Madness Managed

 Within popular culture, depictions of madness or mental illness tend towards a romantic view of the condition. With those who fancy themselves artistic types often view madness as a necessary corollary to creativity. Figures like Charles Baudelaire, Edgar Allan Poe, Ernest Hemingway are viewed tragically. Others like the poets Robert Lowell and John Berryman I studied in a college English seminar attempted to use their madness as material for their own creative work.  Sylvia Plath, who along with Anne Sexton, studied for a time under Robert Lowell, might be the queen bee of this type of view. I remember how many of my female students lionized The Bell Jar in high school and college. When I finally read the book myself, I found it unsettling rather than inspiring. 

Like most adolescents, there were times I found myself wondering like Hamlet if I should live or die. After learning of the death of a classmate during my senior year of high school, I sunk into an existential funk that probably would have been solved a decade later with a dosage of antidepressants. Thankfully, I worked myself out of this mostly on my own, though a few heart-to-hearts with sympathetic teachers and my high school girlfriend kept me from taking any dire measures. 

When I learned of my mother's hospitalization with postpartum psychosis after the birth of my eldest brother, I wondered if I might inherit some form of mental illness from her. I do not think I have, but my admiration and appreciation of writers like Lowell and Berryman, has made me particularly interested in bipolar disorder, formerly known as manic depression. 

Through a winding path, approximately five or six years ago, I found myself taking on the task of teaching Advanced Placement (AP) Psychology. I had virtually no academic training for this course. I took an intro Psychology course in college to fulfill a general education requirement. I had taken various Sociology courses as both an undergrad and grad student, but this is a tangential connection. I did study Philosophy and had taught an elective class on World Philosophy. I had also been a lifelong student of Religion and I knew that one of the earliest academic studies of Religion was American psychologist William James' Varieties of Religious Experience. 

Nevertheless, I dove into the material which included a daunting amount of hard science relating to the brain, nervous system, and other topics more connected to the Sciences than Humanities, my wheelhouse. Around this time I learned of the work of Kay Redfield Jamison. Jamison is one of the world's foremost experts on bipolar disorder, on both a personal and academic level. Jamison has lived with this condition and has become an expert on the topic through her education and academic work. Jamison is on the Psychiatry Faculty at Johns Hopkins Medical School. In addition to her work, An Unquiet Mind: A Memoir of Moods and Madness, Jamison has written additional works on the topic. These include Fires in the Dark: Healing the Unquiet Mind, Touched With Fire: Manic-Depressive Illness and the Artistic Temperament, and more recently Robert Lowell, Setting the River on Fire: A Study of Genius, Mania, and Character. The Lowell book is a distinctive hybrid of a book. It is a biography, but one that foregrounds his struggle with bipolar disorder. She received permission from the Lowell estate to access his medical records. I have read several biographies and literary studies of Lowell, but none of those authors had the personal or professional background of Jamison. 

Regarding An Unquiet Mind, I found the work to be lyrical, candid, and ultimately hopeful as the reader sees how Jamison has managed to have an exceptionally successful life as a psychiatrist and also maintain relationships with friends and family too. Her acknowledgements include numerous debts to professional friends, doctors who treated her, and to her own siblings and her husband. Jamison dedicates the book to her mother.  Sadly, some of the primary victims of bipolar disorder beyond the person suffering from this disorder are family members who endure the vitriol and abuse of the individual while in these episodes. 

In the preface to my edition, Jamison writes about originally publishing the book fifteen years earlier. Jamison had struggled with this condition from the age of 17 and had still managed in the decade since that diagnosis to have earned an assistant professorship at UCLA. She notes that when she decided to write this book twenty years after her first academic appointment, it was not without risks. Though she had by this time earned tenure and had a sterling reputation in the field, who could anticipate the fallout from this type of public acknowledgement. What would her colleagues think of her? Would her academic community embrace this admission?  Jamison had spent two decades keeping this secret from the world, though she admits she was heading into a manic episode right at the time she joined the UCLA faculty.  I applaud Jamison's courage, because then and now, much of society feels mental illness is not truly an illness, but as Jamison writes "Far more people than I had realized conceptualize mental illness as a spiritual flaw or shortcoming in character" (xii). Jamison, like William Styron before her, in his memoir on depression, Darkness Visible, has done a great deal to destigmatize mental illness for the general public. 

Jamison divides the book into four sections: The Wild Blue Yonder, A Not So Fine Madness, This Medicine, Love, and An Unquiet Mind. The first section recounts Jamison's life growing up with a father in the military and frequent moves around the country before settling in Washington state after her father's retirement from active service. Jamison notes her suicidal thoughts that she hid from family and revealed only to a few close friends. When she goes off to college at UCLA, rather than her dream school of the University of Chicago, Jamison cannot hide her disappointment, though she comes to learn this was likely the best experience for her. Jamison completed her undergraduate studies and entered the PhD program in Psychology at UCLA. The first section ends with Jamison's appointment to the UCLA faculty. "I had a glorious-as it turns out, too glorious-summer, and, within three months of becoming a professor, I was ravingly psychotic" (63).

The second part of the book begins with Jamison explaining that her condition did not appear suddenly. As she writes, "I did not wake up one day to find myself mad" (68). Instead it was a process, an acceleration of thoughts that reached a point where she found herself in a world of chaos. Like many patients, Jamison often resisted medication, because how it made her feel.  However, when she emerged from the haze of her mania, the crushingly reality of spending sprees and other destructive behaviors had to be faced. 

Through therapy Jamison learns how to work towards the gentle balance between her condition and the possible treatment. "The challenge was in learning to understand the complexity of this mutual beholdenness and in learning to distinguish the roles of lithium, will, and insight in getting well and leading a meaningful life. It was the task and gift of psychotherapy" (88). Jamison as both a patient and psychiatric practitioner understood the treatment of mental illness is not an either/or choice between medication and therapy, but ideally should involve a complimentary approach to treatment. 

In the chapter "Missing Saturn" Jamison describes the experience of getting better which often required patients to abandon those mental flights they had found exhilarating while in the midst of those states. Finding a new normal is not always easy. "When I am my present 'normal' self, I am far removed from when I have been my liveliest, most productive, most intense, most outgoing and effervescent. In short, for myself, I am a hard act to follow. And I miss Saturn very much." (92). 

Jamison lucidly, but honestly recounts her battles with her medication, in her case, Lithium. Once again, her academic knowledge of mental illness provides an insight beyond other patients. Unfortunately, those who take medications for mental illness often have to work with various medications and dosage levels before finding an optimum combination.  It reminds us that we must be fierce self-advocates unafraid to challenge the medical knowledge and experience of our care providers.  In this same chapter, Jamison includes a humorous but also poignant list of 13 "Rules for the Gracious Acceptance of Lithium into Your Life." Rules #1 and 13 illustrate the societal costs of acknowledging mental illness. Rule # 1 states "Clear out the medicine cabinet before guests arrive for dinner or new lovers stay the night." Rule # 13 "Restock your medicine cabinet." 

In a lighthearted way, Jamison encapsulates the powerful social forces that make one reluctant to admit you suffer from some form of mental illness. As a teacher for approximately 25 years now, I am glad to admit more students and families comfortably inform me of their own or their child's psychological conditions.  Nevertheless, there are still many obstacles and barriers to acceptance on both personal and professional levels.  A recent documentary Persona: The Dark Truth Behind Personality Tests addresses many of these concerns. 

Jamison addresses her eighteen-month struggle with suicidal depression during which she bought a gun and periodically went to the eighth floor stairwell of the UCLA hospital where she pondered jumping off. She eventually took a massive dose of lithium. Jamison continues this narrative with gracious thanks to her personal therapist.  Another element of this work I appreciate is its insistence to not seek easy answers or romanticize her life. While she has been married three times, her second husband died, and had another significant romantic relationship that ended with the tragic death of her love, Jamison does not give false hope about her condition and what someone as close as your spouse can do for you. Near the end of part three, Jamison makes the following statement. "I have become fundamentally and deeply skeptical that anyone who does not have this illness can truly understand it" (174).  She goes on to argue "No amount of love can cure madness or unblacken one's dark moods. . . . 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" (174). Jamison's remark strikes me deep because of knowing both those who suffer from bipolar disorder and caregivers and family of those who suffer from this condition. The frustration, bitterness, and sadness of these caregivers is palpable because they want nothing more than to have their parent, partner, child, or friend to be well and "happy."  Similarly, those suffering from various psychological disorders wish for similar things, but the shame, inadequacy, or guilt they feel is no less real. 

The fourth section of the book is the shortest and it has more professional and academic topics.  The opening chapter "Speaking of Madness" is an excellent personal and professional meditation on the terminology used to refer to various psychological conditions.  Throughout this post, I have used bipolar disorder, though Redfield prefers and uses manic depression. I plan to use this chapter with my AP Psychology students to discuss the importance of accuracy in these matters. Another chapter "The Troubled Helix" explores the genetics of psychological disorders and "Clinical Privileges" recounts some of Jamison's reluctance to tell her colleagues of her condition, though thankfully her department chair proves to be completely supportive of her disclosure. The final chapter "A Life in Moods" and the "Epilogue" address what it has meant for Jamison personally and professionally to have bipolar disorder.  As she has done throughout the memoir, Jamison is honest and I found her conclusions to be well-earned. 

I have purchased a couple of other titles by Jamison and I hope to review them both in these pages. I would recommend Jamison's book for anyone curious about bipolar disorder and especially for those who have this condition and for those who know someone who has bipolar disorder.  I cannot think of a better introduction to this illness than An Unquiet Mind.