An “Unquiet Mind” is the memoir of Kay Redfield Jamison. This book gives an intimate look at manic-depressive (bipolar) illness, from a woman who not only suffers from the illness but is a Professor of Psychiatry who has contributed to many texts and clinical aspects of the illness. She details extensively the intoxicating highs of mania, the debilitating lows of depression, the fear and stigma of having such and illness in the academic and professional worlds and the delicate balances of living a productive and fulfilling life while chasing sanity. The picture she paints of the illness is at times so clear, that I (also having bipolar disorder) felt some of the situations and emotions were plucked from my own past. Dr Jamison brings the reader into her world and mind.
Being born in the mid 40’s and coming of age in the early 60’s Dr Jamison was unable to benefit from the special education services that people with emotional disorders can benefit from today. This lack of services in this area is complicated by the late onset of many mental/emotional illnesses. Bipolar along with many other major disorders do not show evidence of onset until late adolescence the majority of the time. Another major complication to receiving assistance in the area of emotional disorders is that the validity of these disabilities can be debated at times. In many cases the validity of emotional disorders is questioned in ways that blindness, deafness or cerebral palsy would never be. Many times it is suggested that people dealing with these emotional disorders should just “buck up” or handle it without needing medication or any assistance in the matter. Dr Jamison’s memoir gives clear evidence of just how damaging the idea “that I ought to be able to handle whatever difficulties came by way without having to rely on crutches such as medication” (99) can be in these types of conditions. Even people close to those dealing with the illness “find(s) it very difficult to see it as an illness rather than being willful, angry, irrational or simply tiresome”(174) In addition to the myriad of difficulties that come with dealing with difficulties that come with dealing with a disability people diagnosed with mental illness have to face stigma and disbelief in the face of their difficulties. In several instances Dr Jamison recalls how these difficulties affected her. “My early years on the faculty at UCLA were plagued by fears that my illness would be discovered that I would be reported to one kind of hospital or licensing board or another, and that I would be required to give up my clinical practice and teaching” (130)
Coupled with the outsider’s difficulty in accepting the validity of the disorder is the trouble that a person themselves has with the diagnosis, and treatment. This comes in part from the fear and embarrassment that comes from even making that first appointment to see a psychiatrist. “I was also terrified and deeply embarrassed … if I didn’t get professional help, I was quite likely to lose my job, my already precarious marriage and my life as well.” (84) The fear and uncertainty that comes from making the call to see a psychiatrist is countered with the devastating alternatives of not getting treatment, often the decision to seek help only comes when the balance is desperately one sided. Dr Jamison sums up the apprehension “I was confused and frightened and terribly shattered in all my notions of myself” (85) One of the difficulties of a mood disorder is that “moods are such an essential part of the substance of life, of one’s notion of oneself” (91). This all couples into the “denial that what I had was a real disease” (91)
With all the uncertainty, denial and fear surrounding bipolar disorder (and mood disorders in general). It could be easy to write them off when it comes to supportive assistance or even attempting to determine what kind of assistance might need or even what would be useful. Even more bothersome four determining how to best assist people is that the disorder like many psychiatric disorders do not show signs of onset until late adolescence. Teenagers are almost synonymous with volatile emotions, changes in sleep patterns and personality, which leaves many people not knowing they even need assistance until the final years that such assistance is available. For the average person the question then becomes what is so difficult about moods anyway?
“Manic-depression distorts moods and thoughts, initiates dreadful behaviors, destroys the basis of rational thought and too often erodes the desire and will to live.. an illness that is unique in conferring advantages and pleasure yet one that brings …. Almost unendurable suffering and , not infrequently, suicide” (6) There is no more concise way to combine the dangerous seduction of mania and the devastation of utter depression. Many people can relate to or understand how depression could lead to suicide but many have trouble understanding how mania could be a problem. Yet this is when most patients feel most out of control. Mild manias with their “intoxicating moods” increases energy and feelings of sensuality seem harmless, even the tendency to do things to excess are easily explained. But severe mania when “The fast ideas are too fast, … confusion replaces clarity … you are irritable, angry, frightened, uncontrollable …” (67) Then when mania subsides you are left with the desperate questions of “Who knows what? What did I do? Why?… [W]hen will it happen again? Which of my feeling are real?’ (68) You feel completely our of control and totally lost, you lose track of what you have done. The ability to worry about money is overwhelming so it is much simpler to just ignore it all. Violence is common in these times. “Being wildly out of control-physically assaultive, screaming insanely at the top of one’s lungs, running frenetically with no purpose or limit or tying impulsively to leap from cars is frightening to other and unspeakably terrifying to oneself” (120) So why then is it hard for people to want to escape these feelings? How are they considered seductive? Why would someone, anyone, want that?? The answer is almost stupidly simple the mind blots out the nightmare remembering only the mild manias. “I had become addicted to my high moods; I had become dependent on their euphoria, assuredness, and their infectious ability to induce high moods and enthusiasm in other people” (98) While the severe manias are severely disruptive, the milder manias fuel a level of productiveness that is hard to match.
Depression is the other side of this illness. People “imply that they know what it is like to be depressed because they have gone through a divorce, lost a job or broken up with someone. But these experiences carry with them feelings. Depression is flat hollow and unendurable … 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.” (218) This is such a clear representation of depression, many people equate depression with sadness and do not see the extent of the difference between the two. When severely depressed, “Everything – every thought, word, movement – [is] an effort” (110). It is a battle to do the most mundane tasks. ” I seemed to myself to be dull, boring, inadequate, thick brained … I doubted .. my ability to do anything well. I seemed to myself to be dull, boring, inadequate, thick brained … I doubted .. my ability to do anything well. IT seemed as though my mind had slowed down and burned out to the point of being virtually useless .. to taunt me with the total desperate hopelessness of it all” (110) It is this sense of utter hopelessness and the frustration and pain of feeling totally incapacitated and useless that lead to thoughts of suicide. People who have never contemplated suicide think of it as being a selfish, cowardly and stupid solution. The person contemplating the action though, many times sees it as an altruistic act. “I could not stand the pain any longer, could not continue to be responsible for the turmoil I was inflicting upon my friends and family. I was doing the only fair thing for the people I cared about it was also the only sensible thing to do for myself. One would put an animal to death for far less suffering.” (115)
Now that we have had an overview of the difficulties of the illness the question becomes, what to do about it? What options are there? What do we focus on? How to help? The first, and easiest answer to those questions are to be understanding, accepting and compassionate. There is untold comfort in the idea “that I was not alone in dealing with all the pain and uncertainty, and it was clear to me that he genuinely wanted to understand my illness” (145) When a person with bipolar disorder begins taking medication there are new difficulties to face, when a person is “used to sleeping only 4 … hours a night and now sleep eight, are used to staying up all night for days and weeks in a row and now cannot, [a normal schedule] is a very real adjustment … which .. is new restrictive and seemingly less productive” (92) A person with bipolar disorder who desires to be productive and keep themselves in check develop methods of self control, generally involving rigid limits on irritability and avoiding situations that might “trip or jangle .. hypersensitive wiring” (82) The concept of fake it till you make it becomes almost a life mantra. These methods of constant self control, limitation, discipline and checking and re-checking behavior in the ‘normal’ moods or mild ups and downs, put serious additional stress on a person and many times a severe mood swing can seem like a failure, like letting your guard down and losing all control. Something as simple as balancing and coordinating assignment loads so that major assignments don’t overlap if possible or allowing the occasional late assignment if justified can help mitigate the stress and prevent a serious breakdown. Many times there are “pronounced seasonal changes in behaviors and abilities” (48) helping a student find when their more difficult times of the year are and taking steps to prepare for seasonal low and high moods. For example I know that around the end of October through the beginning of December I traditionally have a period of low moods, but in August and September I have a period of higher moods, if I know ahead of time I have an important, multi part assignment due in the end of the term, I will try to begin research, gathering materials, even prepping everything I need so that it is just a process of drawing the final elements together when I am having difficulties with motivation. Being able to prepare for something that is somewhat constant in an illness characterized by change is encouraging and helps encourage treatment.
Understanding that new problems can come with taking medication and helping to mitigate the frustration and difficulty that can come with it. Medication difficulties can include “severe nausea and vomiting” (93) minor but annoying physical problems such as severe cane and hair loss and even more frustrating to the academic environment “affect[ing] .. ability to read, comprehend and remember what [was] read .. can impair concentration and attention span and affect memory” (95) People who are avid readers may find that suddenly they can “not read more than a paragraph or 2 at a time” (145) Though it may seem silly keep in mind that they are new to a “world of more stable moods and more predictable life” (169) They may very well have “no real idea of what it would be like” (169) This may seem in many cases terrifying and frustrating and overwhelming. It is imperative that the importance of medication consistency be stressed, that you remind them how much easier things are overall no matter how stressful it might be it get adjusted. As with many people it is always important to focus on strengths and abilities to encourage them. In a quote that spoke to me “I don’t mind the thought of being seen as intermittently psychotic nearly as much as I mind being pigeonholed as weak and neurotic.” (202)
All page numbers refer to “An Unquiet Mind: A Memoir of Moods and Madness” by Kay Redfield Jamison published by Vintage books copyright 1995