Kay Jamison slouches her lanky frame over the lectern, looks up through her blond bangs, and delivers a bold second opinion on the medical condition of a world-renowned patient. Her insights come about a hundred years too late for the patient himself—author Robert Louis Stevenson—but not a moment too soon for the capacity crowd at the Johns Hopkins auditorium.
“He was a courageous man,” she says, “who continued to write under psychological and physical conditions that would have defeated anyone else.” While Stevenson’s death was caused by tuberculosis, Jamison insists that the battle of his life was with an inherited psychiatric problem, which she has diagnosed as a mood disorder. Jamison is preaching to the converted, over 750 people who treat, or are being treated for, such disorders: major depression and manic-depressive illness. They are members of the regional group that may be the best-informed of America’s roughly 7 million mood disorder sufferers, the pioneering, if badly named, Depression and Related Affective Disorders Association, or DRADA. Jamison has made a career studying and treating these illnesses, particularly manic-depressive illness (the term she prefers to the trendier “bipolar disorder”). She is co-author of the definitive textbook on the subject and she has taught at UCLA, Oxford and now Johns Hopkins. She is also therapist or pal to many of the most internationally prominent people who suffer from her specialty.
Jamison rediagnoses artists from beyond the grave—turning their demons into what she believes they really were, symptoms—and uses their art to evoke feelings the clinical literature can’t even begin to describe.
But it is lectures like this one that have made the 48-year-old Washington-based psychologist and psychiatry professor such a cerebral celebrity in the world of mental health. At all your better psychiatric symposiums, and an increasing number of literary conferences, it is invariably Kay Redfield Jamison who is brought in for tragicomic relief, to give one of her library of talks on the link between manic depression and creativity. She can do van Gogh, she can do Lord Byron, she can do Edgar Allan Poe. In a pinch for a suicide crowd, she can do Hemingway. And, of course, she can do Stevenson, who, she argues, drew on some deep understanding of bipolarity to write The Strange Case of Dr. Jekyll and Mr. Hyde.
Jamison rediagnoses these artists from beyond the grave—turning their demons into what she believes they really were, symptoms—and uses their art to evoke feelings the clinical literature can’t even begin to describe. Instead of dry language and pie charts, her slides include writings from some of the dead poets, writers and composers, and images from the work of deceased visual artists, nearly 200 in all, whom she has identified as having probable mood disorders. On her list is everyone from Michelangelo to Mark Rothko, William Blake to Anne Sexton, Herman Melville to William Faulkner, and Tchaikovsky to Charlie Parker. She identifies them not by analyzing the content of their art so much as by applying psychiatry’s diagnostic criteria to letters and other biographical material.
In doing so, she has figured out a way to make mood disorders a little less … depressing and a lot more approachable. She is engaged in the intellectual merchandising of manic depression. Some feel that her enterprise over-romanticizes mental illness, and could make all the non-geniuses with mood disorders even more bummed out. But it also enables her message to cross over to a public that, generally, doesn’t think it needs to care about serious mental illness. It’s a public that doesn’t really appreciate the difference between people who get counseling for “problems of living” and people who need medication and supportive psychotherapy because they have problems living—as a diabetic would without insulin.
When Jamison finishes her presentation, the stage is prepared for the day’s grand finale—the reason the annual DRADA conference at Johns Hopkins has taken on cult status in mental health circles. The symposium always ends with a talk by a “celebrity consumer”—the term “consumer” now being preferred over “patient.” This is where Dick Cavett, Mike Wallace, William Styron, Frances Lear and others have “come out,” or come much further out, with their psychiatric histories. Today’s featured consumer will be Clinton aide Bob Boorstin, a former New York Times reporter who has been hospitalized twice for manic episodes and is becoming increasingly public and political about his illness. At 35, he is, by 20 or 30 years, the youngest public figure to take the DRADA challenge. Most celebrities speak out when there’s less left to lose.
With a microphone clipped to his lapel, Boorstin speaks with wit and passion about his illness, including the pros and cons of being “out.” As he talks, Jamison watches from a seat in the second row—the last row of doctors before the first row of consumers, a boundary delineated with yellow tape. Jamison and Boorstin are friends, and she has listened to him talk privately about his illness dozens of times. Nothing he is saying is news to her. Yet, she is leaning far forward in her chair, chin in hand, intensely examining Boorstin’s every move.
She knows it is only a matter of time before she’s up there doing the grand finale herself.
I first met Kay Jamison over a year ago, after hearing about her from a friend who has manic-depressive illness and considers the textbook she co-wrote with former National Institute of Mental Health director Frederick Goodwin to be, literally, the bible. When my friend’s symptoms are particularly bad, she reads passages of “the Goodwin-Jamison” over to herself—invariably the sections Jamison wrote, which include many patient anecdotes—to remind herself that what she feels is at least normally abnormal.
The illness—which is believed to afflict 2½ million Americans—is known for its long, severe mood swings from the tortured depths of depression to the thought-racing, hyperactive, deluded heights of mania, punctuated by periods of relative mood stability, which occur naturally, although they are best maintained by medication. The Goodwin-Jamison book explores more of the subtleties of symptoms, such as the all-too-brief periods of “hypomania” or “mild mania,” the one silver lining among the disease’s many thunderous clouds. During hypomania, patients experience “increased energy, expansiveness, risk taking and fluency of thought” that often lead to periods of superhuman productivity (and, if you’re an artist, a lot of art). Unfortunately, the brain’s accelerator eventually pushes past 80, and the patient spins out of control. So people with manic depression can come to distrust their happiest moments for fear of what they’ll lead to.
My friend also recommended Jamison’s 1993 lay book Touched With Fire: Manic-Depressive Illness and the Artistic Temperament, which is a sort of survey course of the research on artists she began doing at Oxford in the early ‘80s that reprises as much of the information from the textbook as a non-professional needs. I decided to write about her because she was about to do her third public television special on mental illness and the arts—following “Moods and Music” in 1990 and “To Paint the Stars: The Life and Mind of Vincent van Gogh” in 1991. This one was to be about Byron. It would bring together her research on his life and work with new findings about the genetics of mental illness, which is being studied by one of her Johns Hopkins colleagues, Raymond DePaulo, and by James Watson, the co-discoverer of DNA.
Jamison and I got together in Philadelphia, where she was giving her general art and mental illness talk—the Kay Sampler—at Friends Hospital. We met for coffee in the lounge of the Four Seasons Hotel, where I arrived with the breaking news of Kurt Cobain’s death. She didn’t know much about Cobain—she’s not really the Nirvana type. But she said she wouldn’t be surprised if he had manic depression. (It later turned out that he had received such a diagnosis, but like too many people, couldn’t stay on his medication—lithium, about which he had once written a song.) Jamison recalled that at the mood disorders clinic at UCLA she helped found in 1977, “we used to get a lot of rock musicians, a lot of drugs, a lot of manic-depressive illness.” Then sighed. “The thing that doesn’t get emphasized enough is the fact that manic-depressive illness kills people. There’s an extremely high suicide rate attached to it… It’s the most important thing about the illness.”
When she talks, Jamison has a way of being both engaging and skittish—a dynamic nervousness. She explained that she was an Air Force brat, the youngest of three children, who had spent many of her formative years in the Washington area though her father’s career—he was a pilot and meteorologist—took the family to Florida, Puerto Rico and Tokyo. They settled in Southern California, where her father took a job with the Rand Corp. and her mother taught elementary school.
“Being open is the sort of thing that I advise people to think very long and hard about. It’s one thing if you’re independently wealthy. It’s another thing if you’re out in the real world.”
Jamison went to UCLA to be a veterinarian. She switched to psychology because she didn’t think she had the temperament for medical school, and then gravitated back toward the physiological, medical side of the field—eventually teaching in the psychiatry department, and taking a minor in comparative psychopharmacology. She fell in with William McGlothlin, who, along with Timothy Leary, was doing the pioneer research into altered mood states using now-illegal drugs. Her dissertation was on LSD and heroin abuse.
I asked how she had become interested specifically in manic-depressive illness. She said there was some incidence in her family. When I asked for details, she said, “Well, I pass on that, okay?” Pressed, she said, “I know that being more open is destigmatizing, but this is also about issues of privacy, and I don’t feel I can talk on behalf of my family.” I asked her to give it some thought. She said, “I’ll think about it, but… I am surrounded by manic-depressive illness all the time, and I am well aware of what my patients go through and my family members go through and my friends go through and my colleagues go through. Being open is the sort of thing that I advise people to think very long and hard about. It’s one thing if you’re independently wealthy. It’s another thing if you’re out in the real world.”
So we went back to annotating her résumé as a clinician, researcher and writer. The story was counterpointed by her cyclically difficult private life. Her parents had divorced and her father remarried and started a second family. Jamison’s first marriage, during graduate school, ended in divorce. She then fell in love with a British army officer named David Laurie, a psychiatrist 13 years her senior, with whom she planned to settle down and “have a houseful of kids.” But in 1979, he died suddenly of a heart attack, and she was left to throw herself into her work.
She hooked up with Goodwin, a towering figure in both biological psychiatry and mood disorders, and began the textbook—which took 10 years and included all the work she was doing on lithium, suicide and psychotherapy. On the side, she began publishing papers on an unorthodox subject: the “positive experiences” associated with mood, or, as they were then usually called, “affective” disorders. This led to her 1984 study of 47 living British artists and writers, which found that 38 percent had been treated for depression or manic depression—much higher than the 1 percent to 6 percent of the population normally affected. Her results echoed the findings of the one earlier major study in this area, by Nancy Andreason, author of the first lay manifesto of biological psychiatry, The Broken Brain.
During this time, Jamison was trying out some of this material at annual Christmas lectures for the staff at the UCLA mood disorders clinic. In her talks, she would synthesize the clinical literature with the works and letters of poets and composers who, she felt, described disordered moods particularly well, whether they meant to or not. Among the quotations from Byron and the music of Handel, Schumann, Berlioz and Mahler—all of whom she would later determine suffered from mood disorders—she also included selections from a less classical source: the musical “Barnum.” She felt that some of the musical’s numbers captured the experience of the focused frenzy of hypomania so well that she even met with “Barnum’s” male lead, Jim Dale, when the show was playing in Los Angeles.
She was soon inspired to make a Barnum-esque attempt to draw attention to mood disorders. She decided to do the biographical research to formally, posthumously diagnose the suspected mood disorders of a group of composers, and then produce a concert devoted to “Moods and Music,” which would mix performance with short talks about the composers and the illnesses. When she floated the idea around her department, it was suggested she get the UCLA doctors’ orchestra. She, instead, persuaded the Los Angeles Philharmonic to do it. And she persuaded her new friends Norman and Frances Lear to help sponsor the 1985 concert, although, because of a quirk in UCLA fund-raising rules, Jamison ended up paying for most of the show, with $25,000 of her savings. “I’m delighted I did it,” she said, “even though it wasn’t a very sensible thing to do.”
We stopped the interview at the mid-’80s because she had to go, and we made plans to speak again at her Washington office, which is in the home she shares with NIMH schizophrenia researcher Richard Wyatt. Several days later she called to ask if we could have an off-the-record conversation.
She told me she has manic-depressive illness herself. Only her family and some of her closest friends and colleagues knew this, she said, but she had plans to go public. Besides her biography of Byron, she had been writing a memoir of her own mental illness. And although it wasn’t to be published for some time, she expressed a willingness to be “outed” first. To some, her disclosure would be a shock; to others, it would be nothing more than a confirmed assumption. But it was likely to be a big deal in psychiatric circles, where the fear of being perceived as crazier than one’s patients is very real and very stigmatizing, and clinical privileges can be jeopardized for political rather than medical reasons.
She only asked that the story not be published until the people who had to know—her close colleagues, her patients—could be forewarned.
Jamison’s manic-depressive illness first manifested itself when she was 16. The early symptoms generally run to one extreme of the mood scale, but they can also be present as more of a “mixed state” with a jumble of manic and depressive symptoms—the most dangerous combination being the agitation and impulsiveness of mania along with the suicidal thoughts of depression. Psychosis, or disordered thought, once associated only with schizophrenia, can be a secondary symptom of depression and mania—the hallucinations and delusions often appearing when the mood disturbance is at its worst.
“I was psychotically depressed, I was delusional,” Jamison says of her first “break-through” symptoms. She is sitting in her dark wood-paneled office, the seriousness of which is undercut by the small animal sculptures—a polar bear here, a skunk there—that occupy every surface not covered with books or papers. “All I wanted to do was die. I couldn’t function. I couldn’t function, but I did function—there’s an interacting shell you present to the world. But I had no fun, which for me was inconceivable. Life, to me, was fun. Then, all of a sudden I had no pleasure in doing anything. I had no name for it, no notion of what it was. Several of my teachers called me aside and said I looked terrible. But they didn’t say ’depressed.’ Back then, nobody thought people in high school were capable of feeling like that.”
The depression broke after several months—even untreated, the mood eventually swings back, although the depressive periods generally last much longer than the manic ones—and Jamison recovered quickly. “When you recover, you’re so normal,” she says. “It’s one of the things that can be deceptive. It’s like having a very bad flu, during which you promise that you’ll do this, that and the other thing, and you’re going to appreciate life more when you feel better. I’m amazed at how rapidly one feels normal and takes it for granted.” (Left untreated, a person with manic depression can expect to have at least 10 manic or major depressive episodes in a lifetime. Treatment is believed to help shorten the episodes and lessen the severity of symptoms.)
Although she had several other depressions and mild manias during college, it wasn’t until after graduate school that Jamison began having floridly manic episodes. They started with the joys of hypomania, “which is very productive, and I would be zipping around like Crusader Rabbit,” she says. “I would be crazy with my boyfriend, who was a very straight arrow and thought it was great, up to a point.” But the symptoms gave way to more agitation and racing thoughts, and crested with textbook hallucinations, grandiosity, bad judgment and hyper-shopping—the kind of experiences that can sometimes make for amusing stories afterward (if you make it to the afterward).
“There is limited humor about physical illnesses, cancer, but illnesses of the mind make for greater humor. The delusions in and of themselves are hilarious.”
“Most of the jewelry and furniture are things I continue to enjoy, actually,” Jamison says with a slight grin. “I do remember once whipping around a drugstore, convinced there was a major rattlesnake problem in the San Fernando Valley. As it turns out, there is a problem, but not something to worry about. I got worried about it. They had these snakebite kits, very portable, and I knew every one of my friends would want to have one. So I bought all of them, a shopping cart full of them … My brother is an economist for the World Bank—he helped me pick up after my manic sprees, when I was hopelessly in debt.”
“This can be one of the funniest illnesses,” says Bob Boorstin. “There is limited humor about physical illnesses, cancer, but illnesses of the mind make for greater humor. The delusions in and of themselves are hilarious.”
For 12 years Jamison refused to get help. “The hallucinations and delusions would last for a while, and I would sit outside the student health service thinking I should go in,” she recalls. “I knew I was really disturbed. But I was from a very WASP military family. You figure it out for yourself … You just go on… Which is probably why I spend a lot of time in my life in churches … I also walked endlessly, which is what I still do. There are lots of ways, but you have to handle it.
“I was lucky I never got into drugs. And, although for a brief period in high school I would put vodka in my orange juice before I went off in the mornings, I never got into alcohol. Something like 50 to 60 percent of people with manic-depressive illness have substance-abuse problems because they ’self-medicate.’ I had alcoholism in my family, and it was just something that frightened me. But the times that I have had anything to drink was when I got manic, to bring myself down again.”
Ever since college she had been surrounded by mental health professionals, but her illness escaped detection. “People are remarkably intolerant of mental illness and remarkably tolerant of deviance,” she says. “You can do some very strange things, especially at a university, and not get picked up for it. People give people a very wide berth … and I’ve never been struck that people are terribly observant about psychological pain.”
After years of studying and working with psychiatrists, Jamison finally saw one at age 27. He put her on the mood stabilizer lithium, which, at that time in the early ’70s, had only recently come into common use. It was revolutionizing the diagnosis and treatment of manic depression (making it easier to distinguish from schizophrenia), and also offered the nascent world of psychopharmacology its best model for a “maintenance drug” to treat a serious mental illness. Jamison was lucky in one respect: Her illness responded to lithium. Not all manic depression does, and it is now known that there are many variations of the illness. Lithium responders are more likely to have the “classic,” long swings of full-blown mania and depression. But those who experience “mixed states” or “rapid cycling” of moods (over hours or days rather than months) are less likely to respond to lithium. And it wasn’t until very recently that several anti-seizure medications proved useful for them as primary mood stabilizers (to which antidepressants, anti-psychotics and other medications can be added when necessary).
Although lithium worked for her, Jamison, for many years, had the common problems staying on her medication—as soon as patients feel better, they often stop taking the drugs that make them feel better, or, in the jargon, they become “noncompliant.” And she has experienced some of lithium’s more extreme side effects, especially before she realized that her mood could be stabilized with a lower, less debilitating dose. For more than a decade, what turned out to be an unnecessarily high dose of lithium left her essentially unable to read. “It’s a rare side effect,” she explains, “a form of neurotoxicity that causes blurred vision mixed with some inability to concentrate. I had to work very slowly, rereading over and over again. It was a period of enormous frustration and throwing books against the wall.”
Jamison has never been hospitalized for her illness—partly because during her worst periods she had doctor friends who took care of her at home so she wouldn’t have to be treated among her own patients. Avoiding the hospital, she now says, “was a stupid thing to do, and it’s what people do all the time. It’s what my colleagues [who have the illness] do … at all costs. It’s barbaric. You should be able to just check into the hospital and get well. It’s bad enough to have the disease—why should you also have to wonder what it will cost you personally and professionally?”
She says she has tried to kill herself only once, a year or two after she began treatment, with a deliberate lithium overdose (coupled with an anti-emetic to keep her from throwing up.) But she has had more than her share of what is called “suicidal ideation”: self-murderous thoughts that spring not from dire circumstances but, seemingly, from the illness itself. She offers a striking example of the difference between depressing things happening in your life, and the onset of a suicidal depression. Recalling her late fiance, she says, “David Laurie’s death was so much easier than depression. It was devastating to my future and my dreams, I was very unhappy. But it never once occurred to me to kill myself then, not for a second or half a second.”
She has kept her illness hidden from everyone except those who needed to know—and has made sure there was always someone there to flag her if a problem arose. Those who had to know were generally supportive. “I remember when we were trying to put together the mood disorders clinic,” she says. “My chairman at UCLA could have had some problems with that: I mean, I was a woman, only a PhD, and manic-depressive, any one of which was not a great calling card for heading a clinic. My chairman came up to me one day and said, ‘Kay, I understand you’ve got some problems with moods. Well, just keep taking your lithium and make sure you’re doing that and you’ll be okay. It’s a treatable illness.’ I remember bursting into tears. I mean, it is a treatable illness, but his kindness and his way of seeking me out … it was very clear he thought I would be just fine.”
In the past 10 years, since she has been taking lithium without fail, her illness has been under control. There have been no long incapacitated periods, “although there have been some terrible days for sure.” If she falls into another deep depression, her psychiatrist, who lives in California, is under orders to prescribe her electro-convulsive therapy. She has never had the treatment—which, in its new, more humane version, is making a comeback as an adjunct or alternative to antidepressant medications—but wishes it had been more popular when she experienced the worst of her depressions in her twenties and thirties.
The suicidal ideation has become just part of the fabric of her life. “It’s an unnecessary early death,” she says, “but I’m not just being philosophical when I say I might die that way … I don’t go around talking about it, but it’s common to me. I talk about it to myself a lot.”
In the medical community, diagnosing famous dead people is like a parlor game that can’t necessarily be won. It is commonly played at conferences or in journals after the more serious papers have been presented. But Jamison takes the game seriously. Because she isn’t just trying to make a better diagnosis than her colleagues. She is trying to use the enterprise as a way to draw attention to the unfolding science of manic-depressive illness—the NIMH estimates that roughly 95 percent of what is known about the brain has been learned in the past 10 years—and to improvements in psychiatric care. She is using long-dead celebrities to endorse new approaches to diagnosis and treatment.
Game or no game, posthumous diagnosis is a tricky business. And an active one: Vincent van Gogh, for example, has had over 100 different posthumous diagnoses. Over the years, his work has been cited as a possible “silver lining” for conditions ranging from glaucoma to epilepsy to tinnitus (ringing in the ears.) And, each time, there has been debate on the accuracy of the diagnosis and the implications of linking art to disease. But there is more at stake when trying to make a psychiatric diagnosis stick, because psychiatry carries a stigma that, say, neurology doesn’t (even though the line between the two is getting thinner). The mental health field is still trying to battle the impression that its diagnoses are “softer” than those in other health care specialties—a view that’s held even by some psychiatrists and psychologists, who resist the “medicalization” and standardization of mental health care as antithetical to treating the individual problems of individual patients. In traditional psychoanalysis, once the preferred treatment for all mental illness, a diagnosis was what you worked toward, instead of what you started with.
Jamison’s work on creativity thrusts her into the middle of the very political science of mental health care. At the theoretical level, there is still a battle being waged between nature and nurture, a battle that too easily breaks down into biology versus psychology or pills versus psychotherapy. At an economic level, psychiatrists, psychologists and social workers are all fighting for the psychotherapy dollar while psychologists are lobbying for a piece of the psychiatrists’ prescription-writing privileges. Advocacy groups for the different psychiatric illnesses compete as well. It may seem benign to want to call attention to an illness that, according to the Department of Health and Human Services, will cost the average untreated 25-year-old woman nine years of life, 12 years of normal health and 14 years of activity (including job and child-rearing). But, in the current mental health environment, nothing is benign.
The strongest public attack on Jamison’s work has come from a Freudian medical psychologist who sees Touched With Fire as a well-written, thoughtful piece of “propaganda” for modern biological psychiatry. In a 1993 Washington Post review of the book, Saul Rosenzweig, a professor emeritus of psychology and psychiatry at Washington University in St. Louis, called Jamison’s medical diagnoses “dubious.” He accused her of having a “genetic bias about the origin of manic-depressive illness” and criticized her dependence on “the assumpion of a genetic, inherited, unitary disease.” Jamison replied to Rosenzweig in a letter published in The Post, arguing that his review “rather ironically illustrated one of the major reasons I wrote the book … [and] underscored a seeming unwillingness to consider the scientific advances of the past 50 years.”
Rosenzweig, reached by phone in St. Louis, elaborates on his opinion. “To diagnose a dead person from documentary evidence is always hazardous,” he says, “and in some cases I think the evidence contradicts her. To say Henry James was manic-depressive … well, I just don’t think there’s much evidence of that. He was depressed and was frustrated and had inferiority problems—I’ve published on this subject myself—but to say he was manic-depressive, I don’t see that.
“But, more important, she has equated creativity with manic-depressive psychosis … Her thesis is an overstatement. I don’t deny for a minute that a number of creative individuals may have manic-depressive illness. But you can have hysteric states because something wonderful has happened to you and can get depressed because of something you have not gotten—to deny such situational events and call them manic depression … to say that individuals who have moods are manic-depressive, that’s ridiculous … that’s extreme, that’s medically unsound.”
Rosenzweig regards much of modern biological psychiatry as a reductionist fad. And Jamison regards Rosenzweig as a psychoanalyst of the school whose training would put him at odds with her own, more biological predisposition. She concedes that there are some built-in methodological problems in her studies of artists. “You’d have to be completely stupid or crooked to say otherwise,” she has said. “Any study anywhere in which there’s a combination of science and art is going to be flawed … but if you have a group of studies … all using dissimilar methods, different groups of artists and writers, and they’re all coming up with the same finding … you have to ask, ‘Is it just chance?’ ”
But she is irked by the charge of reductionism. It sometimes comes up during question-and-answer periods, where Jamison has been accused of “reducing the mystery and wonder of artistry to genetics and brain chemistry,” according to Johns Hopkins Magazine.
“I gave a talk on Poe recently,” she says, “and I went out of my way to say that he was obviously a complicated, interesting man, but I was only going to address one aspect of his life—the moods he had,” she says. “A guy comes up to me afterwards and says, ‘You reduced everything in the world to biology.’ I was so ticked. I said, ‘Yeah, it’s because I’m a reductionist pig. I don’t believe in complexity.’
“The assumption is if you don’t make things complicated you are incapable of understanding complexity. One of the reasons people with manic depression have had a bad time in treatment is because their dreams and experiences are so interesting. There’s enough fodder there to fuel any theory, any psychological theory … Look, the thing the writers who have had the illness can do is to describe the feelings, and that’s important. But if you’re treating somebody, you have an obligation to find out what’s wrong with them. If you’re treating somebody with cancer, of course you want to know what the experience is like. But first and foremost you want to find out what the tumor is and whether it will respond to radiation. Nobody says they’re reductionist because they want to find the tumor. Somehow in psychiatry if you try and be precise and match your treatments with a diagnosis, that’s seen as less complex, less humanistic.”
Another, more subtle criticism of Jamison’s work comes from a researcher whose professional politics are closer to her own—E. Fuller Torrey, a bestselling author and outspoken schizophrenia researcher at St. Elizabeths Hospital. Torrey, ever since his 1972 book, The Death of Psychiatry, has been a lightning rod for controversy and an outside political agitator. There are similarities between his attempts to draw attention to schizophrenia—which his sister has—and Jamison’s efforts. It could be argued that the difference between them is the difference between the severity of the two illnesses, and the cultures that have sprung up around them. (There’s a reason that when Bob Boorstin was hospitalized a second time for a manic episode, he hung a sign over his bed reading “thank God I’m not schizophrenic.”)
But Torrey has some concern about secondary symptoms caused by her work. “I think there’s a real danger in what Kay does,” he says. “The danger is the romanticizing of serious mental illness … Our tendency is to romanticize Sylvia Plath or someone like that without asking whether, if they hadn’t had the disease, they wouldn’t have produced better things over time.”
Jamison agrees that there is a danger in romanticizing mental illness, and throughout her work she raises the question of what these artists might have produced if they had been treated. But she is less certain than Torrey about one big issue: whether these artists would still be artists if they hadn’t had the disease at all. It may be, she speculates, that the illness somehow enables the art, while at the same time destroying the artist. And it may be that the art itself springs from something as dramatic as composers and visual artists trying to re-create their psychotic experiences—or from something as subtle as writers using their abnormal range of emotional experiences to observe human nature in a unique way.
During her talks, Jamison often asks whether we would lose our artists if their manic depression was properly treated. The politically correct answer—because no responsible clinician would dissuade a patient from treatment—is “no, we wouldn’t lose them.” And that’s what she says publicly. But privately she admits that the truth is not so easy. There are trade-offs, and Jamison knows from her patients and friends—as well as from her own experiences—that medications can dampen more than just the troublesome symptoms. Sometimes the choice almost seems to be between quality of life and quantity of life. At any rate, Jamison seems to respect our need for the artist and the art somewhat more than Torrey, who says, “Hey, I would quite happily lose a van Gogh to treat the disease.”
Even Bob Boorstin says he understands why some people criticize the effect of Jamison’s work, if not the work itself. “I think that she has done a great service by addressing these historical figures … and finding that link between creativity and the illness,” he says. “And her books make it very clear that you can have this illness and contribute to society. On the other hand, her work does distort the illness.
“Why? Pretty simply, the only people who left records were the creative people. There must have been hundreds of thousands of middle-class folks who lived alongside Byron and van Gogh who had these illnesses, and we don’t know about them because they didn’t leave letters or diaries. There are millions of people in this country who are not celebrities who have these illnesses … In a way, Kay has glamorized this illness. And for people who deal with it on a day-to-day basis, who don’t have the money, who don’t have access to the best treatment, this is not a glamorous thing. This is something that ruins their lives.”
In 1987, Jamison moved to Washington to be closer to Richard Wyatt, and joined the faculty at Johns Hopkins. A year later, she produced a much grander version of the “Moods and Music” concert. This time it was a gala evening held at the Kennedy Center and taped for a PBS special. The concert was sponsored by the NIMH, the Johns Hopkins psychiatry department and the foundation Jamison had set up to increase public awareness of mood disorders. The concert board included Patty Duke, Katharine Graham, Armand Hammer, Sens. Orrin Hatch and Edward Kennedy, National Gallery Director J. Carter Brown, James Watson and Frances Lear, who donated over $250,000.
The advisory board included a number of the leading lights of psychiatry, including Mogens Schou, the Danish researcher who did the important studies that established lithium as a treatment for manic depression (and, as far as Jamison is concerned, saved her life). Among the co-sponsors were most of the major mental health advocacy groups, including the “consumer”-run National Depressive and Manic-Depressive Illness Association, where Jamison is on the board, and the more politically powerful National Alliance for the Mentally Ill, which had been started by parents with adult children suffering from schizophrenia before branching out into lobbying for all serious mental illnesses.
The PBS special didn’t air until 1990. That same year, the Goodwin-Jamison Manic-Depressive Illness textbook was published. The first comprehensive book on the subject in decades, it was greeted with dizzyingly positive reviews. (It was named “Most Outstanding Book” in the biomedical sciences by the Association of American Publishers.) At the same time, Jamison was putting together another PBS special. “To Paint the Stars: The Life and Mind of Vincent Van Gogh,” which brought together many of her same supporters, had its premiere at the National Gallery of Art. The program, of course, only added to the century-old debate over van Gogh; fewer people are fighting over Schumann and Handel.
“I hope my book will bring the illness out of the closet for professionals. There are a lot of lawyers and doctors and clinical psychologists who don’t get treated for fear of hurting their clinical privileges.”
By this time, besides her teaching at Johns Hopkins and her private psychotherapy practice, Jamison was working on expanding her chapter on creativity in Manic-Depressive Illness into an entire book. It was to include all her published research on the subject, as well as bring together pieces like an afterword she wrote for a book in which the author diagnosed Virginia Woolf’s manic-depressive illness. Touched With Fire was published by Free Press in 1993, and while she was giving interviews and lectures to support it, she was also working on the Lord Byron program, “Taint of Blood,” for public television. (The filming in Britain and at James Watson’s molecular biology lab in Cold Spring Harbor, N.Y., has been completed, but the show is still in post-production.)
It was during this time that she started seriously considering a memoir of her illness—encouraged by Erwin Glikes, her editor at Free Press. She decided to “come out,” she says, because she spends so much time encouraging patients to feel they can talk about their illness. “Part of my efforts are to increase the quality of medical care that people receive for this illness and get the public aware that the illness is treatable and so forth. But a good chunk of my time goes into destigmatization, because the stigma attached to mental illness is such a serious problem, and I think people should be … able to talk about it.
“I also hope my book will bring the illness out of the closet for professionals. There are a lot of lawyers and doctors and clinical psychologists who don’t get treated for fear of hurting their clinical privileges. Or they keep it so much on the sly that they don’t cover themselves. I heard about a surgeon who was manic and just kept cutting: The surgical team had to land on him. If that surgeon gets treatment, and other people know about it, and can pull him off early enough, and he’s a good surgeon, then … well, why should he be judged by anyone else?”
Jamison and Boorstin have talked a lot about how she’ll be judged. “I tried to show her the upside and the downside,” he says. “I discouraged her from ‘coming out’ in terms of how it will affect her position within the scientific community. I’m sure I said ’they won’t take you as seriously,’ because psychiatrists are notorious as the least sensitive people towards illness in a certain way … the closer you get to mental illness, the more you see how thin the wall is between sanity and insanity and how easy it is to leap that wall. Because psychiatrists are exposed to this, they become better at denying—they’re experts at denial. And that’s a problem that Kay will face.”
The problems of mental health professionals with treatable mental illnesses are still only whispered about, although there was a telling scene at the most recent convention of the American Psychiatric Association. At a panel discussion on stigma and celebrity—in which Art Buchwald, Rod Steiger, Suzanne Somers and Cathy Cronkite told of suffering in the closet—a psychiatrist rose during the question-and-answer period and announced that he had been treated for depression and was tired of the prejudice. The audience of psychiatrists gave him the loudest round of applause of the day.
Jamison’s book has been written during a period that might test anyone’s mood. Last spring, Richard Wyatt was in and out of the hospital with heart problems. (After his second hospital stay in six months, the couple eloped to Scotland.) Then her editor at Free Press died suddenly, just as she was about to finish up the book. After recovering from the shock, she realized that her extremely personal book now had no editor with an extremely personal attachment to it. She vacillated between finishing it, or turning into an academic memoir that didn’t include her illness. Instead, a literary agent helped her quietly test the interest of more commercial publishers.
The book was recently sold, for an advance far higher than Free Press ever would have paid, to Knopf. It is scheduled to be published in the fall. The tentative title is An Unquiet Mind.
When it comes out, Jamison will get something more profound than just book reviews. By making the leap from writing about the psychiatric problems of dead people to writing about her own psychiatric problems, she will get a chance to see firsthand just how successful her attempts at destigmatizing the illness have been. She will find out if she has really made the world a safer place to have manic-depressive illness. It’s a rare opportunity that is perhaps rare for a reason.
The book has already caused a major change in her life. She doesn’t feel that “coming out” in and of itself should prevent a mental health professional from doing psychotherapy. But An Unquiet Mind will explore so much of her private life—the sections I’ve read are painful, revelatory, moving—that she isn’t sure she can be a blank enough slate any longer. She plans to continue to do clinical teaching at Johns Hopkins and consult on patients hospitalized there, but she has stopped taking new patients and is considering terminating her psychotherapy practice.
“These are totally uncharted seas,” she says. “Most people will be understanding and some people will say, ‘What on earth is she saying all this for, whatever happened to the days of privacy and discretion?’—all those things I hear from my childhood. You don’t have any idea how many years I’ve thought about doing it, and whether the benefit would outweigh the disadvantages. I don’t like people knowing about my psychiatric illness … it’s a very disturbing thought.”
At least she will no longer have to worry that someone will realize that some of the “patient” excerpts she uses in teaching and writing are, in fact, from her own journals.
At the beginning of one textbook chapter, for example, she includes an excerpt in which she identifies herself as a “patient with manic-depressive illness.” Addressing her therapist, she writes: “I remember sitting in your office a hundred times during those grim months, and each time thinking, what on earth can he say that will make me feel better or keep me alive. Well, there never was anything you could say … [just] your granite belief that mine was a life worth living … you taught me that the road from suicide to life is cold and colder still, but—with steely effort, the grace of God, and an inevitable break in the weather—that I could make it.”
It’s the ultimate doctor-patient relationship. “I have thought several times over the years, ‘What if somebody recognizes the stylistic similarities?’” she says. “When I would use those excerpts in teaching, I would be concerned that my level of intensity while reading something very personal would show through. And it would be apparent to people. I was honored at a DRADA dinner recently, and I ended my talk with a passage that a ‘patient’ had written. I was convinced that everyone there had to know I was talking about myself.”