An Unquiet Mind

by Kay Redfield Jamison

The disease that has, on several occasions, nearly killed me does kill tens of thousands of people every year: most are young, most die unnecessarily, and many are among the most imaginative and gifted that we as a society have.

It took me far too long to realize that lost years and relationships cannot be recovered, that damage done to oneself and others cannot always be put right again, and that freedom from the control imposed by medication loses its meaning when the only alternatives are death and insanity.

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.

I could feel life seeping back into crevices of my body and mind that I had completely written off as dead or dormant.

I cannot hear that piece of music without feeling surrounded by the beautiful sadness of that evening, the love I was privileged to know, and the recollection of the precarious balance that exists between sanity and a subtle, dreadful muffling of the senses.

it also had laid to rest, in a very different way, my relentless warrings with lithium, most of which had been nothing but a futile battle against the givens of my own mind. These warrings had cost me dearly in time lost, and, feeling myself again, I was unwilling to risk losing any more time than I already had. Life had become worth not losing.

Mental exhaustion had taken a long, terrible toll, but, strangely, it was only in feeling well, energetic, and high-spirited again that I had any true sense of the toll taken.

Gradually, as I began to look around me, I realized that this was the kind of evenness and predictability most people had, and probably took for granted, throughout their lives.

when the black tiredness inevitably followed, I would be subdued back into the recognition that I had a bad disease, one that could destroy all pleasure and hope and competence. I began to covet the day-to-day steadiness that most of my colleagues seemed to enjoy. I also began to appreciate how draining and preoccupying it had become just to keep my mind bobbing above water. 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. I was constantly chasing

the tail of my own brain, recovering from, or delving into, new moods and new experiences. The new was beginning to lack both newness and luster, and the mere accumulation of experiences was beginning to seem far less meaningful than I imagined exploring the depths of such experiences ought to be.

The extremes in my moods were not nearly as pronounced as they had been, but it was clear that a low-grade, fitful instability had become an integral part of my life. I had now, after many years, finally convinced myself that a certain intellectual steadiness was not only desirable, but essential; somewhere in my heart, however, I continued to believe that intense and lasting love was possible only in a...

was largely similar to my own. I was late to understand that chaos and intensity are no substitute for lasting love, nor are they necessarily an improvement on real life. Normal people are not always boring. On the contrary. Volatility and passion, although often more romantic and enticing, are not intrinsically preferable to a steadiness of experience and feeling about another person (nor are they incompatible). These are beliefs, of course, that one has intuitively about friendships and family; they become less obvious when caught up in a romantic life that mirrors, magnifies, and perpetuates one’s own mercurial emotional life and tempe...

No amount of love can cure madness or unblacken one’s dark moods. Love can help, it can make the pain more tolerable, but, always, one is beholden to medication that may or may not always work and may or may not be bearable. Madness, on the other hand, most certainly can, and often does, kill love through its mistrustfulness, unrelenting pessimism, discontents, erratic behavior, and, especially, through its savage moods. The sadder, sleepier, slower, and less volatile depressions are more intuitively understood and more easily taken in stride. A quiet melancholy is neither threatening nor beyond ordinary comprehension;

an angry, violent, vexatious despair is both. Experience and love have, over much time, taught both of us a great deal about dealing with manic-depressive illness; I occasionally laugh and tell him that his imperturbability is worth three hundred milligrams of lithium a day to me, and it is probably true.

But if love is not the cure, it certainly can act as a very strong medicine. As John Donne has written, it is not so pure and abstract as one might once have thought and wished, but it does endure, and it does grow.

In the language that is used to discuss and describe mental illness, many different things—descriptiveness, banality, clinical precision, and stigma—intersect to create confusion, misunderstanding, and a gradual bleaching out of traditional words and phrases. It is no longer clear what place words such as “mad,” “daft,” “crazy,” “cracked,” or “certifiable” should have in a society increasingly sensitive to the feelings and rights of those who are mentally ill. 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

One of the best cases in point is the current confusion over the use of the increasingly popular term “bipolar disorder”—now firmly entrenched in the nomenclature of the Diagnostic and Statistical Manual (DSM-IV), the authoritative diagnostic system published by the American Psychiatric Association—instead of the historic term “manic-depressive illness.” Although I always think of myself as a manic-depressive, my official DSM-IV diagnosis is “bipolar I disorder; recurrent;

Most clinicians and many patients feel that “bipolar disorder” is less stigmatizing than “manic-depressive illness.” Perhaps so, but perhaps not. Certainly, patients who have suffered from the illness should have the right to choose whichever term they feel more comfortable with. But two questions arise: Is the term “bipolar” really a medically accurate one, and does changing the name of a condition actually lead to a greater acceptance of it? The answer to the first question, which concerns accuracy, is that “bipolar” is accurate in the sense that it indicates an individual has suffered from both mania (or mild forms of mania) and depression, unlike those individuals who have suffered from depression alone. But splitting mood disorders into bipolar and unipolar categories presupposes a distinction between depression and manic-depressive illness—both clinically and etiologically—that is not always clear, nor supported by science. Likewise, it perpetuates the notion that depression exists rather tidily segregated on its own pole, while mania clusters off neatly and discreetly on another. This polarization of two clinical states flies in the face of everything that we know about the cauldronous, fluctuating nature of manic-depressive illness; 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 ...