| Bipolar
Disorder and An Unquiet Mind
Kären Brandon
In Jamison (1995), Kay Redfield Jamison
reflects upon her struggles with bipolar I disorder.
Born in 1946, in an era when civility and restraint
were looked upon highly, Jamison noticed early in her
adolescence that she had more intense moods than others.
She was prone to grand ideas and fleeting passions for
animals, science, and medicine. She looked upon these
milder states of mania for quite some time with fondness;
it wasn’t until her late teens that she experienced
the depression that inevitably follows mania. Although
Jamison completed graduate studies in Psychology and
earned her Ph.D. from the University of California at
Los Angeles, she was not formally diagnosed with bipolar
I disorder until her thirties. By that time, she had
experienced full-blown psychotic mania and debilitating
depression. After years of hiding her illness, Jamison
decided to write Jamison (1995) in hope of changing
the way illness in professionals in the field of psychology
is treated. Jamison (1995) follows Jamison from early
childhood until her fifties, focusing upon the early
and developing signs of bipolar disorder and the troubles
and blessings it presented later in her life. Her struggles
with taking lithium as properly prescribed, holding
together relationships through mania and depression,
and climbing the university ladder to tenure are also
featured in Jamison (1995). Despite of or maybe even
because of her illness, Jamison has become an expert
on bipolar disorder. She has written definitive books
on the subject and started emergency clinics to help
bipolar patients. Although at one point she was acutely
suicidal and violent, her eventual acceptance of lithium
and psychotherapy as the best treatment for her has
made her life considerably more pleasant and has rid
her almost completely of any “bad” symptoms.
A lower dosage of lithium has allowed her to remain
an intense, driven, and passionate woman. Jamison currently
holds the position of Professor of Psychiatry at Johns
Hopkins University School of Medicine. (Jamison, 1995)
Throughout Jamison (1995), Jamison comments on how laughable
it is for one’s behavior to be reduced to the
few words describing bipolar disorder in the Diagnostic
and Statistical Manual (DSM-IV). But however ridiculous
they may seem, the cut-and-dry descriptions of the American
Psychological Association are necessary to making accurate
diagnoses. So what are those main characteristics which
Jamison laughs at possessing?
The most obvious manifestation of Jamison’s bipolar
disorder is her alternation between periods of mania
and periods of depression. A diagnosis of bipolar I
disorder requires episodes of full-blown mania, in which
the patient has an expansive, elevated, or irritable
mood along with at least three of the following symptoms
for one week: inflated self-esteem or grandiosity, decreased
need for sleep, more talkative than usual, feeling of
a pressure to keep talking, flight of ideas or sense
that thoughts are racing, distractibility, increase
in activity directed at achieving goals, and/or excessive
involvement in potentially dangerous activities (Nolen-Hoeksema,
2004, p. 287). A bipolar I patient may have episodes
of major depression (which is characterized by decreased
mood and/or anhedonia with three other symptoms for
two weeks), but it is not required for a diagnosis (Nolen-Hoeksema,
2004, p. 288). Although hypomanic episodes (less severe
manic episodes) are common, it is not required for a
diagnosis of bipolar I disorder (Nolen-Hoeksema, 2004,
p. 288).
Unfortunately, Dr. Jamison experienced both episodes
of full-fledged psychotic mania and episodes of suicidal
major depression. Mania would often begin as an unbelievable
amount of energy and lucidity of thoughts; it would
end in sheer madness. Especially in the early stages
of her illness, Jamison experienced hypomanic episodes,
in which she would feel energetic, enthusiastic, and
sexually uninhibited. When she was hypomanic, she would
write an article for a psychiatric journal in a day
and wade through mounds of her patients’ paperwork.
These hypomanic states were, generally, a great time
for Jamison. (Jamison, 1995)
Mania was another beast altogether. Jamison would wear
low-cut, revealing clothing during her mania. In the
beginning of her first full-criteria mania, she arrived
at the UCLA Chancellor’s garden party for newly
hired faculty lavishly dressed. She spoke to virtually
everyone in sight, flitting from one side of the garden
to the other with amazing speed. Jamison also went on
shopping sprees that would leave her house full of strange
items and her finances in shambles. In college, she
would go to the bookstore in search of one particular
book and leave with twenty seemingly unrelated books
which she thought would expound the meaning of life.
In a later manic episode, Jamison became convinced that
rattlesnakes presented an urgent problem in California,
and she bought twelve snakebite kits in an effort to
alert the public. Jamison spent thousands during un-medicated
attacks; she confesses to spending $30,000 among her
two most severe manic episodes. (Jamison, 1995)
Along with shopping sprees and an inflated self-esteem,
there came delusions, hallucinations, and violence.
This passage from Jamison describes one of her most
horrific delusions:
… I felt a strange sense of light at the back
of my eyes and almost immediately saw a huge black centrifuge
inside my head. I saw a tall figure in a floor-length
evening gown approach the centrifuge with a vase-sized
glass tube of blood in her hand. As the figure turned
around I saw to my horror that it was me and that there
was blood all over my dress, cape, and long white gloves…The
centrifuge began to whirl.
Then, horrifyingly, the image that previously had been
inside my head now was completely outside of it…Blood
was everywhere…I couldn’t get away from
the sight of the blood and the echoes of the machine’s
clanking as it whirled faster and faster. Not only had
my thoughts spun wild, they had turned into an awful
phantasmagoria, an apt but terrifying vision of an entire
life and mind out of control. (80)
As one can see, Jamison’s manias became her darkest
nightmares, devoid of any semblance of reality and evidence
that her mind was not to be trusted.
Depression would inevitably follow mania, and Jamison’s
dark cave of a mind would hollow deeper still, carving
out new pitfalls. Her depressions forced her to come
to an almost complete standstill physically, intellectually,
and emotionally. She would post a “Do Not Disturb”
sign on her office door and stare for hours out of her
window. She felt that she was a burden to everyone around
her, especially those like her brother, an economist
who helped her remedy the debt she incurred on her buying
frenzies by taking out loans in his own name. Nothing
was enjoyable to Jamison, even the things that she usually
found pleasure in like reading a good book or taking
a long walk. Every little thing was an effort; it took
her hours to wash her hair or just to get out of bed.
She felt that there was no reason to go on living if
it was to be a life of lacerating, black depression.
In the midst of her darkest depressive episode, which
lasted a year and a half, she decided upon suicide.
After going into a rage and smashing her bathroom’s
cabinet mirror, she took a lethal dose of lithium and
some anti-emetic medication (to keep her from vomiting),
and she went to bed. Fortunately, her brother called,
was alarmed by her slurred speech, and alerted the proper
authorities. (Jamison, 1995)
Although, at first, Jamison tried to explain away her
symptoms as reactions to the stresses of being a professor,
advising medical students, and running a clinic, she
finally accepted that bipolar disorder is most likely
caused by genetics that predispose a person to the illness
and the malfunctioning of neurotransmitters in the brain.
Through family history studies, scientists have found
that the rate of bipolar disorder occurring in the first-degree
relatives of people diagnosed with the disorder is 2-3
higher than in the families of people without the disorder
(Nolen-Hoeksema, 2004, p. 292). Jamison’s family
is no exception. She recounts a conversation she had
with Mogens Shou, a Danish psychiatrist, in which they
both laid out the history of mental illness in their
families. Jamison’s father’s side of the
family is riddled with depression, mercurial temperaments,
suicide attempts and hospitalizations. There is hope
that through family studies and analysis of DNA, the
gene(s) responsible for bipolar illness can be found,
thus securing the accuracy and efficiency of diagnosis
and subsequent treatment.
Since analyzing DNA is a long and laborious task (although
great strides are being made every day), bipolar disorder
is best explained as caused by an unbalanced amount
of neurotransmitter activity in the brain. Mania is
thought to be caused by an excess of the monoamine neurotransmitters
serotonin, norepinephrine, and dopamine. Serotonin,
norepinephrine, and dopamine are found in abundance
in the limbic system, the part of the central nervous
system responsible for “the regulation of sleep,
appetite, and emotional processes.” So, it makes
sense that mania, which often is characterized by a
decreased need for sleep and increased mood, is caused
by an increase in the chemicals found in the part of
the brain that regulates these processes. (Nolen-Hoeksema,
2004, pp. 294-5)
Conversely, depression is thought to be caused by abnormally
low amounts of monoamines present in the brain. Through
reuptake and degradation by enzymes, many neurotransmitters
in depressed people’s brains never reach their
destination. Reuptake occurs when a neuron releases
neurotransmitter into the synaptic gap, but instead
of the next neuron receiving it, the neuron that released
it absorbs it. There are enzymes in the synapse that
break down neurotransmitters; when those enzymes break
down too much monoamine, problems in communication between
neurons arise. The decreased mood and increased need
for sleep that depressed people experience is directly
related to their limbic system’s problems regulating
neurotransmitters in the brain. (Nolen-Hoeksema, 2004,
pp. 294-5)
To stabilize neurotransmitter systems, many bipolar
patients are treated with lithium, a naturally occurring
salt. Lithium seems to regulate serotonin, norepinephrine,
and dopamine levels at a happy medium, somewhere between
too little and too much. It is estimated that only 30
to 50 percent of bipolar patients respond well to lithium
(Nolen-Hoeksema, 2004, p.313); that is, they experience
a significant reduction in the number and severity of
their symptoms. Lithium seems to work best on symptoms
of mania; so many bipolar patients take an anti-depressant
such as the Selective Serotonin Reuptake Inhibitor (SSRI)
Prozac (Nolen-Hoeksema, 2004, p. 313). Fortunately,
Jamison is a good lithium responder, and does not need
to take other medication.
Because many patients struggle with taking lithium because
of its adverse side effects, a combination of lithium
and psychotherapy is most effective for treating bipolar
disorder a keeping patients on their medication (Nolen-Hoeksema,
2004, p. 315). As Jamison states:
Lithium prevents my seductive but disastrous highs,
diminishes my depressions, clears out the wool and webbing
from my disordered thinking, slows me down, gentles
me out, keeps me from ruining my career and relationships,
keeps me out of the hospital, alive, and makes psychotherapy
possible. But, ineffably, psychotherapy heals. It makes
some sense of the confusion, reins in the terrifying
thoughts and feelings, returns some control and hope
and possibility of learning from it all. (Jamison, 1995,
pp. 88-9)
One can deduce that the type of psychotherapy Jamison
received was interpersonal therapy, although she never
explicitly discusses the form and content of her sessions
with her psychiatrist. She chooses rather to emphasize
the necessity of psychotherapy to the bipolar patient
and its long-term effects on her life-views. She has
learned to discern her personality from her illness,
thus making it possible for her to avoid explaining
her good qualities as only products of bipolar disorder.
Interpersonal therapy is very much centered upon helping
the patient cope during times of role transitions, grief,
and loss (Nolen-Hoeksema, 2004, p. 319). Jamison says
that she has been through many life-changing events
such as the death of her boyfriend, David, achieving
tenure, and experiencing psychotic mania. Ultimately,
psychotherapy has helped many bipolar patients deal
with their illness and move past it into a brighter,
healthier future.
Jamison has definitely changed my feelings about bipolar
disorder. I am much more empathetic towards people with
mental illness. I realize that they are normal people
who perceive life just as vividly (or more so) as people
without mental illness. I am now convinced that in many
cases people who have experienced or are experiencing
mental illness can be crucial to the field of psychology.
Many, like Jamison, are competent and responsible enough
to treat patients and should not be denied the privilege
of practicing medicine. In fact, those who have experienced
mental illness firsthand are often the most groundbreaking,
thoughtful, and hard working in the field of psychology.
Reading Jamison has dispelled many of my false beliefs
about bipolar disorder. I did not realize how extensively
horrific mania can be until I read Jamison’s story.
Like many others, my thoughts about mania were that
it is a happy experience. Now I know that experiencing
manic episodes can be terribly frightening and often
dangerous.
One of the most intriguing aspects of Jamison (1995)
is its sequence of events. Jamison (1995) is not, by
any means, told in chronological order; instead, information
is revealed carefully so as to heighten its climactic
appeal. This fragmented sequence reflects with supreme
craft bipolar illness’s tendency toward shifting
extremes. Overall, Jamison (1995) is a wonderfully written
and intensely interesting, a work of great value to
the reader who wishes to learn more about bipolar disorder.
Works
Cited
Jamison, K. R. (1995).
An Unquiet Mind: A Memoir of Moods and Madness. New
York: Random House Inc.
Nolen-Hoeksema, S. (2004). Abnormal Psychology. Boston:
McGraw-Hill.
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