Bipolar Disorder

Some Calm for an Unquiet Mind

By Leo Charbonneau
The Medical Post, Nov. 7, 1995

Dr. Kay Redfield Jamison is one of the foremost authorities on manic-depressive illness. Her interest in the subject, we now know, is more than just academic.

A professor of psychiatry at Johns Hopkins University school of medicine, she has authored some 80 scientific papers on mood disorders and related topics, and co-authored what is said to be the standard medical text on manic-depression.

She also wrote Touched with Fire: Manic-Depressive Illness and the Artistic Temperament, which explores the links between this disease and artistic creativity.

What was not widely known about Dr. Jamison, however, was that she has suffered from manic-depressive illness since adolescence. The revelation comes in her new book, An Unquiet Mind, published this fall by Knopf and distributed in Canada by Random House.

The book chronicles, in moving and often poetic language, Dr. Jamison's odyssey from her first intoxicating bouts of mild mania at 17 to her spiralling descent into black despair and, eventually, an attempt at suicide. It is a rare and insightful personal look at mental illness by an expert clinician.

In an interview, Dr. Jamison, 49, said she decided to write the book to give the public an idea of what it is like to experience mania, and hopes it will encourage people suffering from mental illness to seek treatment -- including physicians, who are notorious for ignoring their own medical problems.

Her decision was not without professional concerns. There is still a "devastating stigma," she said, attached to manic-depression (a term she prefers over "bipolar illness," which she finds less descriptive).

Dr. Jamison said she did not at first "conceptualize" her moodiness and fits of mania as mental illness. "It seems like it's just part of your personality, like it's your temperament."

These first manifestations of illness were enjoyable, even seductive, she said. "You have this limitless energy and you have total certainty of knowledge. You feel like you're charming ... Your thinking is quicker, you're more focused, you have all these ideas, and everything is coming together."

In her book, she writes, "I felt great. Not just great, I felt really great. I felt I could do anything, that no task was too difficult."

Tortured mind

But the disease quickly worsened. Through her twenties, her manic episodes began to "escalate wildly and psychotically out of control." These were often followed by "a gray, bleak preoccupation with death," and "periods of total despair."

At times her mind would "grind to a total halt," she writes. Her thinking, "far from being clearer than a crystal, was tortuous."

During this time, amazingly, Dr. Jamison completed her PhD in psychology at UCLA, and in July 1974 joined the university's department of psychiatry as an assistant professor. Within three months, she writes, "I was ravingly psychotic."

It was at this time she was diagnosed with manic-depressive illness, and put on lithium. She responded well to the medication, but like so many others -- a quarter to one-half of people with manic-depressive illness have problems with compliance -- she stopped taking it as soon as she began to feel better. This led inevitably to relapse and even worse bouts of illness.

Dr. Jamison said her reason for quitting lithium was partly denial and partly the side-effects of the drug, although she said the latter is less an issue now that clinicians have much more experience prescribing lithium.

As well, "if you're used to living a very intense life, and all of a sudden you're not quite as intense (because of treatment), I think that's something you miss." But, she says, "there's a tendency to romanticize what you lost."

Eventually, Dr. Jamison said she felt her thoughts "getting scrambled one too many times." She returned to lithium, and with the help of psychotherapy and a lot of work has found a balance in her life.

Asked what her message is for physicians, she said the most important thing to remember is that manic-depressive illness is common, affecting 1% to 2% of the general population.

She also said it's important to distinguish between depression and manic-depression, because antidepressants may make some manic-depressives worse.

As well, "just telling people to take their medication is not particularly helpful," she said. Patients should be told that if they stop taking their lithium, the risk of immediate relapse is high. Physicians should also emphasize the illness will likely worsen over time.

"If I had known the illness was going to get worse left untreated, that would have affected my decision-making, for sure," she said.

Physicians must also try to keep people at the lowest possible dosage of lithium, or try a combination of lithium and an anticonvulsant (such as carbamazepine or valproic acid) to minimize the cognitive and emotional blunting.

Dr. Jamison said she survived her illness "by sheer luck" and others don't have to rely so much on chance.

"One of the things I feel very strongly about as a clinician, based on my personal knowledge of the illness, is the crucial nature of this disease."

One person in five, left untreated commits suicide. "In that respect it's a lot more lethal than heart disease and cancer. It's deadly."

Copyright 1995 Maclean Hunter Publishing Limited
Reprinted with permission.

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