An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison is an intimate look into the havoc that bipolar disorder can wreak. The book captures her journey with bipolar disorder, from its emergence in her late teens to the effects it has had on her accomplished career as a clinical psychologist and university professor.
The book contains rich descriptions, and is searingly honest with no attempt to gloss over the messy and downright ugly bits of mental illness. The author is extremely insightful, and does an excellent job of capturing in words what mental illness feels like. She described the “particular kind of pain, elation, loneliness, and terror involved in this kind of madness… You are irritable, angry, frightened, uncontrollable, and totally enmeshed in the blackest caves of the mind.”
Many of the challenges Jamison has faced will sound very familiar to anyone living with a mood disorder. She is very open about her struggle to accept her diagnosis and the attached stigma. Even once she did recognize that she was struggling with her mental health, fear and shame initially stopped her from seeking treatment. It took a long time for her to accept that she needed to remain on medication, and there were multiple occasions when she stopped her meds and then experienced a relapse of mania. There were several factors that played into her reluctance to take medication, including a wish not to be brought down from the highs of mania. She thought of medications as something that “might be indicated for psychiatric patients, for those of weaker stock, but not for us”. She was placed on high doses of lithium, which caused considerable side effects including nausea and impaired coordination, and at times she ended up with toxic blood levels.
Her work as a psychologist impacted how she experienced and managed her illness and its treatment. When she first met with a psychiatrist, “the questions were familiar, I had asked them of others a hundred times, but I found it unnerving to have to answer them, unnerving not to know where it was all going, and unnerving not to realize how confusing it was to be a patient.”
When she was highly depressed, her psychiatrist tried to persuade her to go to hospital, but she refused. The idea terrified her and she didn’t want to have to “put up with all of the indignities and invasions of privacy that go into being on a psychiatric ward”. She also worried that if it became known she’d been hospitalized “my clinical work and privileges at best would be suspended; at worst, they would be revoked on a permanent basis.” This resonated strongly with me, as I have similar fears about the loss of my nursing license if I were to be hospitalized again.
As Jamison was recovering from a long period of suicidal depression, she began a romantic relationship with a man. He asked her to come to stay with him in London, and she states that although she was “still recovering… and my thoughts were so halting and my feelings so gray I could scarcely bear it I somehow knew that things would be made better by being with him. They were. Immeasurably.” Love helped her replace the awfulness of illness with beauty and vitality, which I found this interesting, as in the past love has made a big difference in my own recovery,
She writes about the issue of language choices when it comes to mental illness. She prefers the term manic-depressive illness to bipolar disorder, as she finds it more accurate. She also questioned whether in the end destigmatization can possibly come from simple language changes, or whether it will instead come from things like public education and improvements in diagnosis and treatment. She touches on stigma within the health professions, giving the example of one doctor who told her she shouldn’t have children due to her illness. She warns that stigma may prevent clinicians with mental illness from seeking treatment because of concerns about their professional license or privileges. She has been careful to create a safety net of colleagues who are aware of her illness and who will step in to keep her from practice should her mental health start to deteriorate. This reminds me of the safety net I had in place several years ago when I was getting outpatient ECT. I knew from past experience that ECT adversely affected my memory and I was often unaware of the full extent of this impairment, so I had spoken to each of the physicians I worked with and asked them to let me know if I was slipping in my management of our shared patients so that I would know if I needed to take time off.
I found the conclusion of the book very powerful. The author stated that as a result of her illness, “I have felt more things, more deeply; had more experiences, more intensely; loved more, and been more loved; laughed more often for having cried more often; appreciated more the springs, for all the winters; worn death ‘as close as dungarees’, appreciated it–and life–more; seen the finest and the most terrible in people, and slowly learned the values of caring, loyalty, and seeing things through.” It’s a good reminder to all of us that as dark as mental illness can be, it does not entirely shut out the light. I would definitely recommend this book.
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