A Clinical Review of an Unquiet Mind

An Unquiet Mind is an autobiography about Kay Redfield Jamison's life. It is a journey through the struggles of a woman and psychologist living with manic-depression, or what is now commonly called bipolar disorder. This illness is genetic, and currently does not have a cure. As in Jamison's situation, there is usually a family history of suicide and mood swings. Bipolar disorder is commonly controlled with Lithium, if the person is lucky enough to respond to it. The development of symptoms may occur at a young age. However, without knowledge of other family members being ill, this disorder may not get diagnosed.

While in her teens, Jamison had a strong support system with close friends at her high school who saw her through times of melancholy and bursts of mania. Since privacy was extremely important in her upbringing, her problems were hidden to all but two friends, and a facade was in place for everyone else. She wished to become a physician and would volunteer as a candy striper in hospitals and ask many questions that were encouraged by the medical staff. She soon headed off to college, and that is where the trouble started to culminate.

College was a nightmare, having to work and go to class with bouts of serious depression. Jamison set her mind to learning more about psychology. She enrolled in an advance class and was recognized as having a unique mind. Because of this, she was accepted by a professor and asked to be a research assistant. This understanding helped give her a focus to learn more about psychology. Soon, Jamison went off to study abroad in the British Isles and had a period of remission. She learned so much at St. Andrew's college, yet she did not recognize her own illness. She went back home and became a psychologist teaching at UCLA. After her first few months of teaching, Kay went into a very serious depression that made her seek help and a diagnosis. She was told she had manic-depressive disorder and needed to take Lithium to control her moods, in addition to psychoanalysis. Jamison went through a stage of denial with a series of periods when she would take the Lithium that was needed to control her moods. Finally, she reached such a low point that she tried to commit suicide by overdosing on Lithium. The reality of the necessity of staying on the drug was founded. Jamison agreed to take the Lithium, accepting the side effects as well as the balanced behavior.

Jamison developed a program of massive research into manic depressive disorder and also ran clinical rounds in a psychiatric facility. The only people who knew of her disorder were those she worked closely with which she disclosed to make sure her clinical judgment if impaired should be overruled for the protection of the patients. Kay was in charge of medical internships in the psychiatric facility and feared that the medical interns she oversaw would not ask her questions if they knew of her illness nor would they speak freely. She did a great deal of research and was the top specialist in manic- depressive disorder. A visiting psychiatrist was in her facility, and they soon developed a relationship and fell in love. She disclosed her illness to him, and he understood. He read to her, since the symptoms of the Lithium dramatically decreased her reading ability because of vision changes and concentration problems. She started taking a lower dose of Lithium and she almost got her life back; she again had the ability to concentrate and read. She was concerned that complete disclosure would make all her research look biased and she would be discredited.

On one occasion, she disclosed to a colleague her disorder and suicide attempt. He said that he was disappointed in her. He also indicated that she hoped she was not planning on having children since it is genetically passed.

People's reactions are very difficult, from the jokes made at conferences to every day comments about other patients. Soon, she fell in love again and moved to Washington, D.C. to work at the medical school at John Hopkins. She was forced to file paperwork in regards to gaining medical facility privileges. She told the head of her department about her illness, and he indicated that he knew all along and he would have to have taken half his faculty away if he discriminated against people with manic- depressive disorder. She found acceptance and hope for the future.

As a child growing up in a military household, privacy was emphasized. At a young age, Jamison was taught that, "anger and discontent, lest they kill, were to be kept to oneself" (29). This attitude of non-disclosure became a reoccurring theme throughout her life, and the first of many psychosocial issues. The poor coping strategy of ignoring changes in emotion or behavior, as well as feeding in to every whim that entered the mind added to the hills and valleys of her illness. The inability to talk to her sister about her manic-depression or seek help within the psychological realm was created by her oppressive family environment. The personal issues revolve, to a large extent, "around issues of family privacy especially because the illness under consideration is a genetic one as well as a general belief that personal matters should be kept personal"( 201). If Jamison had the opportunity to get help early, it is possible that she could have controlled her illness sooner and decreased the likelihood of making a suicide attempt during a depression years later.

During Jamison's undergraduate education, she experienced a major depression. Jamison stated, "I felt utterly alone, and watching the animated conversations between my fellow students made me feel more so" (45). She went through a time where she became extremely antisocial, not answering her phone. The degree of depression experienced as well as changing life situations created larger mood swings that were darker than any experienced in years passed. Depression "breeds relationships through suspicion, lack of confidence and self-respect, the inability to enjoy life, to walk or talk or think normally, the exhaustion, the night terrors, and the day terrors"(217). This was the beginning of the downslide into the most serious depression she had ever experienced. Jamison would go through periods of rapid thoughts that when younger used to be filled with productivity, and now were consumed with dreadful thoughts. Her mind would race with images that "would be drenched with awful sounds and images of decay and dying: dead bodies on the beach, charred remains of animals and toe-tagged corpses in morgues" (45). These feelings created a restlessness filled with anger and irritability with the inability to ask for help. At this time of great lows there was a highlight: her freshmen year psychology professor's acceptance.

Jamison registered for an advanced psychology course had to hand in a psychological analysis exercise. Instead of condemning her, the professor indicated that is was the most imaginative responses he has ever received. His reactions influenced her life, "I remain deeply indebted to him for the intellectual tolerance that cast a positive rather than pathological hue over what I had written" (47). Being encouraged to pursue psychology and finding acceptance with her professor was a solid step in the person she became. The Professor supported her to the extent of getting her a grant so that she no longer had to work allowed her to become focused and concentrate in psychology soon became her passion. Not everyone was as understanding as that first professor. That is why, "there is a reluctance to disclose has been from the cruelty, intentional or otherwise that I have now and again experienced from colleagues of friends that I have chosen to confide in." (199). Knowledge is power, and Jamison submerged herself into becoming aware of everything related to her illness.

Jamison empowered herself by becoming a specialist of manic-depressive disorder. She did research, lectured, ran a psychiatric facility and was a professor in excellent medical programs. This is how she took control of her life. Being so close to the patients one treats can be a hardship. Jamison feared what her colleagues would think, or that the medical community would deem her work as biased and not take her seriously. She felt that "professional anonymity in teaching and research, such as it was, would be compromised" (202). Jamison had strong feelings about wanting to make sure those she taught could feel comfortable with her. One statement Jamison made was, "I cringe at the thought that the medical students and residents may in deference to what they perceive to be my feelings, not say what they really think or not ask the questions that they otherwise should and would ask" (203). She feared the stigma of her illness when she went to conferences and the presenters used jokes that were condescending toward people with psychological issues. There is a lot of ignorance in society, "and a need for freedom, diversity, wit, and directness of language about abnormal mental states and behavior and public perception about mental illness" (181). Work fears were more significant. "She had concerns centered on fears of the California board of Medical Examiners would not grant or revoke my license" (202). The effect on work and normal activities of daily living can be profound.

Current findings in the literature have indicated that, "psychosocial factors were significantly stronger contributors to work outcome than were psychiatric factors prior hospitalizations and recent symptomatology" (3). Personal attitudes, social support, and coping strategies of finding more insight into the illness play an important roll in controlling manic-depressive disorder to function in society.

It has been found that "bipolar disorder is associated with functional deficits even during periods of sustained and substantial remission" (1). According to Jamison, there is increased activity during mania and decreased activity during depression on a brain MRI. The depression stage causes a form of brain damage. This means that, "the degree of functional impairment is correlated with the degree of depressive spectrum symptoms." (1) This is important to really understand that even though a person goes into the remission stage their brain has been affected and functional deficits during everyday life can be affected. The rapid changes and absurd mood swings ranged from highs to lows never giving a chance for recovery. Some of these lows made Jamison turn to isolation, as "withdrawal can have a negative impact on social interactions" (2). This was the start of the peak of her disease and life alterations.

The college years were the start of environmental and social changes when Jamison was out on her own, working and going to college was the first big peak of her disorder. Social and environmental changes are usually anxiety provoking "stressful life events have been shown to predict timing and severity of episodes in bipolar patients" (3). There has been a relationship found between social functioning and insight between poor insight and social functioning deficits. So many changes could create "potentially stigmatizing situation, individuals would not self-disclosed or be less inclined to do so" (2). Being different in society is difficult, especially if it is related to a mental illness.

Social adaptation is necessary when you are working in the academic world. The research into her problems was helpful, as "greater insight is associated with less strangeness, better overall social skill, and a tendency to self-disclose illness" (2). As Jamson's position became more prominent and her social relationships bloomed, she would disclose her illness to those that grew close or clinicians that worked with her closely. She wanted to make sure that the safety of patients came first, and any choices she made would always be in there best interest. Jamison made her illness her life's work. Any knowledge she could listen to or research about bipolar or manic-depressive disorder was absorbed and weighed. Interestingly enough, "most commonly used strategy for dealing with stigma is advocacy and education about mental illness" (2). In general, "those with insight into their disorder, to engage in specific self-presentation strategies" (2). This idea was a helpful coping strategy that Jamison incorporated in her every day life as an adult. The coping strategies through out Jamison's life changed.

Similarly to most reactions of psychiatric stigmas, "psychiatric stigmas have determined that individuals diagnosed with severe mental illness report using secrecy, withdrawal, education, and selective disclosure as strategies for dealing with potentially stigmatizing situations" (2). It has been found that "the greater insight was associated with greater overall social skill, less strangeness, and greater self-disclosure, this pattern was not unique to any one social context." (2)
Although the home environment was not conducive to understanding a disease or disclosing one Jamison still had a social support system. Starting in high school with her three best friends, Jamison was supported in her actions. She found comfort in the doctors and nurses she volunteered with, and support in the numerous love affairs which were filled with love and understanding. This is important because "the presence of good quality supportive relationship was the strongest unique predictor of work" (3). Jamison had many relationships that were rich and full of trust and understanding. Having strong social support is important for normal activities of daily living, as "the qualities of a relationship with patients or their spouse are linked to bipolar patients' functional outcomes" (3).

Manic-Depressive Disorder is usually devastating and a disruptive illness. Similar to Jamison's circumstances, "some patients function well between episodes, whereas others have significant symptomatology and substantial dysfunction in important roles" (3). People react differently depending on the severity as well as symptom control or their personal environment. This is due to the fact that "some patients have coping capabilities that permit them to work effectively despite episodes or subsyndromal symptoms, whereas other patients may function very poorly even when their symptoms do not attain the level of diagnosis" (3).

Kay Jamison was very brave in disclosing the story of her life and the plights of her illness. The strength of the relationships she built and the adaptation of other psychosocial factors played a key roll in life success. Manic depressive disorder also known as bipolar disorder to this day is controlled with Lithium and continues to be genetically based.

1)Fagiolini, A et al. Functional impairments in the remission phase of bipolar disorder. Bipolar Disorders. 7(3): 281-5, 2005 June.

2)Francis, Jennifer L. M. A. and Penn, David L. PhD. The relationship between insight and social skill In persons with severe mental illness. The Journal of Mental Illness 189(12): 822-29, 2001 Dec.

3)Hammen, Constance, Gitlin, Michael and Altshuler, Lori. Predictors of work adjustment Bipolar Patents: A naturalistic longitudinal follow-up. Journal of Consulting and Clinical Psychology. 68(2): 220-25, 2000 April.