during the grayer times.

was constantly chasing the tail of my own brain, recovering from, or delving into, new moods and new experiences.

I have become fundamentally and deeply skeptical that anyone who does not have this illness can truly understand it.

Should, for example, expressive, often humorous, language—phrases such as “taking the fast trip to Squirrel City,” being a “few apples short of a picnic,” “off the wall,” “around the bend,” or “losing the bubble” (a British submariner’s term for madness)—be held hostage to the fads and fashions of “correct” or “acceptable” language?

it ignores the question of whether mania is, ultimately, simply an extreme form of depression; and it minimizes the importance of mixed manic-and-depressive states, conditions that are common, extremely important clinically, and lie at the heart of many of

the critical theoretical issues underlying this particular disease.

from the development of blood tests that will ultimately give medical credibility to psychiatric diseases;

Johns Hopkins, which asked manic-depressive patients and their spouses whether or not they

would abort an affected fetus, found that very few said that they would.)

It is, after all, not just an illness, but something that affects every aspect of my life: my moods, my temperament, my work, and my reactions to almost everything that comes my way. Not talking about manic-depressive

illness, if only to discuss it once, generally consigns a friendship to a certain inevitable level of superficiality.

one of the advantages of science is that one’s work, ultimately, is either replicated or it is not. Biases, because of this, tend to be minimized over time.

felt then, as I do now, that there should be safeguards in place in the event that my clinical judgment became impaired due

mania or severe depression.

often, in an attempt to medicate their own moods, many doctors will also become alcoholics or drug abusers.

Hospitals and professional organizations need to acknowledge the extent to which untreated doctors, nurses, and psychologists present risks to the patients they treat. But they also need to encourage effective and compassionate treatment and work out guidelines for safeguards and intelligent, nonpaternalistic supervision.

Most physician suicides are due to depression or manic-depressive illness,

My mind still, now and again, becomes a carnival of lights, laughter, and sounds and possibilities. The laughter and exuberance and ease will, filling me, spill out and over and into others.

It bleeds relationships through suspicion, lack of confidence and self-respect, the inability

to enjoy life, to walk or talk or think normally, the exhaustion, the night terrors, the day terrors. There is nothing good to be said for it except that it gives you the experience of how it must be to be old, to be old and sick, to be dying; to be slow of mind; to be lacking in grace, polish, and coordination; to be ugly; to have no belief in the possibilities of life, the pleasures of sex, the exquisiteness of music, or the ability to make yourself and others laugh.