An Unquiet Mind

For many years, despite her understanding of the illness as a clinician and medical professional, Jamison was reluctant to take and remain on lithium, stemming partially “from a fundamental denial that what [she] had was a real disease” (91). She writes that this is a typical reaction to the diagnosis: “Moods are such an essential part of the substance of life, of one’s notion of oneself, that even psychotic extremes in mood and behavior somehow can be seen as temporary, even understandable, reactions to what life has dealt” (91). Her family and friends naturally expected that she would embrace medication, but “if you have had stars at your feet and the rings of planets through your hands,” as she imagined and felt she did, “it is a very real adjustment to blend into a three-piece-suit schedule, which […] is new, restrictive, seemingly less productive, and maddeningly less intoxicating” (91-92).

Part of her reluctance stemmed from the side effects of lithium, as in its early days, the standard dosage was higher than it is now, approaching even a toxic level. The medication caused severe nausea and vomiting due to any number of variables, and even if not that, the effect was that of intoxication. Worse, though, was that lithium impaired her ability to read: “I was used to reading three or four books a week; now it was impossible […] I did not read a serious work of literature or nonfiction, cover to cover, for more than ten years” (95). Even journal articles, required for her professional existence, were frustratingly difficult to manage; the only things she was able to continue reading reasonably well were poetry and children’s books.

However, “Psychological issues ultimately proved far more important than side effects,” as she “simply did not want to believe that [she] needed to take medication” and “had become addicted to [her] high moods […] dependent upon their intensity, euphoria, assuredness, and their infectious ability to induce high moods and enthusiasms in other people” (98). This thought was echoed by others, including her sister, who was opposed to medication and insisted that she should simply fight through her depressions, contributing to the doubt that she felt herself about medication. Upon reviewing her old psychiatric records, though, it became clear that her reluctance was part of a larger pattern: accept the need for lithium, feel better, reject lithium, grow worse, resume lithium (100-01).

Jamison writes that she always understood that lithium was not only effective in treating manic-depressive illness, but was effective particularly in treating her manic depression; likewise, she has always believed in the necessity of medication. Still, she “somehow thought that [she] ought to be able to carry on without drugs” (102). Her psychiatrist took her complaints seriously, but continually reframed her decision as a choice “between madness and sanity, and between life and death,” as not taking medication would only “ensure a return of [her] manias and depressions” (102). 

Refusing to take lithium consistently helped contribute to even starker swings in moods, including a suicidal depression that lasted a year and a half: “Everything that once was sparkling now was flat. I seemed to myself to be dull, boring, inadequate, thick brained, unlit, unresponsive, chill skinned, bloodless, and sparrow drab” (110). Jamison was seeing her psychiatrist several times per week; however, although he wished her to commit herself, she refused to do so, for a variety of reasons, but mostly because “if it became public knowledge that [she] had been hospitalized, [her] clinical work and privileges […] would be revoked on a permanent basis” (112); however, under California law, he was not able to commit her himself.

Unable to abide who she’d become any longer, Jamison planned her suicide. She convinced herself that this was the sensible decision not only for herself but for the people she cared about, on whom she felt she was a burden. As she hated being on lithium, she chose to overdose on lithium. She picked up an anti-emetic medication, waited until a gap in her suicide watch, moved her phone to another room, swallowed a massive quantity of lithium pills, then curled up and waited for death. However, when her brother called, she still answered the phone, alerting him to the issue and ultimately saving her life.

Following her suicide attempt, her family, close friends, and psychiatrist helped pull her back together. One of the most difficult parts, for her, was reconciling her actions with the person she wished to be, both before and after the attempt. Jamison writes, “These discrepancies between what one is what one is brought up to believe is the right way of behaving toward others, and what actually happens during these awful black manias, or mixed states, are absolute and disturbing beyond description” (121). Yet, her relationship with manic-depressive illness remains a complicated one: manias “had ignited and propelled much of [her] writing, research, and advocacy work” (122). These discrepancies, she feels, are in some ways attributable to patriarchal attitudes; manias are considered to be more masculine, whereas depression is considered to be more feminine. As a result, despite being equally likely in men as women, manic-depressive illness is often misdiagnosed in women. Regardless, for Jamison, it “is a disease that both kills and gives life” as “[f]ire, by its nature, both creates and destroys” (123).

One such benefit of the “fire” that comes with manic-depressive illness for Jamison is the way mania helped her in the “blood sport” that is obtaining academic tenure, one made all the more difficult due to the fact that she was a woman in a male-dominated field. Her manias initially pulled her in numerous, separate directions, ones that were rather disparate; eventually, though, she narrowed her focus to mood disorders. Despite some opposition, she and two colleagues set up the UCLA Affective Disorders Clinic, which became quite successful both as a medical facility and as a research and teaching facility. She and her colleagues encouraged residents and interns to read firsthand accounts in order to better understand the patients.

Throughout this time, she had support from various colleagues, including her department chair, who knew of her own illness and had safeguards in place to ensure it did not affect her treatment of the patients, which it never did. However, she was constantly fearful that her illness would become more publicly known, which may have forced her to give up practicing and teaching. Worse, her “tidal existence” made it difficult to research and publish as required for tenure. Further, she frequently encountered resistance from the traditional structures and figures in place, such as a colleague called “The Oyster,” who “was patronizing, smug, and had all of the intellectual and emotional complexity of […] a small mollusk. He thought of women in terms of breasts, not minds, and it always seemed to irritate him that most women had both” (133). Nevertheless, at the end of it, she received tenure and embarked on the next era of her life, celebrating “over years of struggling against severe mental illness” in order to attain that “major rite of academic passage” (134-35).