An Unquiet Mind
by Kay Redfield Jamison
c. 1995
Vintage Books: New York
219 pages
Kay Redfield Jamison is a psychologist (Ph.D. in Clinical) on the Psychiatry faculty of John’s Hopkins Medical School. She also suffers from bipolar disorder. (She insists on calling in “manic-depressive illness” which is no longer the official psychiatric diagnosis, and I like the term “bipolar disorder” better, and since she uses what she wants in her book, I am going to use what I want in my blog.)
This book is her memoir, recording her experience with her illness and with trying to live with it and through it. It’s a brutally honest piece that doesn’t dance around the issue, and at parts is a little severe in its descriptions of the problems that come with being bipolar. While I was reading it on the beach this weekend, Ben asked me to read some aloud. After I finished a paragraph about the violence and extremes of her manic periods, he said something along the lines of “Wow. Is the whole book like that?” It was not a cheerful section that he had stumbled upon.
I really do admire Jamison for writing this book, for facing her illness head-on in this manner. She talks about the risks that she is taking in the writing it, including issues of professional anonymity (she worries that anything she says on the topic at a conference, any question she asks another researcher will be colored by the idea that she is taking it personally) and maintaining clinical privileges despite her illness and the safeguards that she has to put in place to make sure that she never puts any of her patients in danger.
This book is her memoir, recording her experience with her illness and with trying to live with it and through it. It’s a brutally honest piece that doesn’t dance around the issue, and at parts is a little severe in its descriptions of the problems that come with being bipolar. While I was reading it on the beach this weekend, Ben asked me to read some aloud. After I finished a paragraph about the violence and extremes of her manic periods, he said something along the lines of “Wow. Is the whole book like that?” It was not a cheerful section that he had stumbled upon.
I really do admire Jamison for writing this book, for facing her illness head-on in this manner. She talks about the risks that she is taking in the writing it, including issues of professional anonymity (she worries that anything she says on the topic at a conference, any question she asks another researcher will be colored by the idea that she is taking it personally) and maintaining clinical privileges despite her illness and the safeguards that she has to put in place to make sure that she never puts any of her patients in danger.
But as she says herself, we will never get over the stigmas that are associated with mental illness in our society if we don’t accept that it is possible to be a functioning and successful adult member of society even if you suffer from one of these diseases. And I think that this memoir is a beautiful example of that. Jamison does not candy coat how severe her illness has been, but anyone familiar at all with the field knows that she has managed a successful career in academic medicine, (not easy, no matter what your mental state) and written several successful books, two of which are currently on the “to read” list. (Including Exuberance, one of the books that led me to Teddy Roosevelt.)
And while at times the suffering she experienced is hard to read about, especially for those of us who have specific associations with this illness, the book itself is never hard to read. The prose is lucid and poetic, even when talking about the times when her life was anything but. And while Jamison does spend rather more time on the romances in her life, and how those men interacted with her illness, than I might have liked, she also discusses with shocking frankness topics that I found fascinating.
Her challenges with medication, (which for her is lithium) were particularly interesting to me. Bipolar disorder is known for having a low rate of medication compliance, and her descriptions of the reasons behind her own decisions to discontinue medication (all disastrous) were enlightening to me, especially since finding effective ways to treat this illness and increase medication compliance is probably going to remain as one of my long term research interests. She describes the crippling side effects of the medications (one of these: the inability to read and comprehend books and journal articles, would certainly push me to stop taking a medication, no matter how convinced I was of its efficacy) and the positive feelings and productivity of hypomania that are given up for the sake of avoiding the psychosis of extreme mania and the crippling pain of severe depression. I can understand her hesitance to give these things up, and that is something that I think I have always needed to try to understand.
Her challenges with medication, (which for her is lithium) were particularly interesting to me. Bipolar disorder is known for having a low rate of medication compliance, and her descriptions of the reasons behind her own decisions to discontinue medication (all disastrous) were enlightening to me, especially since finding effective ways to treat this illness and increase medication compliance is probably going to remain as one of my long term research interests. She describes the crippling side effects of the medications (one of these: the inability to read and comprehend books and journal articles, would certainly push me to stop taking a medication, no matter how convinced I was of its efficacy) and the positive feelings and productivity of hypomania that are given up for the sake of avoiding the psychosis of extreme mania and the crippling pain of severe depression. I can understand her hesitance to give these things up, and that is something that I think I have always needed to try to understand.
The stigma that she faces is sometimes shocking. In one instance, a physician tells her that he doesn’t think that she should ever have children (she never did, although not because of that idiot’s opinion) because she has bipolar disorder, which is thought to be genetic. I was appalled, as she was, that someone in the medical field could be so prejudiced, so horrible. (If we stopped bipolar people from reproducing, I wouldn’t be here to write this damnit!)
But when she talks about the implications of the modern genetic research in the field, these points become more poignant. It is clear that bipolar disorder runs in families, and the children and siblings of bipolar patients are also far more likely than the rest of the population to suffer from unipolar major depression, but the genes associated with either of these illnesses have not been isolated. What will happen when they are? Would parents choose to abort a fetus that carried those genes if a prenatal test were available? While she cites research in which the majority bipolar patients say that they wouldn’t, I wonder what someone who did not have the disease might choose after they had watched it kill someone else in their family.
She mentions here too that weeding out the bad in bipolar disorder might also weed out the good. This is a topic that I think will be a big part of the research that I want to make my career in: these intersections between the advantages and disadvantages of certain mental illnesses. She argues that the illness “can confer advantages on both the individual and society,” and she claims that she herself would choose to have manic-depressive illness if given the choice (this is with the assumption that medication is available and that it works. She is very clear that without effective treatment, the disease would be unbearable, and that she probably would not have survived.) She realizes that claiming as her own something that has clearly caused her so much pain is shocking, but she explains her position with stunning clarity,
“So why would I want anything to do with this illness? Because I honestly believe that as a result of it, I have felt more things, more deeply; had more experiences, more intensely; loved more and been more loved; laughed more often for having cried more often; appreciated more the springs for all the winters; worn death ‘as close as dungarees,’ appreciated it – and life – more; seen the finest and the most terrible in people, and slowly learned the values of caring, loyalty, and seeing things through. I have seen the breadth and depth and width of my mind and heart and seen how frail they both are, and how ultimately unknowable they both are. Depressed, I have crawled on my hands and knees in order to get across a room and have done it for month after month. But, normal or manic, I have run faster, thought faster and loved faster than most I know. And I think much of this is related to my illness – the intensity it gives things and the perspective it forces on me. I think that it has made me test the limits of my mind (which, while wanting, is holding) and the limits of my upbringing, family, education and friends.” (page 218)
It’s interesting to me that anyone would choose to have such a debilitating and often fatal illness. (Suicide rates are very high among people with bipolar disorder, Jamison herself attempted suicide once.) And I’m not sure where I stand, because these ideas are tricky. Where does personality intersect with illness? Where is the line between health and illness lie? Do we run the risk of taking from people some element of their humanity when we treat their mental anguish as a physical ailment, even if that’s what it is? What Jamison makes clear here is that patients suffering from one of these disorders experience their illness as very intimately linked with the person they are. And I do think that a true understanding of that perspective, or at least as true as someone can get without actually having the experience, is very important for me, as someone who wants to work with this patient population for the rest of my life.
Speaking of work… She talks about the current areas of research (admittedly from a perspective ten years old, but one that is still relevant) in a way that made me really glad to have a future (and a present) as a part of it. This quote seemed particularly beautiful when read in the control room of a 1.5 Tesla fMRI scanner, (taking pretty pictures of people’s brains)
“There is a wonderful kind of excitement in modern neuroscience, a romantic, moon-walk sense of exploration and setting out for new frontiers. The science is elegant, the scientists dismayingly young, and the pace of discovery absolutely staggering. Like the molecular biologists, the brain-scanners are generally well aware of the extraordinary frontiers they are crossing, and it would take a mind that is on empty, or a heart made out of stone, to be unmoved by their collective ventures and enthusiasm.” (page 197)
I’ll close with a quote from the very beginning of the book. People who know me know that understanding Bipolar Disorder has a personal meaning for me beyond my research, and I found this passage particularly beautiful both from the perspective of someone that wants to spend a career in part learning about this disease, and from the perspective of someone who has seen it in action.
She mentions here too that weeding out the bad in bipolar disorder might also weed out the good. This is a topic that I think will be a big part of the research that I want to make my career in: these intersections between the advantages and disadvantages of certain mental illnesses. She argues that the illness “can confer advantages on both the individual and society,” and she claims that she herself would choose to have manic-depressive illness if given the choice (this is with the assumption that medication is available and that it works. She is very clear that without effective treatment, the disease would be unbearable, and that she probably would not have survived.) She realizes that claiming as her own something that has clearly caused her so much pain is shocking, but she explains her position with stunning clarity,
“So why would I want anything to do with this illness? Because I honestly believe that as a result of it, I have felt more things, more deeply; had more experiences, more intensely; loved more and been more loved; laughed more often for having cried more often; appreciated more the springs for all the winters; worn death ‘as close as dungarees,’ appreciated it – and life – more; seen the finest and the most terrible in people, and slowly learned the values of caring, loyalty, and seeing things through. I have seen the breadth and depth and width of my mind and heart and seen how frail they both are, and how ultimately unknowable they both are. Depressed, I have crawled on my hands and knees in order to get across a room and have done it for month after month. But, normal or manic, I have run faster, thought faster and loved faster than most I know. And I think much of this is related to my illness – the intensity it gives things and the perspective it forces on me. I think that it has made me test the limits of my mind (which, while wanting, is holding) and the limits of my upbringing, family, education and friends.” (page 218)
It’s interesting to me that anyone would choose to have such a debilitating and often fatal illness. (Suicide rates are very high among people with bipolar disorder, Jamison herself attempted suicide once.) And I’m not sure where I stand, because these ideas are tricky. Where does personality intersect with illness? Where is the line between health and illness lie? Do we run the risk of taking from people some element of their humanity when we treat their mental anguish as a physical ailment, even if that’s what it is? What Jamison makes clear here is that patients suffering from one of these disorders experience their illness as very intimately linked with the person they are. And I do think that a true understanding of that perspective, or at least as true as someone can get without actually having the experience, is very important for me, as someone who wants to work with this patient population for the rest of my life.
Speaking of work… She talks about the current areas of research (admittedly from a perspective ten years old, but one that is still relevant) in a way that made me really glad to have a future (and a present) as a part of it. This quote seemed particularly beautiful when read in the control room of a 1.5 Tesla fMRI scanner, (taking pretty pictures of people’s brains)
“There is a wonderful kind of excitement in modern neuroscience, a romantic, moon-walk sense of exploration and setting out for new frontiers. The science is elegant, the scientists dismayingly young, and the pace of discovery absolutely staggering. Like the molecular biologists, the brain-scanners are generally well aware of the extraordinary frontiers they are crossing, and it would take a mind that is on empty, or a heart made out of stone, to be unmoved by their collective ventures and enthusiasm.” (page 197)
I’ll close with a quote from the very beginning of the book. People who know me know that understanding Bipolar Disorder has a personal meaning for me beyond my research, and I found this passage particularly beautiful both from the perspective of someone that wants to spend a career in part learning about this disease, and from the perspective of someone who has seen it in action.
"The Chinese believe that before you can conquer a beast, you must first 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 distillation both of what is finest in our natures, and of what is most dangerous. In order to contend with it, I first had to know it in all of its moods and infinite disguises, understand its real and imagined powers.” (page 5)
If nothing else, here Jamison has succeeded in making the beast, if not beautiful, as least a little more so. It becomes something human and understandable as opposed to something foreign and exciting, and that is quite an accomplishment.
If nothing else, here Jamison has succeeded in making the beast, if not beautiful, as least a little more so. It becomes something human and understandable as opposed to something foreign and exciting, and that is quite an accomplishment.
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