An Unquiet Mind
Author: Kay Redfield Jamison

Overview

This book paints the intimate portrait of the author’s experience of manic-depressive illness, what she portrayed as ‘a fascinating, albeit deadly, enemy and companion’ that is ‘seductively complicated‘ and gives rise to ‘absolutely intoxicating states’. Depicting it as a biological illness that ‘distorts moods and thoughts‘, the book also casts manic-depression as a disorder that ‘incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live‘. As she traced the ‘unrelenting’ course of her illness and charted the unimaginably contrasting presentations of a truly intriguing mental illness, the author documented how she got ‘caught up in the cycles of manic-depressive illness‘, and how she struggled ‘against the drug that ultimately saved my life and restored my sanity‘. Beyond its autobiographical narrative, the book is also an enlightening exploration of the science behind manic-depression, from its heredity to its far-reaching complications such as alcoholism, drug abuse, violence and suicide. As a healer of the same disease that afflicts her, the author, a psychologist, also helpfully explored its treatments with ‘the combined use of medications and psychotherapy‘ (pages 4-6, 119, 123 and 126-127).

 

Synopsis

The striking feature of the author’s history of mental illness is its chronicity. Recalling that ‘for as long as I can remember I was frighteningly…beholden to moods‘, the author traced her first severe depressive illness to her adolescence when she said ‘my thinking would take a downward turn toward the really dark and brooding side of life’. Also noting that she had depressive bouts interspersed with experiences of ‘long weeks of flying high and sleeping little‘, she recollected her ‘first attack of manic-depressive illness’ in high school when she said she ‘raced about like a crazed weasel, bubbling with plans and enthusiasms’ and ‘making expansive, completely unrealistic plans’. She also remembered how she ‘came to a grinding halt‘ when her ‘tortuous’ thinking became dominated by ‘a grey, bleak preoccupation with death, dying, decaying‘, and when her mind became dominated with thoughts of killing herself. Her college years were also dominated by ‘a recurrent nightmare of violent and dreadful moods’ during which she would wake up with ‘a profound sense of dread‘ and be ‘unable to muster up enough energy to go to class’. Characteristically, these periods alternated with times of ‘great fun, passion, high enthusiasms, and long runs of very hard but enjoyable work’ during which she engaged in ‘impulsive buying’, got involved in ‘a variety of political and social causes’, and did almost everything to excess‘ (pages 35-44 and 48).

The hereditary aspect of manic-depressive illness was an interesting theme of the book which the author illustrated with the way the disease devastated her family, especially manifesting extremely in her father and sister. For example, she described how her father’s illness eroded his outgoing personality and blighted his successful career. She also chronicled his increasingly frequent cycles of ‘grimmer moods‘ which were characterised by despair and ‘bleak emotional withdrawal‘, and by anger and episodes of ‘rage and screaming‘ which she said ‘will fill me with terror’. He also manifested episodic ‘capacity for flight‘ which she said emerged whenever ‘his grandiose ideas started to push the limits’. Sadly, her father’s ‘erratic behaviour…cost him his job’, and ‘essentially estranged‘ him from her mother – all these serving to make her ‘deeply unhappy‘ at the age of fifteen, the time when she said ‘my world began to fall apart‘ (pages 30-31, 34-35 and 41).

 

 

The importance of family and social support in the successful outcome of mental illness was a theme that ran throughout the book. This was evident for example when the author argued that it was her mother’s ‘great ability to love and learn, listen and change‘ that sustained her ‘through all the years of pain and nightmare‘, and that it was her mother, along with her friends, who ‘made it possible for me to survive the turmoil of my home life’. Her brother was also exceptionally supportive especially in helping her to put her life back together after her manic episodes and her suicide attempt. Similarly, it was the understanding and support of her successive partners that helped her through the recurrent socially disruptive crises she experienced. This was illustrated, for example, when she referred to her first husband, a talented painter, as ‘an exceedingly kind and gentle person’, and to a colleague she was dating who encouraged her to seek psychiatric help during one of her most disruptive episodes (pages 19, 35, 57-58, 81, 117, 139-152 and 159-162).

The author’s experience of the different treatments she had was equally compelling, and at the centre of this narrative was lithium. Although the drug ‘worked very well‘ for her, she nevertheless experienced a raft of its debilitating adverse effects such as nausea, vomiting, slurred speech, unsteadiness, poor memory, and difficulty reading. The author also resented the way the drug eliminated her ‘high moods‘, emotions which she said were ‘powerfully inebriating and very conducive to productivity‘. These downsides of the treatment were what the author said triggered her ‘war with lithium‘ and drove her to stop taking it after six months; she referred to the consequences of this lithium resistance as ‘a bitter harvest‘ during which she descended into an 18-month ‘floridly psychotic mania‘ characterised by seeing death ‘everywhere’ and by an attempted suicide. The author used this anecdote to demonstrate that the Achille’s heel of the treatment of manic-depressive illness is the denial of illness and the reluctance to start or to remain on what is a life-long treatment. As much as she attributed a large part of her improvement to her treatments, the author nevertheless credited her psychiatrist for his role in her recovery, asserting that ‘he kept me alive a thousand times over’. She was particularly complimentary of his ‘obvious caring‘, ‘clarity of thought, ‘unwillingness to equivocate in delivering bad news’, ‘ease with ambiguity’, ‘comfort with complexity’, and his ability to ‘be decisive in the midst of chaos and uncertainty’ (pages 83-89 and 92-116).

A compelling feature of the book’s narrative is the impact of mental illness on the author’s professional training and career. For example, she maintained that her decision to turn away from studying medicine, and to pursue a PhD in psychology, was on account of her realisation that studying medicine was ‘an unlikely proposition’ with her history of manic depression. And whilst her career was initially associated with a remission in her mental illness, the author referred to this letup as ‘a deceptive respite from the savagely recurrent course that the untreated illness ultimately takes’; and indeed, three months into her post as an academic she became ‘ravingly psychotic‘. Attributing this episode of ‘florid madness‘ to ‘summer, a lack of sleep, a deluge of work, and exquisitely vulnerable genes‘, she chronicled how her life and mind subsequently ‘spun wildly and absolutely out of control‘, making her lose interest in clinical work and research. She also portrayed how this ‘neuronal pileup on the highways of my brain’ drove her to crave excitement and engage in bizarrely inappropriate social behaviours, and how it manifested as ‘delusional meanderings‘, hallucinations, hypergraphia, a wasteful spending spree, and rapid ‘magnificent and morbid’ thoughts which ‘wove in and raced by’ (pages 20-25 and 53-83).

Opinion

This deeply personal and revealing autobiography gives a most enlightening insight into one of the most dramatic and mysterious mental disorders. Combining a first hand illness narrative with an academic perspective, the author successfully conveyed a comprehensive picture of manic-depressive illness – now known as bipolar disorder. With unimpeachable prose and magnetic storytelling, she captures how the disorder spreads its tentacles to engulf families and friends, and to threaten relationships and careers. She similarly narrates the experience of the treatment of her mood disorder, highlighting the challenges of adhering to long-term treatment regimes and enduring their adverse effects. Beyond describing the illness, the book is also profoundly educational in its detailed description of the diseases symptoms, and the dangers of denial of illness and resistance to treatment.

Overall assessment

Whilst this book conveys the picture of a most pernicious disease, it also illustrates how manic-depressive illness is compatible with a healthy personal life and a productive professional career. The book’s chronological narrative and its detailed depiction of the clinical manifestations of the disorder are invaluable for public enlightenment. And in her depiction of her psychiatrist, a model for all physicians, the author stresses the critical role of empathic healthcare practitioners in the management of all chronic medical disorders. The book is an insightful look at the course and care of a major mental illness, and I recommend it to all doctors.

Book details

Publisher, Place, Year: Picador, London, 1995
Number of parts: 4
Number of pages: 219
ISBN: 978-1-4472-7528-2
Star rating: 5
Price: £7.99