An Unquiet Mind

by Kay Redfield Jamison

I doubt sometimes whether a quiet & unagitated life would have suited me—yet I sometimes long for it. —BYRON

W hen it’s two o’clock in the morning, and you’re manic, even the UCLA Medical Center has a certain appeal. The hospital—ordinarily a cold clotting of uninteresting buildings—became for me, that fall morning not quite twenty years ago, a focus of my finely wired, exquisitely alert nervous system. With vibrissae twinging, antennae perked, eyes fast-forwarding and fly faceted, I took in everything around me. I was on the run. Not just on the run but fast and furious on the run, darting back and forth across the hospital parking lot trying to use up a boundless, restless, manic energy. I was running fast, but slowly going mad.

The man I was with, a colleague from the medical school, had stopped running an hour earlier and was, he said impatiently, exhausted. This, to a saner mind, would not have been surprising: the usual distinction between day and night had long since disappeared for the two of us, and the endless hours of scotch, brawling, and fallings about in laughter had taken an obvious, if not final, toll.

W ithin a month of signing my appointment papers to become an assistant professor of psychiatry at the University of California, Los Angeles, I was well on my way to madness; it was 1974, and I was twenty-eight years old. Within three months I was manic beyond recognition and just beginning a long, costly personal war against a medication that I would, in a few years’ time, be strongly encouraging others to take. My illness, and my struggles against the drug that ultimately saved my life and restored my sanity, had been years in the making.

For as long as I can remember I was frighteningly, although often wonderfully, beholden to moods. Intensely emotional as a child, mercurial as a young girl, first severely depressed as an adolescent, and then unrelentingly caught up in the cycles of manic-depressive illness by the time I began my professional life, I became, both by necessity and intellectual inclination, a student of moods. It has been the only way I know to understand, indeed to accept, the illness I have; it also has been the only way I know to try and make a difference in the lives of others who also suffer from mood disorders.

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 ...

The Chinese believe that before you can conquer a beast you first must make it beautiful. In some strange way, I have tried to do that with manic-depressive illness. It has been a fascinating, albeit deadly, enemy and companion; I have found it to be seductively complicated, a distill...

Because my illness seemed at first simply to be an extension of myself—that is to say, of my ordinarily changeable moods, energies, and enthusiasms—I perhaps gave it at times too much quarter. And, because I thought I ought to be able to handle my increasingly violent mood swings by myself, for the first ten years I did not seek any kind of treatment. Even after my condition became a medical emergency, I still intermittently resisted the medications that both my training and clinical research expertise told me were the only sensible way to deal with the illness I had.

My manias, at least in their early and mild forms, were absolutely intoxicating states that gave rise to great personal pleasure, an incomparable flow of thoughts, and a ceaseless energy that allowed the translation of new ideas into papers and projects. Medications not only cut into these fast-flowing, high-flying times, they also brought with them seemingly intolerable side effects. 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.

The war that I waged against myself is not an uncommon one. The major clinical problem in treating manic-depressive illness is not that there are not effective medications—there ar...

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 am fortunate that I have not died from my illness,

Through writing and teaching I have hoped to persuade my colleagues of the paradoxical core of this quicksilver illness that can both kill and create;

I have had many concerns about writing a book that so explicitly describes my own attacks of mania, depression, and psychosis, as well as my problems acknowledging the need for ongoing medication. Clinicians have been, for obvious reasons of licensing and hospital privileges, reluctant to make their psychiatric problems known to others. These concerns are often well warranted. I have no idea what the long-term effects of discussing such issues so openly will be on my personal and professional life, but, whatever the consequences, they are bound to be better than continuing to be silent. I am tired of hiding, tired of misspent and knotted energies, tired of the hypocrisy, and tired of acting as though I have something to hide. One is what one is, and the dishonesty of hiding behind a degree, or a title, or any manner and collection of words, is still exactly that: dishonest. Necessary, perhaps, but dishonest. I continue to have concerns about my decision to be public about my illness, but one of the advantages of having had manic-depressive illness for more than thirty years is that very little seems insurmountably difficult.

Much like crossing the Bay Bridge when there is a storm over the Chesapeake, one may be terrified to go forward, but there is no question of going back. I find myself somewhat inevitably taking a certain solace in Robert Lowell’s essential question, Yet why not say what happened?

Over the next few days it became clear, from the release of the young pilot’s final message to the control tower before he died, that he knew he could save his own life by bailing out. He also knew, however, that by doing so he risked that his unaccompanied plane would fall onto the playground and kill those of us who were there.

The dead pilot became a hero, transformed into a scorchingly vivid, completely impossible ideal for what was meant by the concept of duty. It was an impossible ideal, but all the more compelling and haunting because of its very unobtainability. The memory of the crash came back to me many times over the years, as a reminder both of how one aspires after and needs such ideals, and of how killingly difficult it is to achieve them. I never again looked at the sky and saw only vastness and beauty. From that afternoon on I saw that death was also and always there.

Perhaps because my own violent struggles with black moods did not occur until I was older, I was given a longer time to inhabit a more benign, less threatening, and, indeed to me, a quite wonderful world of high adventure. This world, I think, was one my sister had never known. The long and important years of childhood and early adolescence were, for the most part, very happy ones for me, and they afforded me a solid base of warmth, friendship, and confidence. They were to be an extremely powerful amulet, a potent and positive countervailing force against future unhappiness. My sister had no such years, no such amulets. Not surprisingly, perhaps, when both she and I had to deal with our respective demons, my sister saw the darkness as being within and part of herself, the family, and the world. I, instead, saw it as a stranger; however lodged within my mind and soul the darkness became, it almost always seemed an outside force that was at war with my natural self.

My sister, like my father, could be vastly charming: fresh, original, and devastatingly witty, she also was blessed with an extraordinary sense of aesthetic design. She was not an easy or untroubled person, and as she grew older her troubles grew with her, but she had an enormous artistic imagination and soul. She also could break your heart and then provoke your temper beyond any reasonable level of endurance. Still, I always felt a bit like pieces of earth to my sister’s fire and flames.

Years later, he gave me a bracelet inscribed with words from Michael Faraday that were engraved over the physics building at UCLA: “Nothing is too wonderful to be true.” Needless to say, Faraday had repeated breakdowns, and the remark is palpably untrue, but the thought and mood are lovely ones, and very much as my father could be, in his wondrous moments.

My mother has said, many times, that she always felt she was in the shadow of my father’s wit, charm, intensity, and imagination. Her observation that he was a Pied Piper with children certainly was borne out by his charismatic effect upon my friends and the other children in whatever neighborhood we found ourselves. My mother, however, was always the one my friends wanted to sit down and talk with: we played with my father; we talked with my mother.

Mother, who has an absolute belief that it is not the cards that one is dealt in life, it is how one plays them, is, by far, the highest card I was dealt. Kind, fair, and generous, she has the type of self-confidence that comes from having been brought up by parents who not only loved h...

My grandmother, whom I knew well, was a warm and caring woman who, like Mother, had a deep and genuine interest in people; this, in turn, translated into a tremendous capacity for friendship and a remarkable ability to put people at their ease. People always came first with her, as they did with my mother, and a lack of time or a busy schedule was never an excuse for being thoughtless or unavailable.

The photographs capture the extraordinary innocence of a different kind of time and world, but they were a time and a world in which my mother looked very comfortable. There were no foreboding shadows, no pensive or melancholic faces, no questions of internal darkness or instability. Her belief that a certain predictability was something that one ought to be able to count upon must have had its roots in the utter normality of the people and events captured in these pictures, as well as in the preceding generations of her ancestors who were reliable, stable, honorable, and saw things through.

But it has been precisely that persevering steadiness of my mother, her belief in seeing things through, and her great ability to love and learn, listen and change, that helped keep me alive through all of the years of pain and nightmare that were to come.

She could not have known how difficult it would be to deal with madness; had no preparation for what to do with madness—none of us did—but consistent with her ability to love, and her native will, she handled it with empathy and intelligence. It never occurred to her to give up.

B oth my mother and father strongly encouraged my interests in writing poetry and school plays, as well as in science and medicine. Neither of them tried to limit my dreams, and they had the sense and sensitivity to tell the difference between a phase I was going through and more serious commitments. Even my phases, however, were for the most part tolerated with kindness and imagination. Being particularly given to...

What they both knew, I am sure, was that I was simply in love with the idea of a strange idea, and that given some other way of expressing my enthusiasms, I would be quite content.

I would arrive at the hospital early, leave late, and bring books and questions with me: What was it like to be a medical student? To deliver babies? To be around death? I must have been particularly convincing about my interest on the latter point because one of the doctors allowed me to attend part of an autopsy, which was extraordinary and horrifying. I stood at the side of the steel autopsy table, trying hard not to look at the dead child’s small, naked body, but being incapable of not doing so. The smell in the room was vile and saturating, and for a long while only the sloshing of water and the quickness of the pathologist’s hands were saving distractions. Eventually, in order to keep from seeing what I was seeing, I reverted back to a more cerebral, curious self, asking question after question, following each answer with yet another question. Why did the pathologist make the cuts he did? Why did he wear gloves? Where did all the body parts go? Why were some parts weighed and others not?

Initially it was a way of avoiding the awfulness of what was going on in front of me; after a while, however, curiosity became a compelling force in its own right. I focused on the questions and stopped seeing the body. 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.

W hen I was fifteen, I went with my fellow candy stripers on a group outing to St. Elizabeths, the federal psychiatric hospital in the District of Columbia. It was, in its own way, a far more horrifying experience than attending the autopsy. All of us were nervous during the bus ride over to the hospital, giggling and making terribly insensitive school-girlish remarks in a va...

I think we were afraid of the strangeness, of possible violence, and what it would be like to see someone completely out of control. “You’ll end up in St. Elizabeths” was one of our childhood taunts, and, 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. God only knew what ran u...

at St. Elizabeths there were ninety patients for each psychiatric attendant. Fascinated by the idea that one person would be expected to control so many potentially violent patients, I asked how the staff protected themselves. There were, she said, drugs that could control most of the patients, but, now and again, it became necessary to “hose them down.” “Hose them down”?! How could anyone be so out of control that they would require such a brute method of restraint? It was something I couldn’t get out of my mind.

Another patient, who at one time must have been quite beautiful, stood in the middle of the dayroom talking to herself and braiding and unbraiding her long reddish hair. All the while, she was tracking, with her quick eyes, the movements of anyone who attempted to come anywhere near her. At first I was frightened by her, but I was also intrigued, somehow captivated. I slowly walked toward her.

The patient, in the meantime, stared through me for a very long time. Then turning sideways so she would not see me directly, she explained why she was in St. Elizabeths. Her parents, she said, had put a pinball machine inside her head when she was five years old. The red balls told her when she should laugh, the blue ones when she should be silent and keep away from other people; the green balls told her that she should start multiplying by three. Every few days a silver ball would make its way through the pins of the machine. At this point her head turned and she stared at me; I assumed she was checking to see if I was still listening. I was, of course. How could one not? The whole thing was bizarre but riveting. I asked her, What does the silver ball mean? She looked at me intently, and then everything went dead in her eyes. She stared off into space, caught up in some internal world. I never found out what the silver ball meant.

Although fascinated, I was primarily frightened by the strangeness of the patients, as well as by the perceptible level of terror in the room; even stronger than the terror, however, were the expressions of pain in the eyes of the women. Some part of me instinctively reached out, and in an odd way understood this pain, never imagining that I would someday look in the mirror and see their sadness and insanity in my own eyes.

She was a nurse, and she listened carefully to me as I went on at great length about my grand plans for medical school, writing, and research. Now and again she would break in with “Yes, yes, that’s very interesting,” “Of course you can,” or “Had you thought of …?” Never, but never, was there an “I don’t think that’s very practical” or “Why don’t you just wait and see how it goes?” Her husband, a mathematician and meteorologist, was very much the same way. He was always careful to ask me what my latest project was, what I was reading, or what kind of animal I was dissecting and why. He talked very seriously with me about science and medicine and encouraged me to go as far as I could with my plans and dreams.

He, like my father, had a deep love for natural science, and he would discuss at length how physics, philosophy, and mathematics were, each in their own ways, jealous mistresses who required absolute passion and attention. It is only now, in looking back—after deflating experiences later in life when I was told either to lower my sights or to rein in my enthusiasms—that I fully appreciate the seriousness with which my ideas were taken by my parents and their friends; and 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 en...

But there was, in the midst of all of this, a gradual awakening to the reality of what it meant to be an intense, somewhat mercurial girl in an extremely traditional and military world. Independence, temperament, and girlhood met very uneasily in the strange land of cotillion.

It also was where children were supposed to learn, as if the preceding fourteen or fifteen years hadn’t already made it painfully clear, that generals outrank colonels who, in turn, outrank majors and captains and lieutenants, and everyone, but everyone, outranks children. Within the ranks of children, boys always outrank girls.

One way of grinding this particularly irritating pecking order into the young girls was to teach them the old and ridiculous art of curtsying. It is hard to imagine that anyone in her right mind would find curtsying an even vaguely tolerable thing to do. But having been given the benefits of a liberal education by a father with strongly nonconforming views and behaviors, it was beyond belief to me that I would seriously be expected to do this. I saw the line of crisply crinolined girls in front of me and watched each of them curtsying neatly. Sheep, I thought, Sheep. Then it was my turn. Something inside of me came to a complete boil. It was one too many times watching one too many girls being expected to acquiesce; far more infuriating, it was one too many times watching girls willingly go along with the rites of submission. I refused. A slight matter, perhaps, in any other world, but within the world of military custom and protocol—where symbols and obedience were everything, and where a child’s misbehavior could jeopardize a father’s chance of promotion—it was a declaration of war. Refusing to obey an adult, however absurd the request, simply wasn’t done.

I resented the bowings, but I loved the elegance of the dress uniforms, the music and dancing, and the beauty of the cotillion evenings. However much I needed my independence, I was learning that I would always be drawn to the world of tradition as well. There was a wonderful sense of security living within this walled-off military world. Expectations were clear and excuses were few; it was a society that genuinely believed in fair play, honor, physical courage, and a willingness to die for one’s country. True, it demanded a certain blind loyalty as a condition of membership, but it tolerated, because it had to, many intense and quixotic young men who were willing to take staggering risks with their lives. And it tolerated, because it had to, an even less socially disciplined group of scientists, many of whom were meteorologists, and most of whom loved the skies almost as much as the pilots did.

It was a society built around a tension between romance and discipline: a complicated world of excitement, stultification, fast life, and sudden death, and it afforded a window back in time to what nineteenth-century living, at its best, and at its worst, must have been: civilized, gracious, elitist, and singularly intolerant of personal weakness. A willingness to sacrifice one’s own desires was a given; self-control and restraint were assumed.

After discussing these issues for a while, she turned to the real topic at hand. Pilots, she said, should never be angry or upset when they fly. Being angry could lead to a lapse in judgment or concentration: flying accidents might happen; pilots could be killed. Pilots’ wives, therefore, should never have any kind of argument with their husbands before the men leave to go flying. Composure and self-restraint were not only desirable characteristics in a woman, they were essential. As my mother put it later, it was bad enough having to worry yourself sick every time your husband went up in an airplane; now, she was being told, she was also supposed to feel responsible if his plane crashed. Anger and discontent, lest they kill, were to be kept to oneself. The military, even more so than the rest of society, clearly put a premium on well-behaved, genteel, and even-tempered women.

Had you told me, in those seemingly uncomplicated days of white gloves and broad-rimmed hats, that within two years I would be psychotic and want only to die, I would have laughed, wondered, and moved on. But mostly I would have laughed.

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.

My relationship with my sister, always a difficult one, had become at best fractious, often adversarial, and, more usually, simply distant. She had far more trouble than I did in adjusting to California, but we never really spoke much about it. We went almost entirely our separate ways, and, for all the difference it made, we could have been living in different houses.

His moods still, on occasion, soared; and, when they did, the sparkle and gaiety that flew out from them created a glow, a warmth and joy that filled all of the rooms of the house. He sailed over the cusp of reason at times, and his grandiose ideas started to push the limits of what Rand could tolerate. At one point, for example, he came up with a scheme that assigned IQ scores to hundreds of individuals, most of whom were dead. The reasoning was ingenious but disturbingly idiosyncratic; it also had absolutely nothing to do with the meteorology research that he was being paid to conduct.

With his capacity for flight came grimmer moods, and the blackness of his depressions filled the air as pervasively as music did in his better periods. Within a year or so of moving to California, my father’s moods were further blackening, and I felt helpless to affect them. 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. After a while, I scarcely recognized him. At times he was immobilized by depression, unable to get out of bed, and profoundly pessimistic about every aspect of his life and future. At other times, his rage and screaming would fill me with terror. I had never known my father—a soft-spoken and gentle man—to raise his voice. Now there were days, and even weeks, when I was frightened to show up for breakfast or come home from school. He also started drinking heavily, which made everything worse.