Thepreeminent onbipolar
experl discusses
disorder
poetry, mixed that
Prozac, thetormenting states
and
have ofthe
changed understanding disease
our
Interviewby Pamela Weintraub Photographs by Miles Ladin
I F BIPOLAR disorder has a voice, it belongs to Kay Redfield famison,
I professot of psychiatry and director of research at the Mood
I Disorders Program at |ohns Hopkins University in Baltimore. In
I 1995 lamison, then at UCLA, burst onto the national scene with
her memoit An Unquiet Mind, about her personal experience with
the disease. It was surprising that a university professor, a clinical
psychologistwho treated patients no less,might be so open about her
life, but it was more shocking still to hear her actual account,a marathon
of psychosisand despairlong hidden from view. From her early manias
to her bout with suicide to her uneasy ddtente with a savior, lithium,
Jamisonrevealedall.
Rather than steamrolling her career,the confessional vested)amison
with a new authority as someone who scientifically studied her own
illness.Over the years she has written other acclaimedbooks: Touched
With Fire, about manic-depressive illness and the artistic temperament;
Night Falk Fasf, about suicide; and Exuberance, about people on the
bipolar spectrum who live lives of high-voltage energy without ever
getting depressed.
But famisont greatest accomplishment may be the tome Manic'
Depressive lllness, the seminal work on the disease,which she cowrote
with colleagueFrederick K. Goodwin. The first version was published
in 1990; in 2007, with advances in neurobiology, psychology, and
psychopharmacology, revision presentsmanic-depressive
a illness in a
radically altered light.
Jamisontook time from correcting galleysto meet with DISCOVER
writer Pamela Weintraub.
Tea and sympathy:
Jamison at a caf6 near her
home in Washington, D.C.
"When
people into
get these mixed they
states, experience
anelectrically
wired
sensation, , it isa kind energy you
,, of that can't off,"
walk
your
Explain decision discuss
the to You'reboth goingthroughand studyingthis no control over what you see,hear,or think. It's
illness
openly. condition. Doesthat alter your scientific lens? worse than depression, where you have no hope
I did it because one of the problems of having It gives a different perspective. My researchhas and no energy and you want to die. As bad as
this kind of iliness is that people don t talk focused on the areasthat I deem imDortant- that is, it isn t as terrifying as losing your mind.
about it. As a result people don t understand it, first and foremosthow lethal the illnessis. It
don't realizeit can be treated,and dont know is very deadly.Suicideis as much a result of Are changing mood states integral to some art?
how devastatingit is. When I first got ill, my bipolar illnessand severedepressionas heart I give lectures in the department of English
mother, who is a great mother, had no idea what attacksare a result ofcardiovascular disease. once a year at St. Andrews in Scotland,in a
was going on. She said, "I really wish I could At the sametime, people with the illness can department permeatedwith poets.Four of
understand what it feelslikel'She'sso normal find parts of it seductive,making long-term the top Scottish poets are in the department.
that she had no idea. treatment dilicuit. For people who have a They are actually pretty normal, but two
euphoric kind of mania, it is addictive. You are are moodier than the others. If you look at
How does the illness manifest itself? asking people to give up statesthat they have the pedigree of these people, their family
Manic-depressive illness magnifies enjoyed and want to recapture. history is full of manic depression.These
common human experiences larger- to disorders are on a spectrum with a range
than-life proportions. Among the symptoms Who would want to give up the heightenedenergy of milder stateslike hypomania Ielation or
are exaggerations normal sadness
of and and awareness? irritability without the psychosis;a mild
joy, profoundly altered thinking, irritability Peopletend to forget the worst part of the form of mania], cyclothymia [alternating .
and rage,psychosisand vioience,and illness.Your mind goesfrom being wonderfully hypomania and depression], and hyperthymia,
deeply disrupted patterns of energy and engagedwith everything at the start of mania to which is somewherebetweencyclothymia
sleep. being fragmented and out of control. You have and exuberance.Poetry requires a primitive
52
cadence and rhythm and intensity of It sounds
excruciating. Arewegettingbetter detecting
at mental
iilness
at
experience, poets are more likely than
so These patients are incredibly uncomfortable itsearliest
stages?
other writers to appear on the spectrum or becausethey experiencethe worst of mania and We are doing in psychiatrywhat has been done in
have mood disorders.Some produce their depressionat the sametime. Hopelessness and hlperlension-looking at lesssymptomatic people
bestwork in their twenties and thirties. before despair combine with a restlessenergy. When earlier in the game.It is alwayseasierto treat
the illness has taken its full toll, then many of people get into mixed states, they experiencean something earlier in a milder form, and that'swhat
them die young. electricallywired sensation.They are agitated, we're trying to do. In general, you want to treat
perturbed, restless, and desperate-it is a kind kids before there is much chancefor their brain to
Youprefer termmanic
the depressionbipolar
to of energy that you can t walk off. There are be adverselyaffectedby disease.
"bipolar" currently
disorder, though
even is in many t)?es of mixed states, but the one I've
uogue.
Why? just described,agitateddepression, the most
is But you now have peoplewho are less pathological
Bipolardisorder involves polarity-periods common and the most lethal. and who have beentreated with antidepressants
of euphoric mood or extreme irritability and earlier.
paranoia with high energy alternating with Commenttheuproar antidepressants
on over and Kids in collegemay be depressed and be put on
periodsof despair and profound lassitude. suieide. an antidepressant. The doctors involved may or
Butthe presenceor absenceof mania is just For a number ofyears the onus has been put may not know what they are doing. The kid can
oneaspectof the illness. The other important on the drugs, but the real issueis the diagnosis then get full-blown mania or mixed states. When
is
aspect cyclicity. The more recurrent one's ofthe different kinds ofdepression.People we intervene in psychiatric illnessmuch earlier,
depression, more it looks like bipolar
the with bipolar depressionusually need mood there is that risk. I alwayssaythat I had the great
illness,whether.mania is present or not. stabilizerslike lithium or anticonvulsantslike advantageofnot having been treated for many
Beyond this, mania and depressioncan coexist Depakote.Antidepressants like Prozaccan years.I wasn'tmade worse by an antidepressant.
in the sameperson at once. Thesemixed agitatethem and can push them toward suicidal Even though when I got into treatment it was an
stateshavebeen observed for hundreds of thought. Unfortunately,the stateofthe science emergencyand I was crazy as a hoodoo and totally
years the transition points between mania,
as is such that you cannot always say for certain manic, at leastfor the 10 yearsbefore that I had
depression, normalcy. People can have
and which people belong in which group. I was put not been made worse by antidepressants. was I
mixedstates, not just as transition points but on antidepressants a superb doctor and I
by fortunate in having a pure responseto lithium,
astheessence the illness.
of went nuts. uncomplicated by antidepressants.
53
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