An Unquiet Mind

“The dead pilot became a hero, transformed into a scorchingly vivid, completely impossible ideal for what was meant by the concept of duty. It was an impossible ideal, but all the more compelling and haunting because of its very unobtainability.” 

The impossibility of this concept of duty might seem odd, as it seems to be well-defined here, but reflected through the lens of mental illness it makes more sense. Later, Jamison deals with this same conflict—what does it mean to be mentally ill, and to what extent is she meant to fall on her own sword in order to protect others? How can she balance protection of her friends and love interests with the very real need for their assistance? To fully insulate others would be to consign herself to a death sentence—which, she very nearly does.

“[My mother] could not have known how difficult it would be to deal with madness; had no preparation for what to do with madness—none of us did—but consistent with her ability to love, and her native will, she handled it with empathy and intelligence.” 

Love is an extremely important theme in the text; by Jamison’s own account, her narrative is as much, if not more, about love as it is about mental illness. Here she defines her mother’s ability to love as the element required for her mother to help her through her more difficult times, directly contrasting that with any kind of training, background, or preparedness. The larger suggestion is that we don’t need to be psychologists in order to help our loved ones struggling with mental illness—we need only love, kindness, and patience.

“[My parents] never tried to discourage me from becoming a doctor, even though it was an era that breathed, If woman, be a nurse.” 

Though folded more into the larger discussion of tradition, sexism and women’s rights are frequent topics of conversation of Jamison; she later returns to and elucidates the obstacles she faced as a woman in academia and in medicine. This early moment suggests the importance of normalizing such things: in contrast with the era, her parents normalized her desire to go into medicine, which undoubtedly contributed to her success in the field later on.

“I had no idea what was going on, and I felt totally unable to ask anyone for help. It never occurred to me that I was ill; my brain just didn’t put it in those terms.” 

At another point, Jamison describes her understanding of her mental illness as gradual rather than sudden; here, this concept is underscored. Stigmatization of mental illness is all-encompassing: as Jamison grew worse, she had no real way to understand what was happening and no concept of who might be able to help her understand it. It is fortunate that her interests led her to courses in psychology as an undergraduate, or else she may never have understood it (as others certainly don’t).

“[My professor] was kind enough to call creative that which some, no doubt, would have called psychotic. It was my first lesson in appreciating the complicated, permeable boundaries between bizarre and original thought, and I remain deeply indebted to him for the intellectual tolerance that cast a positive rather than pathological hue over what I had written [in response to the Rorschach cards].” 

Although it would be a stretch to file this under the theme of love, this is an early demonstration of the kind of acceptance Jamison found so useful in managing the illness. Moreover, though, it underscores the complexity of mental illness; rather than viewing it as a wholly negative pole, mental illness can be simultaneously enriching and devastating—her responses to the cards, for example, can be creative and interesting as well as symptomatic of larger problems.

“Despite the fact that we were being taught how to make clinical diagnoses, I still did not make any connection in my own mind between the problems I had experienced and what was described as manic-depressive illness in the textbooks.”

There were many reasons why Jamison’s understanding of her illness took some time to mature, but here she suggests a kind of blinders she had on. Interestingly, throughout the book, and particularly while describing mania, she demonstrates her ability to make connections across a number of fields, yet this rather straightforward connection never really occurred to her (or else she willfully and subconsciously avoided it).

“Decreased sleep is both a symptom of mania and a cause, but I didn’t know that at the time, and it probably would not have made any difference to me if I had.” 

This quotation highlights two important elements of the text. First, it demonstrates the blurred nature of symptom and cause; e.g., in a more pronounced way, we see this with the genetic component, how her father’s mood swings served both to trigger the illness in herself (cause) and suggest from where they came (symptom). Second, the fact that knowing this wouldn’t have made a difference highlights the delicate interaction between mental illness and life requirements: i.e., she would have needed to run on low sleep regardless of what it meant for her illness because that’s what life required of her then.

“I also had an extended and rather odd conversation with the chairman of my department—odd, but a conversation I found delightful. […] He [Jamison’s eventual psychiatrist] says he remembers having thought to himself, Kay looks manic. I, on the other hand, had thought I was splendid.” 

The blinders we put on can make it very difficult to understand when something is wrong, and Jamison returns to a supercharged version of this with her mania. It is again somewhat fortunate that Jamison’s chosen profession meant that she would be with people who could recognize mania, but this chapter is interesting because it illustrates the disconnect between versions of ourselves that can make it hard to recognize psychosis.

“Although I had been building up to it for weeks, and certainly knew something was seriously wrong, there was a definite point when I knew I was insane.” 

This quotation is a good juxtaposition against the earlier, more gradual understanding of her illness. It does not contradict that gradual understanding because that refers more to the manner in which her illness became apparent; rather, this is more about the epiphanic nature of her understanding, how there is a moment where it simply clicks.

“Although I went to him to be treated for an illness, he taught me, by example, for my own patients, the total beholdenness of brain to mind and mind to brain. […] The challenge was in learning to understand the complexity of this mutual beholdenness and in learning to distinguish the roles of lithium, will, and insight in getting well and leading a meaningful life.”

The complex relationship between life and illness is apparent in two ways here. First, more prominently, Jamison underscores the interaction from “brain to mind and mind to brain” that makes treatment and management so challenging. Second, it illustrates how for Jamison, in particular, her own experiences served her professional, clinical understanding of the illness—in treating herself, she could better understand how to approach treating others, as well. 

“When I became ill, my sister was adamant that I should not take lithium and was disgusted that I did. […] The combination of her worsening moods with mine, along with the dangerous seductiveness of her views about medication, made it very difficult for me to maintain a relationship with her.” 

Jamison never had a close relationship with her sister, but as a counterpoint, this illustrates the important role family can play in management of an illness. In this case, she was forced to reevaluate her ability to continue that relationship because of the profoundly negative effect her sister’s views might have had on her recovery. In order to get better, it is sometimes necessary to separate ourselves from that which may lead us astray.

“He always kept the basic choice in perspective: The issue was not whether lithium was a problematic drug […] The choice, as he saw it—and as is now painfully clear to me—was between madness and sanity, and between life and death.” 

This passage underscores the role of lithium in making recovery difficult. Jamison’s lived experience was fundamentally separate from the clinical understanding of the drug as a treatment method; she resisted treatment because it was a choice between attempting drug-free recovery and taking a drug that dampened her vitality. Her psychiatrist reconciled these two things, though, in reframing the choice as one between accepting madness and death in exchange for her manias, that the choice was really simply whether she wanted to live or die.

“In fact, underneath it all, I was actually secretly terrified that lithium might not work: What if I took it, and I still got sick? If, on the other hand, I didn’t take it, I wouldn’t have to see my worst fears realized.” 

This further exemplifies the problem of choice and the illusion of free will along with a blinding of the self in managing illness. Of course, the stakes are very high: her suicidal tendencies stemmed from the intolerability of her condition; if lithium did not work, that would mean her condition would continue without hope, making suicide, for her, the only option. Ironically, though, she tries to avoid this conundrum by simply not taking it, which would be the same outcome.

“The complexities of what we are given in life are vast and beyond comprehension. It was as if my father had given me, by way of temperament, an impossibly wild, dark, and unbroken horse. It was a horse without a name, and a horse with no experience of a bit between its teeth. My mother taught me to gentle it; gave me the discipline and love to break it; and […] she understood, and taught me, that the beast was best handled by turning it toward the sun.” 

This again ties into the complex nature of both mental illness and familial relationships. For Jamison, family—specifically, genetics—is the root cause of her psychosis, courtesy of her father; however, it is also the root of her ability to navigate mental illness, courtesy of her mother. The metaphor she uses for her father is interesting, though, as it ties back into riding horses, one of her great passions, suggesting that the two roles are necessarily joined, not that the former is a problem that needs solving, per se.

“Depression, somehow, is much more in line with society’s notions of what women are all about: passive, sensitive, hopeless, helpless, stricken, dependent, confused, rather tiresome, and with limited aspirations. Manic states, on the other hand, seem to be more the provenance of men: restless, fiery, aggressive, volatile, energetic, risk taking, grandiose and visionary.” 

Jamison here deconstructs social norms and gender roles both overtly and subtly: Her two lists of adjectives demonstrate poles of experience to an extent, but the second list contains adjectives that are typically considered to be desirable traits, so in naming them as gendered associations, she suggests that society naturally views supposedly “male” traits as positive and “female” traits as negative. She further deconstructs these roles through the frame of manic-depressive illness, which combines all of these traits in a single individual. Finally, she uses that deconstruction to illustrate how such gendered norms can be dangerous to women, as she goes on to state that women are more likely to be misdiagnosed as merely depressive due to those connotations—we focus on the depressive elements, but not the manic elements, presuming those elements to be male, not female, traits.

“I was fortunate to have the support of the chairman of my department. He backed my being director of a medical clinic despite the fact that I was not a physician, and despite the fact that he knew I had manic-depressive illness. Rather than using my illness as a reason to curtail my clinical and teaching responsibilities, he […] encouraged me to use it to try and develop better treatments and to help change public attitude.” 

This quotation highlights the importance of acceptance and open-mindedness in working with people who suffer from mental illness as well as the professional concerns that loomed constantly over Jamison’s head. Further, though, it also illustrates the complex, often beneficial nature of the illness for her: although it was a source of constant fear and concern for Jamison, her experience was also useful.

“I reached into my purse for my medication, opened the bottle, and immediately dropped all of the pills onto the cathedral floor. […] It was a moment not only of embarrassment, but of reckoning as well; it meant I would have to ask David to write a prescription for me, and that meant, of course, that I would have to tell him about my illness.” 

This highlights the ways in which mental illness and its management seeps into every aspect of life and, again, looms constantly over her head. Due to one single careless error, she was forced to open up to her romantic partner about a rather major insight; she was unable to control the timing of it. Fortunately, David reacted overly well, but it could have just as easily gone the other way.

“There were so many dreams lost: all of our plans for a house full of children were lost; all of seemingly everything was lost. But grief, fortunately, is very different from depression: it is sad, it is awful, but it is not without hope.” 

Here and elsewhere Jamison seeks to differentiate between sadness and depression. The feeling of many is that they have too experienced sadness and grief, and they therefore understand how to overcome it; depression as an experience is then marginalized. In losing David, she too experienced grief; having also experienced depression, she can illustrate and explain the fundamental difference between the two, and why depression is so much worse than simple sadness or grief.

“But mostly, as I was sitting there in the graveyard, I thought of all the things that David had missed by dying young. And then, after an hour or more of being lost in my thoughts, I was caught up short by the realization that I had been thinking, for the first time, about how much David had missed, rather than what we together would miss.” 

Building on the theme of grief, we see a maturation of thoughts at the same time as we see introspection. Jamison’s concern had always been for David, but through the frame of their relationship; here, she has let go of the relationship and is instead focused on what it means to die young. This has tangible repercussions for her, however, as she has of course been suicidal:  

the thought of what one will miss dying young is simultaneously selfless and introspective in this case.

“Mental exhaustion had taken a long, terrible toll, but, strangely, it was only in feeling well, energetic, and high-spirited again that I had any true sense of the toll taken.” 

Jamison frequently returns to matters of perspective throughout the text; here, perspective is less about how mania or depression colors her understanding of the world and more about how a restorative process can make a huge difference for our ability to manage life, but we must go through the process first. This can be symbolic for the process of treatment, as well—we of course view our prior actions differently, but we also recognize the illness itself with distance.

“No amount of love can cure madness or unblacken one’s dark moods. Love can help, it can make the pain more tolerable, but, always, one is beholden to the medication that may or may not always work and may or may not be bearable.” 

The healing power of love is a constant theme throughout the text, but here Jamison provides something of a counterpoint to the idea, underscoring the necessity of medication and treatment. Love is important, but it is not a substitute for proper treatment.

“No matter what struggles I had had with lithium, it was painfully clear to me that without it I would have been long dead or on the back wards of a state hospital. I was one of many who owed their lives to the black circles and squares in Schou’s family tree.” 

Family plays a complicated role in the text, not only from Jamison’s perspective but in any conversation about manic-depressive illness as a whole. Jamison has previously discussed the complex nature of gratitude she owes genetics, but this nature extends here to others’ family trees, as well. Schou likewise had used his own familial history in order to do good in the world, and Jamison recognizes this good and this gratitude as a result.

“There is, for me, a mixture of longings for an earlier age; this is inevitable, perhaps, in any life, but there is an extra twist of almost painful nostalgia brought about by having lived a life particularly intense in moods. This makes it even harder to leave the past behind, and life, on occasion, becomes a kind of elegy for lost moods.” 

Jamison frequently locates the complexities of her experience. Elsewhere she has described how it is beneficial, not only for her but for society, as well, despite the deeply negative and problematic aspects of it. Here, though, she is quite personal: the experience itself is one she is loath to give up, an experience she may not want to dive back into, but nevertheless one she has no regrets about having.