An Unquiet Mind Read online

  ACCLAIM FOR Kay Redfield Jamison’s

  AN UNQUIET MIND

  “Written with poetic and moving sensitivity … a rare and insightful view of mental illness from inside the mind of a trained specialist.”

  —Time

  “Enlightening … eloquent and profound.”

  —San Francisco Chronicle

  “A riveting portrayal of a courageous brain alternating between exhilarating highs and numbing lows.”

  —James D. Watson, Nobel laureate and author of The Double Helix

  “In a most intimate and powerful telling, Jamison weaves the personal and professional threads of her life together.… [She] brings us inside the disease and helps us understand manic depression.… What comes through is a remarkably whole person with the grit to defeat her disease.”

  —Cleveland Plain Dealer

  “A riveting read. I devoured it at a single sitting and found the book almost as compelling on a second read.… An Unquiet Mind may well become a classic.… Jamison sets an example of courage.”

  —Howard Gardner, Nature

  “Stunning.… I have never read a more exquisite (in both a literary and medical sense) autobiography.… This is an important, wonderful book.”

  —Jackson Clarion Ledger

  “Piercingly honest.… Jamison’s literary coming-out is a mark of courage.”

  —People

  “Brave, insightful, richly textured and chillingly authentic.”

  —Boston Globe

  “Extraordinary.… An Unquiet Mind must be read.”

  —The New England Journal of Medicine

  “A beautiful, funny, original book. Powerfully written, it is a wonderful and important account of mercurial moods and madness. I absolutely love this book.”

  —Pat Conroy, author of The Prince of Tides

  “A landmark.… The combination of the intensity of her personal life and the intellectual rigor of her professional experience make the book unique.… A vibrant and engaging account of the life, love, and experience of a woman, a therapist, an academic, and a patient.”

  —The British Medical Journal

  “Affecting, honest, touching … fluid, felt and often lyrical.”

  —Will Self, The Observer (London)

  “Quite astonishing … cuts through the dead jargon and detached observations of psychiatric theory and practice to create a fiery, passionate, authentic account of the devastation and exaltation, the blindness and illumination of the psychotic experience.”

  —The Sunday Times (London)

  “Rises to the poetic and has a mystical touch … a courageous and fascinating book, a moving account of the life of a remarkable woman.”

  —The Daily Telegraph (London)

  “Fast-paced, startingly honest and frequently lyrical … [Jamison has] a novelist’s openness of phrase and talent for bringing character alive.”

  —Scotland on Sunday

  “Superbly written.… A compelling work of literature.”

  —Independent on Sunday (London)

  Kay Redfield Jamison

  AN UNQUIET MIND

  Kay Redfield Jamison is Professor of Psychiatry at the Johns Hopkins University School of Medicine. She is the author of Touched with Fire: Manic-Depressive Illness and the Artistic Temperament, Night Falls Fast: Understanding Suicide, Exuberance: The Passion for Life, and coauthor of the standard medical text on manic-depressive illness, chosen in 1990 as the Most Outstanding Book in Biomedical Sciences by the Association of American Publishers. The recipient of numerous national and international scientific awards, Dr. Jamison was a member of the first National Advisory Council for Human Genome Research, as well as the clinical director for the Dana Consortium on the Genetic Basis of Manic-Depressive Illness. She lives in Washington, D.C.

  FIRST VINTAGE BOOKS EDITION, OCTOBER 1996

  Copyright © 1995 by Kay Redfield Jamison

  All rights reserved under International and Pan-American Copyright Conventions. Published in the United States by Vintage Books, a division of Random House, Inc., New York, and simultaneously in Canada by Random House of Canada Limited, Toronto. Originally published in hardcover by Alfred A. Knopf, Inc., New York, in 1995.

  Owing to limitations of space, acknowledgments for permission to reprint previously published material may be found on this page.

  The Library of Congress has cataloged the Knopf edition as follows:

  Jamison, Kay R.

  An unquiet mind / Kay Redfield Jamison.— 1st ed.

  p. cm.

  eISBN: 978-0-307-49848-9

  1. Jamison, Kay R.—Mental health. 2. Manic-depressive psychoses—Patients—United States—Biography. 3. Women college teachers—United States—Biography. I. Title.

  RC516.J363 1995

  616.89’5’0092—dc20

  [B] 95-14273

  Random House Web address: http://www.randomhouse.com/

  v3.1_r1

  For my mother,

  Dell Temple Jamison

  Who gave me life not

  once, but countless times

  I doubt sometimes whether

  a quiet & unagitated life

  would have suited me—yet I

  sometimes long for it.

  —BYRON

  Contents

  Cover

  About the Authors

  Title Page

  Copyright

  Dedication

  Epigraph

  Prologue

  Part One

  THE WILD BLUE YONDER

  Part Two

  A NOT SO FINE MADNESS

  Part Three

  THIS MEDICINE, LOVE

  Part Four

  AN UNQUIET MIND

  Epilogue

  Acknowledgments

  Permissions Acknowledgments

  Prologue

  When it’s two o’clock in the morning, and you’re manic, even the UCLA Medical Center has a certain appeal. The hospital—ordinarily a cold clotting of uninteresting buildings—became for me, that fall morning not quite twenty years ago, a focus of my finely wired, exquisitely alert nervous system. With vibrissae twinging, antennae perked, eyes fast-forwarding and fly faceted, I took in everything around me. I was on the run. Not just on the run but fast and furious on the run, darting back and forth across the hospital parking lot trying to use up a boundless, restless, manic energy. I was running fast, but slowly going mad.

  The man I was with, a colleague from the medical school, had stopped running an hour earlier and was, he said impatiently, exhausted. This, to a saner mind, would not have been surprising: the usual distinction between day and night had long since disappeared for the two of us, and the endless hours of scotch, brawling, and fallings about in laughter had taken an obvious, if not final, toll. We should have been sleeping or working, publishing not perishing, reading journals, writing in charts, or drawing tedious scientific graphs that no one would read.

  Suddenly a police car pulled up. Even in my less-than-totally-lucid state of mind I could see that the officer had his hand on his gun as he got out of the car. “What in the hell are you doing running around the parking lot at this hour?” he asked. A not unreasonable question. My few remaining islets of judgment reached out to one another and linked up long enough to conclude that this particular situation was going to be hard to explain. My colleague, fortunately, was thinking far better than I was and managed to reach down into some deeply intuitive part of his own and the world’s collective unconscious and said, “We’re both on the faculty in the psychiatry department.” The policeman looked at us, smiled, went back to his squad car, and drove away.

  Being professors of psychiatry explained everything.

  Within a month of signing my appointment p
apers to become an assistant professor of psychiatry at the University of California, Los Angeles, I was well on my way to madness; it was 1974, and I was twenty-eight years old. Within three months I was manic beyond recognition and just beginning a long, costly personal war against a medication that I would, in a few years’ time, be strongly encouraging others to take. My illness, and my struggles against the drug that ultimately saved my life and restored my sanity, had been years in the making.

  For as long as I can remember I was frighteningly, although often wonderfully, beholden to moods. Intensely emotional as a child, mercurial as a young girl, first severely depressed as an adolescent, and then unrelentingly caught up in the cycles of manic-depressive illness by the time I began my professional life, I became, both by necessity and intellectual inclination, a student of moods. It has been the only way I know to understand, indeed to accept, the illness I have; it also has been the only way I know to try and make a difference in the lives of others who also suffer from mood disorders. 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.

  The Chinese believe that before you can conquer a beast you first must 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. Because my illness seemed at first simply to be an extension of myself—that is to say, of my ordinarily changeable moods, energies, and enthusiasms—I perhaps gave it at times too much quarter. And, because I thought I ought to be able to handle my increasingly violent mood swings by myself, for the first ten years I did not seek any kind of treatment. Even after my condition became a medical emergency, I still intermittently resisted the medications that both my training and clinical research expertise told me were the only sensible way to deal with the illness I had.

  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. Medications not only cut into these fast-flowing, high-flying times, they also brought with them seemingly intolerable side effects. It took me far too long to realize that lost years and relationships cannot be recovered, that damage done to oneself and others cannot always be put right again, and that freedom from the control imposed by medication loses its meaning when the only alternatives are death and insanity.

  The war that I waged against myself is not an uncommon one. The major clinical problem in treating manic-depressive illness is not that there are not effective medications—there are—but that patients so often refuse to take them. Worse yet, because of a lack of information, poor medical advice, stigma, or fear of personal and professional reprisals, they do not seek treatment at all. Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide.

  I am fortunate that I have not died from my illness, fortunate in having received the best medical care available, and fortunate in having the friends, colleagues, and family that I do. Because of this, I have in turn tried, as best I could, to use my own experiences of the disease to inform my research, teaching, clinical practice, and advocacy work. Through writing and teaching I have hoped to persuade my colleagues of the paradoxical core of this quicksilver illness that can both kill and create; and, along with many others, have tried to change public attitudes about psychiatric illnesses in general and manic-depressive illness in particular. It has been difficult at times to weave together the scientific discipline of my intellectual field with the more compelling realities of my own emotional experiences. And yet it has been from this binding of raw emotion to the more distanced eye of clinical science that I feel I have obtained the freedom to live the kind of life I want, and the human experiences necessary to try and make a difference in public awareness and clinical practice.

  I have had many concerns about writing a book that so explicitly describes my own attacks of mania, depression, and psychosis, as well as my problems acknowledging the need for ongoing medication. Clinicians have been, for obvious reasons of licensing and hospital privileges, reluctant to make their psychiatric problems known to others. These concerns are often well warranted. I have no idea what the long-term effects of discussing such issues so openly will be on my personal and professional life, but, whatever the consequences, they are bound to be better than continuing to be silent. I am tired of hiding, tired of misspent and knotted energies, tired of the hypocrisy, and tired of acting as though I have something to hide. One is what one is, and the dishonesty of hiding behind a degree, or a title, or any manner and collection of words, is still exactly that: dishonest. Necessary, perhaps, but dishonest. I continue to have concerns about my decision to be public about my illness, but one of the advantages of having had manic-depressive illness for more than thirty years is that very little seems insurmountably difficult. Much like crossing the Bay Bridge when there is a storm over the Chesapeake, one may be terrified to go forward, but there is no question of going back. I find myself somewhat inevitably taking a certain solace in Robert Lowell’s essential question, Yet why not say what happened?

  Part One

  THE WILD BLUE YONDER

  Into the Sun

  I was standing with my head back, one pigtail caught between my teeth, listening to the jet overhead. The noise was loud, unusually so, which meant that it was close. My elementary school was near Andrews Air Force Base, just outside Washington; many of us were pilots’ kids, so the sound was a matter of routine. Being routine, however, didn’t take away from the magic, and I instinctively looked up from the playground to wave. I knew, of course, that the pilot couldn’t see me—I always knew that—just as I knew that even if he could see me the odds were that it wasn’t actually my father. But it was one of those things one did, and anyway I loved any and all excuses just to stare up into the skies. My father, a career Air Force officer, was first and foremost a scientist and only secondarily a pilot. But he loved to fly, and, because he was a meteorologist, both his mind and his soul ended up being in the skies. Like my father, I looked up rather more than I looked out.

  When I would say to him that the Navy and the Army were so much older than the Air Force, had so much more tradition and legend, he would say, Yes, that’s true, but the Air Force is the future. Then he would always add: And—we can fly. This statement of creed would occasionally be followed by an enthusiastic rendering of the Air Force song, fragments of which remain with me to this day, nested together, somewhat improbably, with phrases from Christmas carols, early poems, and bits and pieces of the Book of Common Prayer: all having great mood and meaning from childhood, and all still retaining the power to quicken the pulses.

  So I would listen and believe and, when I would hear the words “Off we go into the wild blue yonder,” I would think that “wild” and “yonder” were among the most wonderful words I had ever heard; likewise, I would feel the total exhilaration of the phrase “Climbing high, into the sun” and know instinctively that I was a part of those who loved the vastness of the sky.

  The noise of the jet had become louder, and I saw the other children in my second-grade class suddenly dart their heads upward. The plane was coming in very low, then it streaked past us, scarcely missing the playground. As we stood there clumped t
ogether and absolutely terrified, it flew into the trees, exploding directly in front of us. The ferocity of the crash could be felt and heard in the plane’s awful impact; it also could be seen in the frightening yet terrible lingering loveliness of the flames that followed. Within minutes, it seemed, mothers were pouring onto the playground to reassure children that it was not their fathers; fortunately for my brother and sister and myself, it was not ours either. Over the next few days it became clear, from the release of the young pilot’s final message to the control tower before he died, that he knew he could save his own life by bailing out. He also knew, however, that by doing so he risked that his unaccompanied plane would fall onto the playground and kill those of us who were there.

  The dead pilot became a hero, transformed into a scorchingly vivid, completely impossible ideal for what was meant by the concept of duty. It was an impossible ideal, but all the more compelling and haunting because of its very unobtainability. The memory of the crash came back to me many times over the years, as a reminder both of how one aspires after and needs such ideals, and of how killingly difficult it is to achieve them. I never again looked at the sky and saw only vastness and beauty. From that afternoon on I saw that death was also and always there.

  Although, like all military families, we moved a lot—by the fifth grade my older brother, sister, and I had attended four different elementary schools, and we had lived in Florida, Puerto Rico, California, Tokyo, and Washington, twice—our parents, especially my mother, kept life as secure, warm, and constant as possible. My brother was the eldest and the steadiest of the three of us children and my staunch ally, despite the three-year difference in our ages. I idolized him growing up and often trailed along after him, trying very hard to be inconspicuous, when he and his friends would wander off to play baseball or cruise the neighborhood. He was smart, fair, and self-confident, and I always felt that there was a bit of extra protection coming my way whenever he was around. My relationship with my sister, who was only thirteen months older than me, was more complicated. She was the truly beautiful one in the family, with dark hair and wonderful eyes, who from the earliest times was almost painfully aware of everything around her. She had a charismatic way, a fierce temper, very black and passing moods, and little tolerance for the conservative military lifestyle that she felt imprisoned us all. She led her own life, defiant, and broke out with abandon whenever and wherever she could. She hated high school and, when we were living in Washington, frequently skipped classes to go to the Smithsonian or the Army Medical Museum or just to smoke and drink beer with her friends.