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.

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.

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

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.

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.

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.

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.

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.

At times he was immobilized by depression, unable to get out of bed, and profoundly pessimistic about every aspect of his life and future.

You’re talking too fast, Kay. Slow down, Kay. You’re wearing me out, Kay. Slow down, Kay. And those times when they didn’t actually come out and say it, I still could see it in their eyes: For God’s sake, Kay, slow down.

The Arthurian tragedy explained everything there was to know about human nature—its passions, betrayals, violence, grace, and aspirations—and my mind wove and wove, propelled by the certainty of absolute truth.

and I would wake up in the morning with a profound sense of dread that I was going to have to somehow make it through another entire day.

It was my first lesson in appreciating the complicated, permeable boundaries between bizarre and original thought, and I remain deeply indebted to him for the intellectual tolerance that cast a positive rather than pathological hue over what I had written.

As important, I had read William James’s great psychological study, The Varieties of Religious Experience, during my year in St. Andrews and had become completely captivated by the idea of studying psychology, especially individual differences in temperament and variations in emotional capacities, such as mood and intense perceptions.

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.

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. Since almost everyone I knew was seeing a psychiatrist, and since I had an absolute belief that I should be able to handle my own problems, I naturally bought a horse.

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 noticed, though, that I was more comfortable treating psychotic patients than were many of my colleagues.

“How far do our feelings take their colour from the dive underground? I mean, what is the reality of any feeling?”

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.

for having accidentally killed a rented circus elephant with LSD—a

W hen I am high I couldn’t worry about money if I tried. So I don’t. The money will come from somewhere; I am entitled; God will provide. Credit cards are disastrous, personal checks worse.

It is devastating to have the illness and aggravating to have to pay for medications, blood tests, and psychotherapy. They, at least, are partially deductible. But money spent while manic doesn’t fit into the Internal Revenue Service concept of medical expense or business loss. So after mania, when most depressed, you’re given excellent reason to be even more so.

When I went home at night it was to a place of increasing chaos: Books, many of them newly purchased, were strewn everywhere. Clothes were piled up in mounds in every room, and there were unwrapped packages and unemptied shopping bags as far as the eye could see.

The chaos in my mind began to mirror the chaos of my rooms;

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, keeps me out of a hospital, alive, and makes psychotherapy possible.

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.

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.

Contemplate the similarity between the phrases “being patient” and “being a patient.”

although the anticonvulsant medications now work very effectively, and often with fewer side effects, for many people who have manic-depressive illness, lithium remains an extremely effective drug.

Patient sees 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.

but there is a different kind of herding behavior in May—the peak month for suicide, one might note—when fifteen thousand shrinks of all stripes attend the annual meeting of the American Psychiatric Association.

A year before this same patient had held a knife to my throat during a psychotherapy session in my office. I had called the police at that time, and he had been involuntarily committed to one of the locked wards at UCLA’s Neuropsychiatric Institute. Seventy-two hours later, in the impressively blind wisdom of the American justice system, he had been released back into the community.

From the time I woke up in the morning until the time I went to bed at night, I was unbearably miserable and seemingly incapable of any kind of joy or enthusiasm. Everything—every thought, word, movement—was an effort.

“Despairs for the future; fears recurrence and fears having to deal with the fact that she has felt what she has felt”; “Patient feels very embarrassed about feelings she has and takes attitude that regardless of the course of her depression she ‘won’t put up with it’ ”;

Mostly, however, I was concerned that if it became public knowledge that I had been hospitalized, my clinical work and privileges at best would be suspended; at worst, they would be revoked on a permanent basis.

The only note made by my psychiatrist on the day before I attempted suicide was: Severely depressed. Very quiet.

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

those who “fail” at killing themselves not only are weak, but incompetent, incapable even of getting their dying quite right. Suicide, however, is almost always an irrational act and seldom is it accompanied by the kind of rigorous intellect that goes with one’s better days.

It is also often impulsive and not necessarily undertaken in the way one originally planned.

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

Lithium is used to teach coyotes to stop killing sheep: often a single experience with a lithium-treated sheep carcass will make a coyote sick enough to keep his teeth to himself.

He taught me that the road from suicide to life is cold and colder and colder still, but—with steely effort, the grace of God, and an inevitable break in the weather—that I could make it.

There were times when I would struggle to put together a lecture, and, having no idea whether it made sense or not, I would deliver it through the din and dreadful confusion that masqueraded as my mind.

God, conspicuously, was nowhere to be found.

depression is twice as common in women as men. But manic-depressive illness occurs equally often in women and men, and, being a relatively common condition, mania ends up affecting a large number of women.

Fortunately, having fire in one’s blood is not without its benefits in the world of academic medicine, especially in the pursuit of tenure.

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.

I observed many medical students, clinical psychology interns, and residents denied permission to continue their studies because of psychiatric illness.

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 paperwork that defined the job of a clinic director.