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.

The major clinical problem in treating manic-depressive illness is not that there are not effective medications—there are—but that patients so often refuse to take them.

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.

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.

I have no idea how I managed to pass as normal in school, except that other people are generally caught up in their own lives and seldom notice despair in others if those despairing make an effort to disguise the pain.

particularly virulent ones with those analysts who oppose treating severe mood disorders with medications, long after the evidence clearly showed that lithium and the antidepressants are far more effective than psychotherapy alone—I

And always, 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 Or the shy, withdrawn, desperate, suicidal, doomed, and tired one?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 is 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 is the reality of any feeling?”

as I had been almost entirely free of serious mood swings for more than a year, I assumed that those problems were behind me. Feeling normal for any extended period of time raises hopes that turn out, almost invariably, to be writ on water.

Decreased sleep is both a symptom of mania and a cause, but I didn’t know that at the time, and it probably would not have made any difference to me if I had.

I had on much more makeup than usual and seemed, to him, to be frenetic and far too talkative. He says he remembers having thought to himself, Kay looks manic. I, on the other hand, had thought I was splendid.

it, “engaging in unrestrained buying sprees”—is a classic part of mania.

was clear from reading the medical literature, however, that lithium was the only drug that had any serious chance of working for me.

there was a definite point when I knew I was insane. My thoughts were so fast that I couldn’t remember the beginning of a sentence halfway through. Fragments of ideas, images, sentences, raced

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

I was not only very ill when I first called for an appointment, I was also terrified and deeply embarrassed. I had never been to a psychiatrist or a psychologist before. I had no choice. I had completely, but completely, lost my mind; if I didn’t get professional help, I was quite likely to lose my job, my already precarious marriage, and my life as well.

He was very tough, as well as very kind, and even though he understood more than anyone how much I felt I was losing—in energy, vivacity, and originality—by taking medication, he never was seduced into losing sight of the overall perspective of how costly, damaging, and life threatening my illness was.

A t this point in my existence, I cannot imagine leading a normal life without both taking lithium and having had the benefits of psychotherapy. Lithium prevents my seductive but disastrous highs, diminishes my depressions, clears out the wool and webbing from my disordered thinking, slows me down, gentles me out, keeps me from ruining my career and relationships,

But, ineffably, psychotherapy heals. It makes some sense of the confusion, reins in the terrifying thoughts and feelings, returns some control and hope and possibility of learning from it all. Pills cannot, do not, ease one back into reality; they only bring one back headlong, careening, and faster than can be endured at times. Psychotherapy is a sanctuary; it is a battleground; it is a place I have been psychotic, neurotic, elated, confused, and despairing beyond belief. But, always, it is where I have believed—or have learned to believe—that I might someday be able to contend with all of this.

T hat I owed my life to pills was not, however, obvious to me for a long time; my lack of judgment about the necessity to take lithium proved to be an exceedingly costly one.

The intensity, glory, and absolute assuredness of my mind’s flight made it very difficult for me to believe, once I was better, that the illness was one I should willingly give up.

it is a very real adjustment to blend into a three-piece-suit schedule, which, while comfortable to many, is new, restrictive, seemingly less productive, and maddeningly less intoxicating. People say, when I complain of being less lively, less energetic, less high-spirited, “Well, now you’re just like the rest of us,” meaning, among other things, to be reassuring. 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,

I found that children’s books, which, in addition to being shorter than books written for adults, also had larger print, were relatively accessible to me, and I read over and over again the classics of childhood—Peter Pan, Mary Poppins, Charlotte’s Web, Huckleberry Finn, the Oz books, Doctor Dolittle—that had once, so many years earlier, opened up such unforgettable worlds to me. Now they gave me a second chance, a second wind of pleasure and beauty. But of all the children’s books, I returned most often to The Wind in the Willows. I found myself occasionally totally overwhelmed by it.

All things considered, being a woman, a nonphysician, and a manic-depressive was not the ideal way to start down the notoriously difficult road to tenure.

My own experience as a patient had made me particularly aware of how critical psychotherapy could be in making some sense out of all the pain; how it could keep one alive long enough to have a chance at getting well; and how it could help one to learn to reconcile the resentments at taking medication with the terrible consequences of not taking it.

“It is the history of our kindnesses that alone makes this world tolerable,” wrote Robert Louis Stevenson. “If it were not for that, for the effect of kind words, kind looks, kind letters … I should be inclined to think our life a practical jest in the worst possible spirit.”

Having finally cottoned onto the disastrous consequences of starting and stopping lithium, I took it faithfully and found that life was a much stabler and more predictable place than I had ever reckoned. My moods were still intense and my temperament rather quick to the boil, but I could make plans with far more certainty and the periods of absolute blackness were fewer and less extreme.

A few days after lowering my dose, I was walking in Hyde Park, along the side of the Serpentine, 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. The quacking of the ducks was more insistent, clearer, and more intense; the bumps on the sidewalk were far more noticeable; I felt more energetic and alive. Most significant, I could once again read without effort. It was, in short, remarkable.

Thank you for a lovely weekend. They tell me it rained.

L owering 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

What I experience as beyond my control can instead seem to him deliberate and frightening. It is, at these times, impossible for me to convey my desperation and pain; it is harder still, afterward, to recover from the damaging acts and dreadful words. These terrible black manias, with their agitated, ferocious, and savage sides, are understandably difficult for Richard to understand and almost as difficult for me to explain.

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.

Depression, instead, is flat, hollow, and unendurable. It is also tiresome. People cannot abide being around you when you are depressed. They might think that they ought to, and they might even try, but you know and they know that you are tedious beyond belief: you’re irritable and paranoid and humorless and lifeless and critical and demanding and no reassurance is ever enough. You’re frightened, and you’re frightening, and you’re “not at all like yourself but will be soon,” but you know you won’t.