By Kay Redfield Jamison
Bipolar Affective Disorder
This is a book about one person’s battle with bipolar illness, usually referred to as Manic-Depressive Illness, This is a courageous memoir, in which the author accepts the risks of sharing herself, and achieves enormous benefits, both personal and for society.
Positives; Author gives an honest and moving account of her own illness. Coherent and thoughtful
Problems with book;
Somewhat repetitive;
Much use of cliché; (this is common in non-fiction, including memoirs)
Some unnecessary digressions; eg details about her niece (P193) add nothing to
account
Issues raised by book
Stigma of Mental Illness
Insensitivity of Medical Profession
Resistance to taking Meds. Why?
Class of Illness; Mood Disorder ”Beholden to moods”. What does this mean? How much control do we have over our moods? How much is nature, how much nurture? If nature, what is role of therapy vs. meds?
This illness is deadly. High rate of suicide. .
Philosophic issues
Who is the real me?
Questions to be considered
1. Why did she not want to take meds?
A) The one she gives, i.e. mania feels great, much pleasure, energy, creativity; meds prevents these feelings. The feeling of being high is great. Ideas are fast and frequent. Shyness disappears, Self-confident, right words, power to captivate others.
B). Accepting meds means accepting diagnosis. Not taking meds
Allows one to deny diagnosis
C) At that time, higher doses of lithium were the norm, and these doses were associated with unpleasant adverse effects. Author on lower doses still has some swings but never severe, and avoids side effects.
D) A personal sense of specialness. “My depression is more complicated, couldn’t be chemical”
E) Stigma of illness; Reinforced by messages from society. Often brought up to believe that it is sign of weakness. ( I (we) are stronger than those others). A
2. P5. How does disease mimic other things?
Often confused with personality disorder. Extreme lability can resemble borderline personality disorder.
Psychosis can be misdiagnosed as schizophrenia (often is, with tragic results re management)
Infinite disguises;
Often goes unrecognized because patient thinks it is just “extension” of previous mood lability
3. What are the downsides of the illness?
P6 she lists downside of illness; distortion of mood, bad behavior, destroys rational thought, can lead to suicide.
Destroys personal relationships
Destroys ones financial status re spending
Damages ones work situation
Stigma can cause limits on employment, education, etc.
Thomas Eagleton; history destroyed a promising political career
Can destroy life via suicide.
4. What are the positives in the illness?
P194 Disease can confer advantages.
Artistic temperament and imagination
Influences on scientists, business, religious, military and political leaders
There are risk takers who are leaders in arts, politics, science, business.
Increased energy
Increased work productivity
Clarity of thought (up to a point)
Enhanced self-confidence (thin line between desirable vs. over the top)
5. What are the causes?
Genetic
Biochemical
Environmental
Sleep duration
Childbirth
Alcohol
Drugs
Light exposure
6. Who is the real me? Question I am often asked by patients. The person with the illness, or the person treated without the illness. Important question re another frequent question. Should I take meds to turn me into a different person? Which of the feelings are real? Her sister told her that “her soul would wither “ if she took lithium
How much of our personality is simply a result of biology and chemistry?. Impossible to answer this.
7. Would it be better for person with Manic-Depressive illness to not be born? To not have children?
Philosophic issue; see P 191. She has no regrets about being born. (Marvelous existence)
Related to issue of should they have children.
Eugenics is a dangerous business. Can be used to justify who shall live, who can procreate. No one should make these decisions for someone else. Issues of non-maleficience and of autonomy.
8. Should we try to get rid of the genes for manic-depressive illness?
She asks whether we risk making the world more bland or homogenized.
There are risk takers who are leaders in arts, politics, science, business, who would not take these risks if they didn’t have illness.
On the other hand some researchers would gladly get rid of the disease even at a great cost.
9. The sharing of one’s self, in this case, her illness. Risks vs. benefits
A. What are the risks of telling her story? Humiliation, erosion of self confidence, influence on employment, Loss of hospital privileges licensure loss, all risks depend on the recipient of news buying into stigma), Pigeonholed as “weak and neurotic” Mouseheart factor. Will this affect how people view her? Will what was considered “zany” now be thought to represent “instability”? Will her professional research be considered biased or tainted? Will her colleagues consider her to be an accomplished authority, or someone with a “personal ax to grind”?
B. Benefits of telling her story; support from others, personal relief of not hiding,
education of others, de-stigmatizing illness, the achievement of acceptance, (both personally and for society to accept illness), better understanding that this is not a sign of weakness,
10. Re genetics of illness. How does author’s father fit into the story? What are his symptoms? What can be learned from his story?
Initially his moods soared. Grandiosity caused problems at work
Then a switch. Depression. Blackness, anger, despair, bleak, withdrawn, rage, immobilized by depression, heavy drinking.
A life partly ruined because of non-recognition and non-treatment.
11. What do we learn about symptoms and course of mania/hypomania?
Energy, enthusiasm exhausting to those around her. Flying high, sleeping little.
Then downward turn. In milder stages, illness felt really great (describes it as mild mania). P36 Felt invincible. Friends told her to slow down. Then the crash
12. What do we learn about symptoms and course of depression?
Wonderful descriptions of depression.
Would wake up in AM with profound sense of dread. Didn’t understand what this was all about. Lack of energy to go to class. Sense of pointlessness. Sense of inadequacy and blackness. Sense that only death would release her. Deadness, dreariness. Total despair. Sometimes associated with marked agitation. Images of decay, death, charred animals, corpses in morgues. Restless, angry, irritable. Pacing, unable to sit still.
Nothing made sense, couldn’t follow in class, unaware of surroundings, feeling scared, nothing was interesting. Consumed with subject of death. “I was going to die, so what difference did anything make?” Life is meaningless, did not change clothes, avoided friends,
Preoccupation with death and decay. “Everything was born to die”. Thoughts of suicide. Loss of oneself, closeness to death.
13. Is it fair to ask her (e.g. on application forms) questions about her illness?
Or is this an unfair invasion of privacy, or is it indicative of a tendency to view this disease in an unenlightened way? P207. There is always the possibility that the illness could interfere with clinical judgment, so these are fair questions to ask.
Clinicians who fail to get treatment (for whatever reasons) may endanger both themselves and others.
14. Is Self-treatment a problem here?
Because of stigma, or fear of consequences if diagnosis is known, many patients forego treatment. What often ends up happening is that these are the person who abuse drugs or alcohol as an attempt at self-treatment
15. Why is the diagnosis often missed? (Lives are destroyed when the diagnosis is missed, yet is quite frequent. Happens very frequently never diagnosed in someone’s lifetime)
To patient, not some biologic illness, but their own experience. They don’t necessarily realize it is abnormal.
Many doctors miss it.
Charm and high energy of hypomania does not feel like a disease, both to patient and to others who witness them
There is no objective test, e.g. no blood test.
16. Ethics of Suicide;
(A) Is suicide always an irrational act? An ethicist of my acquaintance once said, that it is reasonable to try to prevent it the first time, but if one tries more than once, it indicates that “they really mean It”, and the ethical thing is to respect their autonomy and not try to stop them. Problem is that autonomy presupposes a rational mind; if one is not competent via illness to make good decisions, then beneficence trumps autonomy.
(B)Can it be prevented? Bipolar or unipolar diseases are very treatable. Thus we can prevent suicide.
17. What are the walls that we build to keep away the sadnesses of life? P 214. We build these over a lifetime. They include our work, family, friends, religion, denial, alcohol, meds, recreational drugs, love. Want these walls to be high enough to be reliable, to keep out severe turmoil, and yet not so high that they do not allow in “fresh seawater”
18. What does author have to say about love as a barrier against the terror? See P 215. We build walls to protect ourselves. Love is effective in shutting out the terror, but at the same time in allows in “life, beauty, vitality.”
19. What does author say about the place of adversity, and how her illness has served her? P213-215 Fatalistic about future. More philosophical. Better armed. Having “encountered the monsters” she is less frightened of those still to be met. Realization that everything will pass. In fact, many philosophers believe that only through adversity do we fully live; and that we only undergo personal growth by experiencing adversity. .
Neitze, tragedy as an affirmation of life
Schopenhauer analysis of “will” led him to the conclusion that emotional, physical, and sexual desires can never be fulfilled. Consequently, he favored a lifestyle of negating human desires, similar to the teachings of ancient Greek Stoic philosophers, Buddhism, and Vedanta
20. When did her illness start? She says age 16, but some of the descriptions of her earlier behavior suggest it actually started eelier. A problem in this disease is that if cycling moods are all that we know, then we don’t think it is abnormal.
21. Why did the author decide against Med School?
PUSH; her restlessness and temperament meant that she would not be able to sit still in class. Did not want to be chained to a schedule.
PULL; Psychology became very appealing, found she liked research and writing, Mentors that she found impressive were psychologists.
22. What are the factors that go into choosing a career?
How did she choose a career?
Chose psychology;
Enjoyed the work as an undergraduate.
Read William James “Variety of Religious Experience”
Influence of mentors, especially one in particular. In addition, found a mentor who
also had mood disorder.
Temperament more suited; restless, unstable
Related more to her personal situation.
She saw a chance to study something that might give her answers to her own
mood disorders.
23. Reading William James had major effect on her. How many of you can track major changes in your life to a particular book, or article, or film? (Either career, political orientation, etc)
24. What were some of the early manifestations of her illness?
College was a “terrible struggle” Shifting moods, violent, interspersed with fun, enthusiasms (hypomania)
Everything done to excess
Got immersed in variety of political and social causes. Lots of students do this, not always due to mania. But the converse is that mania often leads to excessive involvement to the detriment of school work.
Impulsive buying which she could not afford. Purchases seemed essential at the time.
Sense of essential key to absolute truth
UCLA was a good school but it couldn’t protect her against her agitation.
25. There has been an ongoing battle between psychoanalysis vs. biologic approach. What do you think? Ongoing battle, esp. in 1960s and 1970s, as research developed. She found that Freud and Jung were emphasized during her earlier years in grad school. Emphasis on early expressions, conflicts, dreams, symbols, in doing therapy. Later, a medical approach, which included newer treatments including meds.
26. Why has Pendulum swung away from analysis and to biology?
A) No real science behind analytic approaches, while there is good science behind biological approaches
B) Faster and clearer results from meds.
C) Insurance companies, when began to cover mental health, wanted to cover shorter term care, vs. 5 X/week therapy.
27. Lithium vs. psychotherapy. Which does she favor? Both, They do different things. “Lithium moderates the illness; psychotherapy teaches you to live with it”
28. Is the distinction between mental illness and medical illness valid?
Mind-body distinctions in American medicine. Insurance companies, and the American public, have long considered mental illness to be different than medical illness. Jamison believes they are no different. What do you think? If they are different, what are the differences?
29 Why are there no accounts here of unrequited love? Jamison talks about her two husbands, numerous lovers including David, a very significant man in her life. Yet nowhere does she speak of any experience of unrequited love. Such love is part of most people’s experience. Indeed, some believe that this is the only kind of love in which the passion stays alive.
I suspect that she doesn’t mention this because it doesn’t happen to her. This is likely due to a combination of her beauty, charm and high energy as consequence of hypomania, and brilliance.
30. Should people with mental illness be allowed to treat patients? She says yes. What do you think?
------------------------
huge personal and academic toll.
P49; age 20, to St. Andrews (Scotland)
Q What was the significance of this to her? Escape form despair, amulet against longing and loss.
P 53. Returns to UCLA. Med school now looks unlikely
P 54 She describes some of the reasons to resist meds
P 55 Got interested in treating her mood disturbance. Had to choose between psychiatry and getting a horse. Why did she choose a horse?
Her illness caused her to downplay the impracticality of a horse, and emphasize the fun aspects. She really couldn’t afford a horse, but mania leads to inappropriate spending
The remission of the illness at the start of grad school; she attributed this to a return to her normal self.
P 56 Here we have one of the few problematic areas in the book. She states that there were no words or disease names at the time (1971) that could be applied to mood swings. NOT TRUE. I have known of MD illness since Med School in the 50s. She is making excuses for her failure to recognize her won illness. But doesn’t need to. She is simply too close to it.
Part Two; A Not So Fine Madness
Flights of the Mind
When you are high, its great. Ideas are fast and frequent. Shyness disappears, Self-confident, right words, power to captivate others. Sensuality, desire to seduce, intense, feelings of omnipotence, euphoria, power. Clarity ---> confusion. Irritable, angry, scared, uncontrollable, “black caves of the mind”
Behavior is bizarre, frenetic, aimless, Incredible feelings to sort through. Who knows what?
Medicine to take, resent, forget.
Bounced checks, credit cards revoked, apologies, work problems to explain, intermittent memories, friendships gone, marriage ruined.
What is the reality of any feeling? Who am I? Wild, impulsive, energetic, crazy? Shy, withdrawn, suicidal, no energy,
Part Three
An Unquiet Mind
By Kay Redfield Jamison
Bipolar Affective Disorder
This is a book about one person’s battle with bipolar illness, usually referred to as Manic-Depressive Illness, This is a courageous memoir, in which the author accepts the risks of sharing herself, and achieves enormous benefits, both personal and for society.
Positives; Author gives an honest and moving account of her own illness. Coherent and thoughtful
Problems with book;
Somewhat repetitive;
Much use of cliché; (this is common in non-fiction, including memoirs)
Some unnecessary digressions; eg details about her niece (P193) add nothing to
account
Issues raised by book
Stigma of Mental Illness
Insensitivity of Medical Profession
Resistance to taking Meds. Why?
Class of Illness; Mood Disorder ”Beholden to moods”. What does this mean? How much control do we have over our moods? How much is nature, how much nurture? If nature, what is role of therapy vs. meds?
This illness is deadly. High rate of suicide. .
Philosophic issues
Who is the real me?
Questions to be considered
1. Why did she not want to take meds?
A) The one she gives, i.e. mania feels great, much pleasure, energy, creativity; meds prevents these feelings. The feeling of being high is great. Ideas are fast and frequent. Shyness disappears, Self-confident, right words, power to captivate others.
B). Accepting meds means accepting diagnosis. Not taking meds
Allows one to deny diagnosis
C) At that time, higher doses of lithium were the norm, and these doses were associated with unpleasant adverse effects. Author on lower doses still has some swings but never severe, and avoids side effects.
D) A personal sense of specialness. “My depression is more complicated, couldn’t be chemical”
E) Stigma of illness; Reinforced by messages from society. Often brought up to believe that it is sign of weakness. ( I (we) are stronger than those others). A
2. P5. How does disease mimic other things?
Often confused with personality disorder. Extreme lability can resemble borderline personality disorder.
Psychosis can be misdiagnosed as schizophrenia (often is, with tragic results re management)
Infinite disguises;
Often goes unrecognized because patient thinks it is just “extension” of previous mood lability
3. What are the downsides of the illness?
P6 she lists downside of illness; distortion of mood, bad behavior, destroys rational thought, can lead to suicide.
Destroys personal relationships
Destroys ones financial status re spending
Damages ones work situation
Stigma can cause limits on employment, education, etc.
Thomas Eagleton; history destroyed a promising political career
Can destroy life via suicide.
4. What are the positives in the illness?
P194 Disease can confer advantages.
Artistic temperament and imagination
Influences on scientists, business, religious, military and political leaders
There are risk takers who are leaders in arts, politics, science, business.
Increased energy
Increased work productivity
Clarity of thought (up to a point)
Enhanced self-confidence (thin line between desirable vs. over the top)
5. What are the causes?
Genetic
Biochemical
Environmental
Sleep duration
Childbirth
Alcohol
Drugs
Light exposure
6. Who is the real me? Question I am often asked by patients. The person with the illness, or the person treated without the illness. Important question re another frequent question. Should I take meds to turn me into a different person? Which of the feelings are real? Her sister told her that “her soul would wither “ if she took lithium
How much of our personality is simply a result of biology and chemistry?. Impossible to answer this.
7. Would it be better for person with Manic-Depressive illness to not be born? To not have children?
Philosophic issue; see P 191. She has no regrets about being born. (Marvelous existence)
Related to issue of should they have children.
Eugenics is a dangerous business. Can be used to justify who shall live, who can procreate. No one should make these decisions for someone else. Issues of non-maleficience and of autonomy.
8. Should we try to get rid of the genes for manic-depressive illness?
She asks whether we risk making the world more bland or homogenized.
There are risk takers who are leaders in arts, politics, science, business, who would not take these risks if they didn’t have illness.
On the other hand some researchers would gladly get rid of the disease even at a great cost.
9. The sharing of one’s self, in this case, her illness. Risks vs. benefits
A. What are the risks of telling her story? Humiliation, erosion of self confidence, influence on employment, Loss of hospital privileges licensure loss, all risks depend on the recipient of news buying into stigma), Pigeonholed as “weak and neurotic” Mouseheart factor. Will this affect how people view her? Will what was considered “zany” now be thought to represent “instability”? Will her professional research be considered biased or tainted? Will her colleagues consider her to be an accomplished authority, or someone with a “personal ax to grind”?
B. Benefits of telling her story; support from others, personal relief of not hiding,
education of others, de-stigmatizing illness, the achievement of acceptance, (both personally and for society to accept illness), better understanding that this is not a sign of weakness,
10. Re genetics of illness. How does author’s father fit into the story? What are his symptoms? What can be learned from his story?
Initially his moods soared. Grandiosity caused problems at work
Then a switch. Depression. Blackness, anger, despair, bleak, withdrawn, rage, immobilized by depression, heavy drinking.
A life partly ruined because of non-recognition and non-treatment.
11. What do we learn about symptoms and course of mania/hypomania?
Energy, enthusiasm exhausting to those around her. Flying high, sleeping little.
Then downward turn. In milder stages, illness felt really great (describes it as mild mania). P36 Felt invincible. Friends told her to slow down. Then the crash
12. What do we learn about symptoms and course of depression?
Wonderful descriptions of depression.
Would wake up in AM with profound sense of dread. Didn’t understand what this was all about. Lack of energy to go to class. Sense of pointlessness. Sense of inadequacy and blackness. Sense that only death would release her. Deadness, dreariness. Total despair. Sometimes associated with marked agitation. Images of decay, death, charred animals, corpses in morgues. Restless, angry, irritable. Pacing, unable to sit still.
Nothing made sense, couldn’t follow in class, unaware of surroundings, feeling scared, nothing was interesting. Consumed with subject of death. “I was going to die, so what difference did anything make?” Life is meaningless, did not change clothes, avoided friends,
Preoccupation with death and decay. “Everything was born to die”. Thoughts of suicide. Loss of oneself, closeness to death.
13. Is it fair to ask her (e.g. on application forms) questions about her illness?
Or is this an unfair invasion of privacy, or is it indicative of a tendency to view this disease in an unenlightened way? P207. There is always the possibility that the illness could interfere with clinical judgment, so these are fair questions to ask.
Clinicians who fail to get treatment (for whatever reasons) may endanger both themselves and others.
14. Is Self-treatment a problem here?
Because of stigma, or fear of consequences if diagnosis is known, many patients forego treatment. What often ends up happening is that these are the person who abuse drugs or alcohol as an attempt at self-treatment
15. Why is the diagnosis often missed? (Lives are destroyed when the diagnosis is missed, yet is quite frequent. Happens very frequently never diagnosed in someone’s lifetime)
To patient, not some biologic illness, but their own experience. They don’t necessarily realize it is abnormal.
Many doctors miss it.
Charm and high energy of hypomania does not feel like a disease, both to patient and to others who witness them
There is no objective test, e.g. no blood test.
16. Ethics of Suicide;
(A) Is suicide always an irrational act? An ethicist of my acquaintance once said, that it is reasonable to try to prevent it the first time, but if one tries more than once, it indicates that “they really mean It”, and the ethical thing is to respect their autonomy and not try to stop them. Problem is that autonomy presupposes a rational mind; if one is not competent via illness to make good decisions, then beneficence trumps autonomy.
(B)Can it be prevented? Bipolar or unipolar diseases are very treatable. Thus we can prevent suicide.
17. What are the walls that we build to keep away the sadnesses of life? P 214. We build these over a lifetime. They include our work, family, friends, religion, denial, alcohol, meds, recreational drugs, love. Want these walls to be high enough to be reliable, to keep out severe turmoil, and yet not so high that they do not allow in “fresh seawater”
18. What does author have to say about love as a barrier against the terror? See P 215. We build walls to protect ourselves. Love is effective in shutting out the terror, but at the same time in allows in “life, beauty, vitality.”
19. What does author say about the place of adversity, and how her illness has served her? P213-215 Fatalistic about future. More philosophical. Better armed. Having “encountered the monsters” she is less frightened of those still to be met. Realization that everything will pass. In fact, many philosophers believe that only through adversity do we fully live; and that we only undergo personal growth by experiencing adversity. .
Neitze, tragedy as an affirmation of life
Schopenhauer analysis of “will” led him to the conclusion that emotional, physical, and sexual desires can never be fulfilled. Consequently, he favored a lifestyle of negating human desires, similar to the teachings of ancient Greek Stoic philosophers, Buddhism, and Vedanta
20. When did her illness start? She says age 16, but some of the descriptions of her earlier behavior suggest it actually started eelier. A problem in this disease is that if cycling moods are all that we know, then we don’t think it is abnormal.
21. Why did the author decide against Med School?
PUSH; her restlessness and temperament meant that she would not be able to sit still in class. Did not want to be chained to a schedule.
PULL; Psychology became very appealing, found she liked research and writing, Mentors that she found impressive were psychologists.
22. What are the factors that go into choosing a career?
How did she choose a career?
Chose psychology;
Enjoyed the work as an undergraduate.
Read William James “Variety of Religious Experience”
Influence of mentors, especially one in particular. In addition, found a mentor who
also had mood disorder.
Temperament more suited; restless, unstable
Related more to her personal situation.
She saw a chance to study something that might give her answers to her own
mood disorders.
23. Reading William James had major effect on her. How many of you can track major changes in your life to a particular book, or article, or film? (Either career, political orientation, etc)
24. What were some of the early manifestations of her illness?
College was a “terrible struggle” Shifting moods, violent, interspersed with fun, enthusiasms (hypomania)
Everything done to excess
Got immersed in variety of political and social causes. Lots of students do this, not always due to mania. But the converse is that mania often leads to excessive involvement to the detriment of school work.
Impulsive buying which she could not afford. Purchases seemed essential at the time.
Sense of essential key to absolute truth
UCLA was a good school but it couldn’t protect her against her agitation.
25. There has been an ongoing battle between psychoanalysis vs. biologic approach. What do you think? Ongoing battle, esp. in 1960s and 1970s, as research developed. She found that Freud and Jung were emphasized during her earlier years in grad school. Emphasis on early expressions, conflicts, dreams, symbols, in doing therapy. Later, a medical approach, which included newer treatments including meds.
26. Why has Pendulum swung away from analysis and to biology?
A) No real science behind analytic approaches, while there is good science behind biological approaches
B) Faster and clearer results from meds.
C) Insurance companies, when began to cover mental health, wanted to cover shorter term care, vs. 5 X/week therapy.
27. Lithium vs. psychotherapy. Which does she favor? Both, They do different things. “Lithium moderates the illness; psychotherapy teaches you to live with it”
28. Is the distinction between mental illness and medical illness valid?
Mind-body distinctions in American medicine. Insurance companies, and the American public, have long considered mental illness to be different than medical illness. Jamison believes they are no different. What do you think? If they are different, what are the differences?
29 Why are there no accounts here of unrequited love? Jamison talks about her two husbands, numerous lovers including David, a very significant man in her life. Yet nowhere does she speak of any experience of unrequited love. Such love is part of most people’s experience. Indeed, some believe that this is the only kind of love in which the passion stays alive.
I suspect that she doesn’t mention this because it doesn’t happen to her. This is likely due to a combination of her beauty, charm and high energy as consequence of hypomania, and brilliance.
30. Should people with mental illness be allowed to treat patients? She says yes. What do you think?
Prologue
P3. Opens with a great description of manic energy. “on the run”
P4. Being professors of psychiatry explained everything” Use of humor.
P4 Onset of mania in 1974, age 28
P4 Intensely emotional as child, mercurial as young girl, severely depressed as adolescent, then cycles. This is a major burden. Especially a burden if at the same time, one is building a career or raising a family.
P5. Infinite disguises;
P5 Often goes unrecognized because patient thinks it is just “extension” of previous mood lability.
Origin biological
Experience; feels psychological
Part One; The Wild Blue Yonder
Into the Sun
P11-12 Describes growing up as daughter of Air Force flyer and scientist
P13. She witnesses a crash in which pilot sacrifices his own life to prevent risks to children. Concept of duty, of idealism, She discusses need to aspire to such ideals, and difficulty of achieving them.
P13. Relationship with brother; fair, steady self-confident, protective; good model
P14. Sister; black moods, self-conscious, defiant, rebellious, fierce temper. Her mood disturbance began earlier in life than Kay
P15 Kay had happy life early on; protection against later unhappiness.
P15 Father; charming, ebullient, enthusiasm, expansive, magical, enchanting, charismatic, pied piper with children, Played with father, but talked with mother. We later learn that his erratic behavior cost him a job at Rand (P 41)
P23-25 Visit to Psych Hosp; St Elisabeth; first contact with insanity.
P30 Comment on her switch at age 15 from military environment to civilian school. Sociologic study, culture shock. From army to wealthy S Cal kids, conserve to liberal, military persons to corp. lawyers, film producers, etc.
P34-35
------------------------
An Education for Life
Episode described of looking into brook, thinking of Tennyson’s poem - immediate sense of urgency. Went to get copy of Tennyson’ poem, ended up with 20 books that all seemed very related. in the legend of Arthur.
Mood would eventually crash. Good description of depression.
P 48; Manic moods and depression; huge personal and academic toll.
P49; age 20, to St. Andrews (Scotland)
Q What was the significance of this to her? Escape form despair, amulet against longing and loss.
P 53. Returns to UCLA. Med school now looks unlikely
P 54 She describes some of the reasons to resist meds
P 55 Got interested in treating her mood disturbance. Had to choose between psychiatry and getting a horse. Why did she choose a horse?
Her illness caused her to downplay the impracticality of a horse, and emphasize the fun aspects. She really couldn’t afford a horse, but mania leads to inappropriate spending
The remission of the illness at the start of grad school; she attributed this to a return to her normal self.
P 56 Here we have one of the few problematic areas in the book. She states that there were no words or disease names at the time (1971) that could be applied to mood swings. NOT TRUE. I have known of MD illness since Med School in the 50s. She is making excuses for her failure to recognize her won illness. But doesn’t need to. She is simply too close to it.
Part Two; A Not So Fine Madness
Flights of the Mind
When you are high, its great. Ideas are fast and frequent. Shyness disappears, Self-confident, right words, power to captivate others. Sensuality, desire to seduce, intense, feelings of omnipotence, euphoria, power. Clarity ---> confusion. Irritable, angry, scared, uncontrollable, “black caves of the mind”
Behavior is bizarre, frenetic, aimless, Incredible feelings to sort through. Who knows what?
Medicine to take, resent, forget.
Bounced checks, credit cards revoked, apologies, work problems to explain, intermittent memories, friendships gone, marriage ruined.
What is the reality of any feeling? Who am I? Wild, impulsive, energetic, crazy? Shy, withdrawn, suicidal, no energy,
Part Three
Part Four
Epilogue
An Unquiet Mind
By Kay Redfield Jamison
Bipolar Affective Disorder
This is a book about one person’s battle with bipolar illness, usually referred to as Manic-Depressive Illness, This is a courageous memoir, in which the author accepts the risks of sharing herself, and achieves enormous benefits, both personal and for society.
Positives; Author gives an honest and moving account of her own illness. Coherent and thoughtful
Problems with book;
Somewhat repetitive;
Much use of cliché; (this is common in non-fiction, including memoirs)
Some unnecessary digressions; eg details about her niece (P193) add nothing to
account
Issues raised by book
Stigma of Mental Illness
Insensitivity of Medical Profession
Resistance to taking Meds. Why?
Class of Illness; Mood Disorder ”Beholden to moods”. What does this mean? How much control do we have over our moods? How much is nature, how much nurture? If nature, what is role of therapy vs. meds?
This illness is deadly. High rate of suicide. .
Philosophic issues
Who is the real me?
Questions to be considered
1. Why did she not want to take meds?
A) The one she gives, i.e. mania feels great, much pleasure, energy, creativity; meds prevents these feelings. The feeling of being high is great. Ideas are fast and frequent. Shyness disappears, Self-confident, right words, power to captivate others.
B). Accepting meds means accepting diagnosis. Not taking meds
Allows one to deny diagnosis
C) At that time, higher doses of lithium were the norm, and these doses were associated with unpleasant adverse effects. Author on lower doses still has some swings but never severe, and avoids side effects.
D) A personal sense of specialness. “My depression is more complicated, couldn’t be chemical”
E) Stigma of illness; Reinforced by messages from society. Often brought up to believe that it is sign of weakness. ( I (we) are stronger than those others). A
2. P5. How does disease mimic other things?
Often confused with personality disorder. Extreme lability can resemble borderline personality disorder.
Psychosis can be misdiagnosed as schizophrenia (often is, with tragic results re management)
Infinite disguises;
Often goes unrecognized because patient thinks it is just “extension” of previous mood lability
3. What are the downsides of the illness?
P6 she lists downside of illness; distortion of mood, bad behavior, destroys rational thought, can lead to suicide.
Destroys personal relationships
Destroys ones financial status re spending
Damages ones work situation
Stigma can cause limits on employment, education, etc.
Thomas Eagleton; history destroyed a promising political career
Can destroy life via suicide.
4. What are the positives in the illness?
P194 Disease can confer advantages.
Artistic temperament and imagination
Influences on scientists, business, religious, military and political leaders
There are risk takers who are leaders in arts, politics, science, business.
Increased energy
Increased work productivity
Clarity of thought (up to a point)
Enhanced self-confidence (thin line between desirable vs. over the top)
5. What are the causes?
Genetic
Biochemical
Environmental
Sleep duration
Childbirth
Alcohol
Drugs
Light exposure
6. Who is the real me? Question I am often asked by patients. The person with the illness, or the person treated without the illness. Important question re another frequent question. Should I take meds to turn me into a different person? Which of the feelings are real? Her sister told her that “her soul would wither “ if she took lithium
How much of our personality is simply a result of biology and chemistry?. Impossible to answer this.
7. Would it be better for person with Manic-Depressive illness to not be born? To not have children?
Philosophic issue; see P 191. She has no regrets about being born. (Marvelous existence)
Related to issue of should they have children.
Eugenics is a dangerous business. Can be used to justify who shall live, who can procreate. No one should make these decisions for someone else. Issues of non-maleficience and of autonomy.
8. Should we try to get rid of the genes for manic-depressive illness?
She asks whether we risk making the world more bland or homogenized.
There are risk takers who are leaders in arts, politics, science, business, who would not take these risks if they didn’t have illness.
On the other hand some researchers would gladly get rid of the disease even at a great cost.
9. The sharing of one’s self, in this case, her illness. Risks vs. benefits
A. What are the risks of telling her story? Humiliation, erosion of self confidence, influence on employment, Loss of hospital privileges licensure loss, all risks depend on the recipient of news buying into stigma), Pigeonholed as “weak and neurotic” Mouseheart factor. Will this affect how people view her? Will what was considered “zany” now be thought to represent “instability”? Will her professional research be considered biased or tainted? Will her colleagues consider her to be an accomplished authority, or someone with a “personal ax to grind”?
B. Benefits of telling her story; support from others, personal relief of not hiding,
education of others, de-stigmatizing illness, the achievement of acceptance, (both personally and for society to accept illness), better understanding that this is not a sign of weakness,
10. Re genetics of illness. How does author’s father fit into the story? What are his symptoms? What can be learned from his story?
Initially his moods soared. Grandiosity caused problems at work
Then a switch. Depression. Blackness, anger, despair, bleak, withdrawn, rage, immobilized by depression, heavy drinking.
A life partly ruined because of non-recognition and non-treatment.
11. What do we learn about symptoms and course of mania/hypomania?
Energy, enthusiasm exhausting to those around her. Flying high, sleeping little.
Then downward turn. In milder stages, illness felt really great (describes it as mild mania). P36 Felt invincible. Friends told her to slow down. Then the crash
12. What do we learn about symptoms and course of depression?
Wonderful descriptions of depression.
Would wake up in AM with profound sense of dread. Didn’t understand what this was all about. Lack of energy to go to class. Sense of pointlessness. Sense of inadequacy and blackness. Sense that only death would release her. Deadness, dreariness. Total despair. Sometimes associated with marked agitation. Images of decay, death, charred animals, corpses in morgues. Restless, angry, irritable. Pacing, unable to sit still.
Nothing made sense, couldn’t follow in class, unaware of surroundings, feeling scared, nothing was interesting. Consumed with subject of death. “I was going to die, so what difference did anything make?” Life is meaningless, did not change clothes, avoided friends,
Preoccupation with death and decay. “Everything was born to die”. Thoughts of suicide. Loss of oneself, closeness to death.
13. Is it fair to ask her (e.g. on application forms) questions about her illness?
Or is this an unfair invasion of privacy, or is it indicative of a tendency to view this disease in an unenlightened way? P207. There is always the possibility that the illness could interfere with clinical judgment, so these are fair questions to ask.
Clinicians who fail to get treatment (for whatever reasons) may endanger both themselves and others.
14. Is Self-treatment a problem here?
Because of stigma, or fear of consequences if diagnosis is known, many patients forego treatment. What often ends up happening is that these are the person who abuse drugs or alcohol as an attempt at self-treatment
15. Why is the diagnosis often missed? (Lives are destroyed when the diagnosis is missed, yet is quite frequent. Happens very frequently never diagnosed in someone’s lifetime)
To patient, not some biologic illness, but their own experience. They don’t necessarily realize it is abnormal.
Many doctors miss it.
Charm and high energy of hypomania does not feel like a disease, both to patient and to others who witness them
There is no objective test, e.g. no blood test.
16. Ethics of Suicide;
(A) Is suicide always an irrational act? An ethicist of my acquaintance once said, that it is reasonable to try to prevent it the first time, but if one tries more than once, it indicates that “they really mean It”, and the ethical thing is to respect their autonomy and not try to stop them. Problem is that autonomy presupposes a rational mind; if one is not competent via illness to make good decisions, then beneficence trumps autonomy.
(B)Can it be prevented? Bipolar or unipolar diseases are very treatable. Thus we can prevent suicide.
17. What are the walls that we build to keep away the sadnesses of life? P 214. We build these over a lifetime. They include our work, family, friends, religion, denial, alcohol, meds, recreational drugs, love. Want these walls to be high enough to be reliable, to keep out severe turmoil, and yet not so high that they do not allow in “fresh seawater”
18. What does author have to say about love as a barrier against the terror? See P 215. We build walls to protect ourselves. Love is effective in shutting out the terror, but at the same time in allows in “life, beauty, vitality.”
19. What does author say about the place of adversity, and how her illness has served her? P213-215 Fatalistic about future. More philosophical. Better armed. Having “encountered the monsters” she is less frightened of those still to be met. Realization that everything will pass. In fact, many philosophers believe that only through adversity do we fully live; and that we only undergo personal growth by experiencing adversity. .
Neitze, tragedy as an affirmation of life
Schopenhauer analysis of “will” led him to the conclusion that emotional, physical, and sexual desires can never be fulfilled. Consequently, he favored a lifestyle of negating human desires, similar to the teachings of ancient Greek Stoic philosophers, Buddhism, and Vedanta
20. When did her illness start? She says age 16, but some of the descriptions of her earlier behavior suggest it actually started eelier. A problem in this disease is that if cycling moods are all that we know, then we don’t think it is abnormal.
21. Why did the author decide against Med School?
PUSH; her restlessness and temperament meant that she would not be able to sit still in class. Did not want to be chained to a schedule.
PULL; Psychology became very appealing, found she liked research and writing, Mentors that she found impressive were psychologists.
22. What are the factors that go into choosing a career?
How did she choose a career?
Chose psychology;
Enjoyed the work as an undergraduate.
Read William James “Variety of Religious Experience”
Influence of mentors, especially one in particular. In addition, found a mentor who
also had mood disorder.
Temperament more suited; restless, unstable
Related more to her personal situation.
She saw a chance to study something that might give her answers to her own
mood disorders.
23. Reading William James had major effect on her. How many of you can track major changes in your life to a particular book, or article, or film? (Either career, political orientation, etc)
24. What were some of the early manifestations of her illness?
College was a “terrible struggle” Shifting moods, violent, interspersed with fun, enthusiasms (hypomania)
Everything done to excess
Got immersed in variety of political and social causes. Lots of students do this, not always due to mania. But the converse is that mania often leads to excessive involvement to the detriment of school work.
Impulsive buying which she could not afford. Purchases seemed essential at the time.
Sense of essential key to absolute truth
UCLA was a good school but it couldn’t protect her against her agitation.
25. There has been an ongoing battle between psychoanalysis vs. biologic approach. What do you think? Ongoing battle, esp. in 1960s and 1970s, as research developed. She found that Freud and Jung were emphasized during her earlier years in grad school. Emphasis on early expressions, conflicts, dreams, symbols, in doing therapy. Later, a medical approach, which included newer treatments including meds.
26. Why has Pendulum swung away from analysis and to biology?
A) No real science behind analytic approaches, while there is good science behind biological approaches
B) Faster and clearer results from meds.
C) Insurance companies, when began to cover mental health, wanted to cover shorter term care, vs. 5 X/week therapy.
27. Lithium vs. psychotherapy. Which does she favor? Both, They do different things. “Lithium moderates the illness; psychotherapy teaches you to live with it”
28. Is the distinction between mental illness and medical illness valid?
Mind-body distinctions in American medicine. Insurance companies, and the American public, have long considered mental illness to be different than medical illness. Jamison believes they are no different. What do you think? If they are different, what are the differences?
29 Why are there no accounts here of unrequited love? Jamison talks about her two husbands, numerous lovers including David, a very significant man in her life. Yet nowhere does she speak of any experience of unrequited love. Such love is part of most people’s experience. Indeed, some believe that this is the only kind of love in which the passion stays alive.
I suspect that she doesn’t mention this because it doesn’t happen to her. This is likely due to a combination of her beauty, charm and high energy as consequence of hypomania, and brilliance.
30. Should people with mental illness be allowed to treat patients? She says yes. What do you think?
Prologue
P3. Opens with a great description of manic energy. “on the run”
P4. Being professors of psychiatry explained everything” Use of humor.
P4 Onset of mania in 1974, age 28
P4 Intensely emotional as child, mercurial as young girl, severely depressed as adolescent, then cycles. This is a major burden. Especially a burden if at the same time, one is building a career or raising a family.
P5. Infinite disguises;
P5 Often goes unrecognized because patient thinks it is just “extension” of previous mood lability.
Origin biological
Experience; feels psychological
Part One; The Wild Blue Yonder
Into the Sun
P11-12 Describes growing up as daughter of Air Force flyer and scientist
P13. She witnesses a crash in which pilot sacrifices his own life to prevent risks to children. Concept of duty, of idealism, She discusses need to aspire to such ideals, and difficulty of achieving them.
P13. Relationship with brother; fair, steady self-confident, protective; good model
P14. Sister; black moods, self-conscious, defiant, rebellious, fierce temper. Her mood disturbance began earlier in life than Kay
P15 Kay had happy life early on; protection against later unhappiness.
P15 Father; charming, ebullient, enthusiasm, expansive, magical, enchanting, charismatic, pied piper with children, Played with father, but talked with mother. We later learn that his erratic behavior cost him a job at Rand (P 41)
P23-25 Visit to Psych Hosp; St Elisabeth; first contact with insanity.
P30 Comment on her switch at age 15 from military environment to civilian school. Sociologic study, culture shock. From army to wealthy S Cal kids, conserve to liberal, military persons to corp. lawyers, film producers, etc.
P34-35
------------------------
An Education for Life
Episode described of looking into brook, thinking of Tennyson’s poem - immediate sense of urgency. Went to get copy of Tennyson’ poem, ended up with 20 books that all seemed very related. in the legend of Arthur.
Mood would eventually crash. Good description of depression.
P 48; Manic moods and depression; huge personal and academic toll.
P49; age 20, to St. Andrews (Scotland)
Q What was the significance of this to her? Escape form despair, amulet against longing and loss.
P 53. Returns to UCLA. Med school now looks unlikely
P 54 She describes some of the reasons to resist meds
P 55 Got interested in treating her mood disturbance. Had to choose between psychiatry and getting a horse. Why did she choose a horse?
Her illness caused her to downplay the impracticality of a horse, and emphasize the fun aspects. She really couldn’t afford a horse, but mania leads to inappropriate spending
The remission of the illness at the start of grad school; she attributed this to a return to her normal self.
P 56 Here we have one of the few problematic areas in the book. She states that there were no words or disease names at the time (1971) that could be applied to mood swings. NOT TRUE. I have known of MD illness since Med School in the 50s. She is making excuses for her failure to recognize her won illness. But doesn’t need to. She is simply too close to it.
Part Two; A Not So Fine Madness
Flights of the Mind
When you are high, its great. Ideas are fast and frequent. Shyness disappears, Self-confident, right words, power to captivate others. Sensuality, desire to seduce, intense, feelings of omnipotence, euphoria, power. Clarity ---> confusion. Irritable, angry, scared, uncontrollable, “black caves of the mind”
Behavior is bizarre, frenetic, aimless, Incredible feelings to sort through. Who knows what?
Medicine to take, resent, forget.
Bounced checks, credit cards revoked, apologies, work problems to explain, intermittent memories, friendships gone, marriage ruined.
What is the reality of any feeling? Who am I? Wild, impulsive, energetic, crazy? Shy, withdrawn, suicidal, no energy,
Part Three
An Unquiet Mind
By Kay Redfield Jamison
Bipolar Affective Disorder
This is a book about one person’s battle with bipolar illness, usually referred to as Manic-Depressive Illness, This is a courageous memoir, in which the author accepts the risks of sharing herself, and achieves enormous benefits, both personal and for society.
Positives; Author gives an honest and moving account of her own illness. Coherent and thoughtful
Problems with book;
Somewhat repetitive;
Much use of cliché; (this is common in non-fiction, including memoirs)
Some unnecessary digressions; eg details about her niece (P193) add nothing to
account
Issues raised by book
Stigma of Mental Illness
Insensitivity of Medical Profession
Resistance to taking Meds. Why?
Class of Illness; Mood Disorder ”Beholden to moods”. What does this mean? How much control do we have over our moods? How much is nature, how much nurture? If nature, what is role of therapy vs. meds?
This illness is deadly. High rate of suicide. .
Philosophic issues
Who is the real me?
Questions to be considered
1. Why did she not want to take meds?
A) The one she gives, i.e. mania feels great, much pleasure, energy, creativity; meds prevents these feelings. The feeling of being high is great. Ideas are fast and frequent. Shyness disappears, Self-confident, right words, power to captivate others.
B). Accepting meds means accepting diagnosis. Not taking meds
Allows one to deny diagnosis
C) At that time, higher doses of lithium were the norm, and these doses were associated with unpleasant adverse effects. Author on lower doses still has some swings but never severe, and avoids side effects.
D) A personal sense of specialness. “My depression is more complicated, couldn’t be chemical”
E) Stigma of illness; Reinforced by messages from society. Often brought up to believe that it is sign of weakness. ( I (we) are stronger than those others). A
2. P5. How does disease mimic other things?
Often confused with personality disorder. Extreme lability can resemble borderline personality disorder.
Psychosis can be misdiagnosed as schizophrenia (often is, with tragic results re management)
Infinite disguises;
Often goes unrecognized because patient thinks it is just “extension” of previous mood lability
3. What are the downsides of the illness?
P6 she lists downside of illness; distortion of mood, bad behavior, destroys rational thought, can lead to suicide.
Destroys personal relationships
Destroys ones financial status re spending
Damages ones work situation
Stigma can cause limits on employment, education, etc.
Thomas Eagleton; history destroyed a promising political career
Can destroy life via suicide.
4. What are the positives in the illness?
P194 Disease can confer advantages.
Artistic temperament and imagination
Influences on scientists, business, religious, military and political leaders
There are risk takers who are leaders in arts, politics, science, business.
Increased energy
Increased work productivity
Clarity of thought (up to a point)
Enhanced self-confidence (thin line between desirable vs. over the top)
5. What are the causes?
Genetic
Biochemical
Environmental
Sleep duration
Childbirth
Alcohol
Drugs
Light exposure
6. Who is the real me? Question I am often asked by patients. The person with the illness, or the person treated without the illness. Important question re another frequent question. Should I take meds to turn me into a different person? Which of the feelings are real? Her sister told her that “her soul would wither “ if she took lithium
How much of our personality is simply a result of biology and chemistry?. Impossible to answer this.
7. Would it be better for person with Manic-Depressive illness to not be born? To not have children?
Philosophic issue; see P 191. She has no regrets about being born. (Marvelous existence)
Related to issue of should they have children.
Eugenics is a dangerous business. Can be used to justify who shall live, who can procreate. No one should make these decisions for someone else. Issues of non-maleficience and of autonomy.
8. Should we try to get rid of the genes for manic-depressive illness?
She asks whether we risk making the world more bland or homogenized.
There are risk takers who are leaders in arts, politics, science, business, who would not take these risks if they didn’t have illness.
On the other hand some researchers would gladly get rid of the disease even at a great cost.
9. The sharing of one’s self, in this case, her illness. Risks vs. benefits
A. What are the risks of telling her story? Humiliation, erosion of self confidence, influence on employment, Loss of hospital privileges licensure loss, all risks depend on the recipient of news buying into stigma), Pigeonholed as “weak and neurotic” Mouseheart factor. Will this affect how people view her? Will what was considered “zany” now be thought to represent “instability”? Will her professional research be considered biased or tainted? Will her colleagues consider her to be an accomplished authority, or someone with a “personal ax to grind”?
B. Benefits of telling her story; support from others, personal relief of not hiding,
education of others, de-stigmatizing illness, the achievement of acceptance, (both personally and for society to accept illness), better understanding that this is not a sign of weakness,
10. Re genetics of illness. How does author’s father fit into the story? What are his symptoms? What can be learned from his story?
Initially his moods soared. Grandiosity caused problems at work
Then a switch. Depression. Blackness, anger, despair, bleak, withdrawn, rage, immobilized by depression, heavy drinking.
A life partly ruined because of non-recognition and non-treatment.
11. What do we learn about symptoms and course of mania/hypomania?
Energy, enthusiasm exhausting to those around her. Flying high, sleeping little.
Then downward turn. In milder stages, illness felt really great (describes it as mild mania). P36 Felt invincible. Friends told her to slow down. Then the crash
12. What do we learn about symptoms and course of depression?
Wonderful descriptions of depression.
Would wake up in AM with profound sense of dread. Didn’t understand what this was all about. Lack of energy to go to class. Sense of pointlessness. Sense of inadequacy and blackness. Sense that only death would release her. Deadness, dreariness. Total despair. Sometimes associated with marked agitation. Images of decay, death, charred animals, corpses in morgues. Restless, angry, irritable. Pacing, unable to sit still.
Nothing made sense, couldn’t follow in class, unaware of surroundings, feeling scared, nothing was interesting. Consumed with subject of death. “I was going to die, so what difference did anything make?” Life is meaningless, did not change clothes, avoided friends,
Preoccupation with death and decay. “Everything was born to die”. Thoughts of suicide. Loss of oneself, closeness to death.
13. Is it fair to ask her (e.g. on application forms) questions about her illness?
Or is this an unfair invasion of privacy, or is it indicative of a tendency to view this disease in an unenlightened way? P207. There is always the possibility that the illness could interfere with clinical judgment, so these are fair questions to ask.
Clinicians who fail to get treatment (for whatever reasons) may endanger both themselves and others.
14. Is Self-treatment a problem here?
Because of stigma, or fear of consequences if diagnosis is known, many patients forego treatment. What often ends up happening is that these are the person who abuse drugs or alcohol as an attempt at self-treatment
15. Why is the diagnosis often missed? (Lives are destroyed when the diagnosis is missed, yet is quite frequent. Happens very frequently never diagnosed in someone’s lifetime)
To patient, not some biologic illness, but their own experience. They don’t necessarily realize it is abnormal.
Many doctors miss it.
Charm and high energy of hypomania does not feel like a disease, both to patient and to others who witness them
There is no objective test, e.g. no blood test.
16. Ethics of Suicide;
(A) Is suicide always an irrational act? An ethicist of my acquaintance once said, that it is reasonable to try to prevent it the first time, but if one tries more than once, it indicates that “they really mean It”, and the ethical thing is to respect their autonomy and not try to stop them. Problem is that autonomy presupposes a rational mind; if one is not competent via illness to make good decisions, then beneficence trumps autonomy.
(B)Can it be prevented? Bipolar or unipolar diseases are very treatable. Thus we can prevent suicide.
17. What are the walls that we build to keep away the sadnesses of life? P 214. We build these over a lifetime. They include our work, family, friends, religion, denial, alcohol, meds, recreational drugs, love. Want these walls to be high enough to be reliable, to keep out severe turmoil, and yet not so high that they do not allow in “fresh seawater”
18. What does author have to say about love as a barrier against the terror? See P 215. We build walls to protect ourselves. Love is effective in shutting out the terror, but at the same time in allows in “life, beauty, vitality.”
19. What does author say about the place of adversity, and how her illness has served her? P213-215 Fatalistic about future. More philosophical. Better armed. Having “encountered the monsters” she is less frightened of those still to be met. Realization that everything will pass. In fact, many philosophers believe that only through adversity do we fully live; and that we only undergo personal growth by experiencing adversity. .
Neitze, tragedy as an affirmation of life
Schopenhauer analysis of “will” led him to the conclusion that emotional, physical, and sexual desires can never be fulfilled. Consequently, he favored a lifestyle of negating human desires, similar to the teachings of ancient Greek Stoic philosophers, Buddhism, and Vedanta
20. When did her illness start? She says age 16, but some of the descriptions of her earlier behavior suggest it actually started eelier. A problem in this disease is that if cycling moods are all that we know, then we don’t think it is abnormal.
21. Why did the author decide against Med School?
PUSH; her restlessness and temperament meant that she would not be able to sit still in class. Did not want to be chained to a schedule.
PULL; Psychology became very appealing, found she liked research and writing, Mentors that she found impressive were psychologists.
22. What are the factors that go into choosing a career?
How did she choose a career?
Chose psychology;
Enjoyed the work as an undergraduate.
Read William James “Variety of Religious Experience”
Influence of mentors, especially one in particular. In addition, found a mentor who
also had mood disorder.
Temperament more suited; restless, unstable
Related more to her personal situation.
She saw a chance to study something that might give her answers to her own
mood disorders.
23. Reading William James had major effect on her. How many of you can track major changes in your life to a particular book, or article, or film? (Either career, political orientation, etc)
24. What were some of the early manifestations of her illness?
College was a “terrible struggle” Shifting moods, violent, interspersed with fun, enthusiasms (hypomania)
Everything done to excess
Got immersed in variety of political and social causes. Lots of students do this, not always due to mania. But the converse is that mania often leads to excessive involvement to the detriment of school work.
Impulsive buying which she could not afford. Purchases seemed essential at the time.
Sense of essential key to absolute truth
UCLA was a good school but it couldn’t protect her against her agitation.
25. There has been an ongoing battle between psychoanalysis vs. biologic approach. What do you think? Ongoing battle, esp. in 1960s and 1970s, as research developed. She found that Freud and Jung were emphasized during her earlier years in grad school. Emphasis on early expressions, conflicts, dreams, symbols, in doing therapy. Later, a medical approach, which included newer treatments including meds.
26. Why has Pendulum swung away from analysis and to biology?
A) No real science behind analytic approaches, while there is good science behind biological approaches
B) Faster and clearer results from meds.
C) Insurance companies, when began to cover mental health, wanted to cover shorter term care, vs. 5 X/week therapy.
27. Lithium vs. psychotherapy. Which does she favor? Both, They do different things. “Lithium moderates the illness; psychotherapy teaches you to live with it”
28. Is the distinction between mental illness and medical illness valid?
Mind-body distinctions in American medicine. Insurance companies, and the American public, have long considered mental illness to be different than medical illness. Jamison believes they are no different. What do you think? If they are different, what are the differences?
29 Why are there no accounts here of unrequited love? Jamison talks about her two husbands, numerous lovers including David, a very significant man in her life. Yet nowhere does she speak of any experience of unrequited love. Such love is part of most people’s experience. Indeed, some believe that this is the only kind of love in which the passion stays alive.
I suspect that she doesn’t mention this because it doesn’t happen to her. This is likely due to a combination of her beauty, charm and high energy as consequence of hypomania, and brilliance.
30. Should people with mental illness be allowed to treat patients? She says yes. What do you think?
Prologue
P3. Opens with a great description of manic energy. “on the run”
P4. Being professors of psychiatry explained everything” Use of humor.
P4 Onset of mania in 1974, age 28
P4 Intensely emotional as child, mercurial as young girl, severely depressed as adolescent, then cycles. This is a major burden. Especially a burden if at the same time, one is building a career or raising a family.
P5. Infinite disguises;
P5 Often goes unrecognized because patient thinks it is just “extension” of previous mood lability.
Origin biological
Experience; feels psychological
Part One; The Wild Blue Yonder
Into the Sun
P11-12 Describes growing up as daughter of Air Force flyer and scientist
P13. She witnesses a crash in which pilot sacrifices his own life to prevent risks to children. Concept of duty, of idealism, She discusses need to aspire to such ideals, and difficulty of achieving them.
P13. Relationship with brother; fair, steady self-confident, protective; good model
P14. Sister; black moods, self-conscious, defiant, rebellious, fierce temper. Her mood disturbance began earlier in life than Kay
P15 Kay had happy life early on; protection against later unhappiness.
P15 Father; charming, ebullient, enthusiasm, expansive, magical, enchanting, charismatic, pied piper with children, Played with father, but talked with mother. We later learn that his erratic behavior cost him a job at Rand (P 41)
P23-25 Visit to Psych Hosp; St Elisabeth; first contact with insanity.
P30 Comment on her switch at age 15 from military environment to civilian school. Sociologic study, culture shock. From army to wealthy S Cal kids, conserve to liberal, military persons to corp. lawyers, film producers, etc.
P34-35
------------------------
An Education for Life
Episode described of looking into brook, thinking of Tennyson’s poem - immediate sense of urgency. Went to get copy of Tennyson’ poem, ended up with 20 books that all seemed very related. in the legend of Arthur.
Mood would eventually crash. Good description of depression.
P 48; Manic moods and depression; huge personal and academic toll.
P49; age 20, to St. Andrews (Scotland)
Q What was the significance of this to her? Escape form despair, amulet against longing and loss.
P 53. Returns to UCLA. Med school now looks unlikely
P 54 She describes some of the reasons to resist meds
P 55 Got interested in treating her mood disturbance. Had to choose between psychiatry and getting a horse. Why did she choose a horse?
Her illness caused her to downplay the impracticality of a horse, and emphasize the fun aspects. She really couldn’t afford a horse, but mania leads to inappropriate spending
The remission of the illness at the start of grad school; she attributed this to a return to her normal self.
P 56 Here we have one of the few problematic areas in the book. She states that there were no words or disease names at the time (1971) that could be applied to mood swings. NOT TRUE. I have known of MD illness since Med School in the 50s. She is making excuses for her failure to recognize her won illness. But doesn’t need to. She is simply too close to it.
Part Two; A Not So Fine Madness
Flights of the Mind
When you are high, its great. Ideas are fast and frequent. Shyness disappears, Self-confident, right words, power to captivate others. Sensuality, desire to seduce, intense, feelings of omnipotence, euphoria, power. Clarity ---> confusion. Irritable, angry, scared, uncontrollable, “black caves of the mind”
Behavior is bizarre, frenetic, aimless, Incredible feelings to sort through. Who knows what?
Medicine to take, resent, forget.
Bounced checks, credit cards revoked, apologies, work problems to explain, intermittent memories, friendships gone, marriage ruined.
What is the reality of any feeling? Who am I? Wild, impulsive, energetic, crazy? Shy, withdrawn, suicidal, no energy,
Part Three
An Unquiet Mind
By Kay Redfield Jamison
Bipolar Affective Disorder
This is a book about one person’s battle with bipolar illness, usually referred to as Manic-Depressive Illness, This is a courageous memoir, in which the author accepts the risks of sharing herself, and achieves enormous benefits, both personal and for society.
Positives; Author gives an honest and moving account of her own illness. Coherent and thoughtful
Problems with book;
Somewhat repetitive;
Much use of cliché; (this is common in non-fiction, including memoirs)
Some unnecessary digressions; eg details about her niece (P193) add nothing to
account
Issues raised by book
Stigma of Mental Illness
Insensitivity of Medical Profession
Resistance to taking Meds. Why?
Class of Illness; Mood Disorder ”Beholden to moods”. What does this mean? How much control do we have over our moods? How much is nature, how much nurture? If nature, what is role of therapy vs. meds?
This illness is deadly. High rate of suicide. .
Philosophic issues
Who is the real me?
Questions to be considered
1. Why did she not want to take meds?
A) The one she gives, i.e. mania feels great, much pleasure, energy, creativity; meds prevents these feelings. The feeling of being high is great. Ideas are fast and frequent. Shyness disappears, Self-confident, right words, power to captivate others.
B). Accepting meds means accepting diagnosis. Not taking meds
Allows one to deny diagnosis
C) At that time, higher doses of lithium were the norm, and these doses were associated with unpleasant adverse effects. Author on lower doses still has some swings but never severe, and avoids side effects.
D) A personal sense of specialness. “My depression is more complicated, couldn’t be chemical”
E) Stigma of illness; Reinforced by messages from society. Often brought up to believe that it is sign of weakness. ( I (we) are stronger than those others). A
2. P5. How does disease mimic other things?
Often confused with personality disorder. Extreme lability can resemble borderline personality disorder.
Psychosis can be misdiagnosed as schizophrenia (often is, with tragic results re management)
Infinite disguises;
Often goes unrecognized because patient thinks it is just “extension” of previous mood lability
3. What are the downsides of the illness?
P6 she lists downside of illness; distortion of mood, bad behavior, destroys rational thought, can lead to suicide.
Destroys personal relationships
Destroys ones financial status re spending
Damages ones work situation
Stigma can cause limits on employment, education, etc.
Thomas Eagleton; history destroyed a promising political career
Can destroy life via suicide.
4. What are the positives in the illness?
P194 Disease can confer advantages.
Artistic temperament and imagination
Influences on scientists, business, religious, military and political leaders
There are risk takers who are leaders in arts, politics, science, business.
Increased energy
Increased work productivity
Clarity of thought (up to a point)
Enhanced self-confidence (thin line between desirable vs. over the top)
5. What are the causes?
Genetic
Biochemical
Environmental
Sleep duration
Childbirth
Alcohol
Drugs
Light exposure
6. Who is the real me? Question I am often asked by patients. The person with the illness, or the person treated without the illness. Important question re another frequent question. Should I take meds to turn me into a different person? Which of the feelings are real? Her sister told her that “her soul would wither “ if she took lithium
How much of our personality is simply a result of biology and chemistry?. Impossible to answer this.
7. Would it be better for person with Manic-Depressive illness to not be born? To not have children?
Philosophic issue; see P 191. She has no regrets about being born. (Marvelous existence)
Related to issue of should they have children.
Eugenics is a dangerous business. Can be used to justify who shall live, who can procreate. No one should make these decisions for someone else. Issues of non-maleficience and of autonomy.
8. Should we try to get rid of the genes for manic-depressive illness?
She asks whether we risk making the world more bland or homogenized.
There are risk takers who are leaders in arts, politics, science, business, who would not take these risks if they didn’t have illness.
On the other hand some researchers would gladly get rid of the disease even at a great cost.
9. The sharing of one’s self, in this case, her illness. Risks vs. benefits
A. What are the risks of telling her story? Humiliation, erosion of self confidence, influence on employment, Loss of hospital privileges licensure loss, all risks depend on the recipient of news buying into stigma), Pigeonholed as “weak and neurotic” Mouseheart factor. Will this affect how people view her? Will what was considered “zany” now be thought to represent “instability”? Will her professional research be considered biased or tainted? Will her colleagues consider her to be an accomplished authority, or someone with a “personal ax to grind”?
B. Benefits of telling her story; support from others, personal relief of not hiding,
education of others, de-stigmatizing illness, the achievement of acceptance, (both personally and for society to accept illness), better understanding that this is not a sign of weakness,
10. Re genetics of illness. How does author’s father fit into the story? What are his symptoms? What can be learned from his story?
Initially his moods soared. Grandiosity caused problems at work
Then a switch. Depression. Blackness, anger, despair, bleak, withdrawn, rage, immobilized by depression, heavy drinking.
A life partly ruined because of non-recognition and non-treatment.
11. What do we learn about symptoms and course of mania/hypomania?
Energy, enthusiasm exhausting to those around her. Flying high, sleeping little.
Then downward turn. In milder stages, illness felt really great (describes it as mild mania). P36 Felt invincible. Friends told her to slow down. Then the crash
12. What do we learn about symptoms and course of depression?
Wonderful descriptions of depression.
Would wake up in AM with profound sense of dread. Didn’t understand what this was all about. Lack of energy to go to class. Sense of pointlessness. Sense of inadequacy and blackness. Sense that only death would release her. Deadness, dreariness. Total despair. Sometimes associated with marked agitation. Images of decay, death, charred animals, corpses in morgues. Restless, angry, irritable. Pacing, unable to sit still.
Nothing made sense, couldn’t follow in class, unaware of surroundings, feeling scared, nothing was interesting. Consumed with subject of death. “I was going to die, so what difference did anything make?” Life is meaningless, did not change clothes, avoided friends,
Preoccupation with death and decay. “Everything was born to die”. Thoughts of suicide. Loss of oneself, closeness to death.
13. Is it fair to ask her (e.g. on application forms) questions about her illness?
Or is this an unfair invasion of privacy, or is it indicative of a tendency to view this disease in an unenlightened way? P207. There is always the possibility that the illness could interfere with clinical judgment, so these are fair questions to ask.
Clinicians who fail to get treatment (for whatever reasons) may endanger both themselves and others.
14. Is Self-treatment a problem here?
Because of stigma, or fear of consequences if diagnosis is known, many patients forego treatment. What often ends up happening is that these are the person who abuse drugs or alcohol as an attempt at self-treatment
15. Why is the diagnosis often missed? (Lives are destroyed when the diagnosis is missed, yet is quite frequent. Happens very frequently never diagnosed in someone’s lifetime)
To patient, not some biologic illness, but their own experience. They don’t necessarily realize it is abnormal.
Many doctors miss it.
Charm and high energy of hypomania does not feel like a disease, both to patient and to others who witness them
There is no objective test, e.g. no blood test.
16. Ethics of Suicide;
(A) Is suicide always an irrational act? An ethicist of my acquaintance once said, that it is reasonable to try to prevent it the first time, but if one tries more than once, it indicates that “they really mean It”, and the ethical thing is to respect their autonomy and not try to stop them. Problem is that autonomy presupposes a rational mind; if one is not competent via illness to make good decisions, then beneficence trumps autonomy.
(B)Can it be prevented? Bipolar or unipolar diseases are very treatable. Thus we can prevent suicide.
17. What are the walls that we build to keep away the sadnesses of life? P 214. We build these over a lifetime. They include our work, family, friends, religion, denial, alcohol, meds, recreational drugs, love. Want these walls to be high enough to be reliable, to keep out severe turmoil, and yet not so high that they do not allow in “fresh seawater”
18. What does author have to say about love as a barrier against the terror? See P 215. We build walls to protect ourselves. Love is effective in shutting out the terror, but at the same time in allows in “life, beauty, vitality.”
19. What does author say about the place of adversity, and how her illness has served her? P213-215 Fatalistic about future. More philosophical. Better armed. Having “encountered the monsters” she is less frightened of those still to be met. Realization that everything will pass. In fact, many philosophers believe that only through adversity do we fully live; and that we only undergo personal growth by experiencing adversity. .
Neitze, tragedy as an affirmation of life
Schopenhauer analysis of “will” led him to the conclusion that emotional, physical, and sexual desires can never be fulfilled. Consequently, he favored a lifestyle of negating human desires, similar to the teachings of ancient Greek Stoic philosophers, Buddhism, and Vedanta
20. When did her illness start? She says age 16, but some of the descriptions of her earlier behavior suggest it actually started eelier. A problem in this disease is that if cycling moods are all that we know, then we don’t think it is abnormal.
21. Why did the author decide against Med School?
PUSH; her restlessness and temperament meant that she would not be able to sit still in class. Did not want to be chained to a schedule.
PULL; Psychology became very appealing, found she liked research and writing, Mentors that she found impressive were psychologists.
22. What are the factors that go into choosing a career?
How did she choose a career?
Chose psychology;
Enjoyed the work as an undergraduate.
Read William James “Variety of Religious Experience”
Influence of mentors, especially one in particular. In addition, found a mentor who
also had mood disorder.
Temperament more suited; restless, unstable
Related more to her personal situation.
She saw a chance to study something that might give her answers to her own
mood disorders.
23. Reading William James had major effect on her. How many of you can track major changes in your life to a particular book, or article, or film? (Either career, political orientation, etc)
24. What were some of the early manifestations of her illness?
College was a “terrible struggle” Shifting moods, violent, interspersed with fun, enthusiasms (hypomania)
Everything done to excess
Got immersed in variety of political and social causes. Lots of students do this, not always due to mania. But the converse is that mania often leads to excessive involvement to the detriment of school work.
Impulsive buying which she could not afford. Purchases seemed essential at the time.
Sense of essential key to absolute truth
UCLA was a good school but it couldn’t protect her against her agitation.
25. There has been an ongoing battle between psychoanalysis vs. biologic approach. What do you think? Ongoing battle, esp. in 1960s and 1970s, as research developed. She found that Freud and Jung were emphasized during her earlier years in grad school. Emphasis on early expressions, conflicts, dreams, symbols, in doing therapy. Later, a medical approach, which included newer treatments including meds.
26. Why has Pendulum swung away from analysis and to biology?
A) No real science behind analytic approaches, while there is good science behind biological approaches
B) Faster and clearer results from meds.
C) Insurance companies, when began to cover mental health, wanted to cover shorter term care, vs. 5 X/week therapy.
27. Lithium vs. psychotherapy. Which does she favor? Both, They do different things. “Lithium moderates the illness; psychotherapy teaches you to live with it”
28. Is the distinction between mental illness and medical illness valid?
Mind-body distinctions in American medicine. Insurance companies, and the American public, have long considered mental illness to be different than medical illness. Jamison believes they are no different. What do you think? If they are different, what are the differences?
29 Why are there no accounts here of unrequited love? Jamison talks about her two husbands, numerous lovers including David, a very significant man in her life. Yet nowhere does she speak of any experience of unrequited love. Such love is part of most people’s experience. Indeed, some believe that this is the only kind of love in which the passion stays alive.
I suspect that she doesn’t mention this because it doesn’t happen to her. This is likely due to a combination of her beauty, charm and high energy as consequence of hypomania, and brilliance.
30. Should people with mental illness be allowed to treat patients? She says yes. What do you think?
Prologue
P3. Opens with a great description of manic energy. “on the run”
P4. Being professors of psychiatry explained everything” Use of humor.
P4 Onset of mania in 1974, age 28
P4 Intensely emotional as child, mercurial as young girl, severely depressed as adolescent, then cycles. This is a major burden. Especially a burden if at the same time, one is building a career or raising a family.
P5. Infinite disguises;
P5 Often goes unrecognized because patient thinks it is just “extension” of previous mood lability.
Origin biological
Experience; feels psychological
Part One; The Wild Blue Yonder
Into the Sun
P11-12 Describes growing up as daughter of Air Force flyer and scientist
P13. She witnesses a crash in which pilot sacrifices his own life to prevent risks to children. Concept of duty, of idealism, She discusses need to aspire to such ideals, and difficulty of achieving them.
P13. Relationship with brother; fair, steady self-confident, protective; good model
P14. Sister; black moods, self-conscious, defiant, rebellious, fierce temper. Her mood disturbance began earlier in life than Kay
P15 Kay had happy life early on; protection against later unhappiness.
P15 Father; charming, ebullient, enthusiasm, expansive, magical, enchanting, charismatic, pied piper with children, Played with father, but talked with mother. We later learn that his erratic behavior cost him a job at Rand (P 41)
P23-25 Visit to Psych Hosp; St Elisabeth; first contact with insanity.
P30 Comment on her switch at age 15 from military environment to civilian school. Sociologic study, culture shock. From army to wealthy S Cal kids, conserve to liberal, military persons to corp. lawyers, film producers, etc.
P34-35
------------------------
An Education for Life
Episode described of looking into brook, thinking of Tennyson’s poem - immediate sense of urgency. Went to get copy of Tennyson’ poem, ended up with 20 books that all seemed very related. in the legend of Arthur.
Mood would eventually crash. Good description of depression.
P 48; Manic moods and depression; huge personal and academic toll.
P49; age 20, to St. Andrews (Scotland)
Q What was the significance of this to her? Escape form despair, amulet against longing and loss.
P 53. Returns to UCLA. Med school now looks unlikely
P 54 She describes some of the reasons to resist meds
P 55 Got interested in treating her mood disturbance. Had to choose between psychiatry and getting a horse. Why did she choose a horse?
Her illness caused her to downplay the impracticality of a horse, and emphasize the fun aspects. She really couldn’t afford a horse, but mania leads to inappropriate spending
The remission of the illness at the start of grad school; she attributed this to a return to her normal self.
P 56 Here we have one of the few problematic areas in the book. She states that there were no words or disease names at the time (1971) that could be applied to mood swings. NOT TRUE. I have known of MD illness since Med School in the 50s. She is making excuses for her failure to recognize her won illness. But doesn’t need to. She is simply too close to it.
Part Two; A Not So Fine Madness
Flights of the Mind
When you are high, its great. Ideas are fast and frequent. Shyness disappears, Self-confident, right words, power to captivate others. Sensuality, desire to seduce, intense, feelings of omnipotence, euphoria, power. Clarity ---> confusion. Irritable, angry, scared, uncontrollable, “black caves of the mind”
Behavior is bizarre, frenetic, aimless, Incredible feelings to sort through. Who knows what?
Medicine to take, resent, forget.
Bounced checks, credit cards revoked, apologies, work problems to explain, intermittent memories, friendships gone, marriage ruined.
What is the reality of any feeling? Who am I? Wild, impulsive, energetic, crazy? Shy, withdrawn, suicidal, no energy,
Part Three
Part Four
Epilogue
Part Four
Epilogue
Part Four
Epilogue
Part Four
Epilogue
Thursday, February 11, 2010
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