Noted psychiatrist tells of her own depression

Kay Redfield Jamison, an internationally recognized authority on manic depressive illness, told a packed house last week of her difficulty confronting the disease, which she has struggled with since high school. "I come from a really straight-arrow WASP military family, where keeping it together was everything," explained the Johns Hopkins University psychiatry professor. "If you actually had problems, you just quietly took your service revolver and went out in the field and shot yourself -- you didn't bum everyone else out." Jamison led her audience through the manic and depressive phases of the illness, using her own experiences to illustrate her points. "People go mad in idiosyncratic ways," she read, from her recently published book An Unquiet Mind: A Memoir of Moods and Madness. "Perhaps it was not surprising that, as a meteorologist's daughter, I found myself, in that glorious illusion of high summer days, gliding, flying, now and again lurching through cloud banks and ethers, past stars and across fields of ice crystals," she added. Bipolar, or manic depressive, illness is characterized by extremes of mood lasting months at a time. The disease, which is fatal in about 20 percent of all cases, is also genetic and lasts throughout patients' lives. Although treatable by medication, bipolar disorder patients often refuse to follow the necessary regimens, Jamison said. The "highs" she and other manic depressives experience are "addictive, both biologically and, certainly, psychologically," Jamison said. She countered any comparison between hypomania, a phase of the illness in which mood and energy are moderately elevated, with the euphoria cocaine users report. "From my own experience of both, I can tell you that hypomania leaves cocaine in the dust in terms of the experience, the intensity," Jamison said. "Asking people to give this up is often sending yourself on a fool's errand." Lithium, the primary medication used to treat the disorder, levels out the euphoria patients often experience in the illness's manic phase, she said. This is one reason why many patients quit taking the drug. "It's such a disgusting substance," she added. Jamison referred to studies of coyotes in which it has been found that the most effective way to prevent the animals from eating sheep is to present them with sheep carcasses dipped in lithium. Despite her clear understanding of lithium's negative attributes, Jamison said she finally decided it was essential for her to remain on the drug indefinitely after the disease led her to a suicide attempt. "Death and its kin were constant companions. I saw death everywhere and I saw winding sheets and toe tags and body bags in my mind's eye," she read. "Everything was a reminder that everything ended at the charnel house. I simply wanted to die and be done with it. I resolved to kill myself." Since learning just how lethal manic depression can be, Jamison has devoted much of her academic career to devising ways to convince patients to stick with their medication. Following her talk, the speaker took questions from the audience, composed mainly of Medical Center faculty, students and staff. In response to a question about the cost of revealing her own illness to the public, Jamison spoke of the "cold silence" with which certain colleagues have greeted her story. Some readers have told her that being a lapsed Christian caused her disease and others have written about their relief that she has never had children. In response to other questions, Jamison said she wanted the mentally ill to organize politically to fight for parity of insurance coverage and extension of the protections of the Americans with Disabilities Act to mental patients. At an informal luncheon for psychiatric residents following her talk, Jamison continued discussing genetic and ethical issues surrounding manic depressive illness. She reminded students that the mentally ill were "sent to the ovens" in Nazi Germany even before Jewish citizens. She also noted that in modern China, those who have experienced psychosis -- a common feature of manic depression -- are not permitted to reproduce. With researchers on the verge of discovering the gene responsible for manic depression, Jamison alluded to the possibility of a eugenics movement directed at those afflicted with it. But she expressed hope that research showing the prevalence of psychiatric illnesses will serve to focus public attention on treatment instead. Her talk took place last Thursday in the Clinical Research Building as part of the the Grand Rounds Lecture Series, which is sponsored by the Department of Psychiatry and Behavioral Health Services and the Philadelphia Child Guidance Center.