Kay Redfield Jamison
Appearances
Short Wave
Unpacking Bipolar Disorder
It was undeniable. I mean, I knew I was psychotic. I knew I was completely beyond the pale. And the people who were around me knew that. And so I had to go to a doctor for the first time. And fortunately, it was a doctor who knew what he was doing, a deeply skilled psychiatrist, psychopharmacologist, psychotherapist, all rolled into one.
Short Wave
Unpacking Bipolar Disorder
The thing I would emphasize from the start over and over again is that it's treatable. And it's really important to get it treated because it's also very associated, more than anything really, with suicide, with substance abuse, with a great deal of suffering for individuals who have it and for family members.
Short Wave
Unpacking Bipolar Disorder
Well, yes and no. I mean, it's hopelessly complicated. You're talking about an illness that affects mood, motivation, behavior, personality, temperament. You know, it affects so much of what goes on in a very complicated brain. I would say what we do know is it's genetic, has a very strong genetic component. It runs in families and people have known that for hundreds, if not thousands of years.
Short Wave
Unpacking Bipolar Disorder
And the research is going on now, uh, to try and find out what causes bipolar illness would focus on the changes in biorhythms in the brain, the body, but certainly genetics.
Short Wave
Unpacking Bipolar Disorder
In depression, the mood is overwhelmingly hopeless, despairing, lack of pleasure and things that you would ordinarily find pleasure in. The mood and mania most of the time is euphoric, expansive, grandiose. People feel like they can do anything about this energy.
Short Wave
Unpacking Bipolar Disorder
Certainly, some people would say environmental factors. But the genetic propensity has to be there. So I think that if you look, once people reach the age of risk, which in bipolar illness was about 18 or so, then things we know are very likely to precipitate the onset of mania are sleep deprivation. And substance abuse, particularly alcohol, marijuana.
Short Wave
Unpacking Bipolar Disorder
This is really unfortunate for college kids because they're right at the age of risk. And when they go off to college, they stay up all night. They leave their work to the last moments. And parties and using alcohol for the first time are bad. increasing their alcohol level.
Short Wave
Unpacking Bipolar Disorder
There are all sorts of combinations. Oddly enough, the major, the gold standard of treatment for bipolar disorder, which remains lithium, one of the best predictors of lithium outcome is whether your mania comes first, followed by depression or the other way around. So people who have manic periods first tend to be more responsive, respond better to lithium.
Short Wave
Unpacking Bipolar Disorder
I don't think anyone really knows. It's just that we know that at the heart of bipolar illness is the tendency to fluctuate, to often be seasonal, to come and go. And lithium, above all else, affects that rhythmic pattern.
Short Wave
Unpacking Bipolar Disorder
You know, it's like any field, I think, in medicine. If you get a wrong diagnosis, you're going to get likely the wrong treatment. And it not only can not do anything to remedy the situation, but it can make people worse. For example, antidepressants, however effective and important they are for major depression and anxiety and other things, in
Short Wave
Unpacking Bipolar Disorder
can in many people with bipolar illness make people worse. So you've got to get it right. It's not enough to diagnose depression. You've got to know whether that depression is in the context of somebody who has bipolar illness or in the context of someone who has depression alone.
Short Wave
Unpacking Bipolar Disorder
So there are two major clinical problems in treating bipolar illness. One is to get people to acknowledge or recognize that they have something that needs and can be treated. That's one thing. The other thing is once they're in treatment, to keep them in treatment because people tend to quit, particularly younger people.
Short Wave
Unpacking Bipolar Disorder
And it will tend to get worse over time if it's left untreated and much harder to treat. When I'm teaching residents at Johns Hopkins, I always emphasize that's the art and science of treating mood disorders. It's just they're complicated. There are huge feelings involved and denial and hopelessness. So the very thing that you need to get better, which is your brain, is making you hopeless.
Short Wave
Unpacking Bipolar Disorder
And so I think you need to educate patients. family members to the extent that you can get families in to talk about what's going on, what kind of questions, what kind of plans should be made if somebody gets manic or somebody gets depressed or somebody gets suicidal. I mean, there are all sorts of things that you can do just by being straightforward and educated yourself as a clinician.
Short Wave
Unpacking Bipolar Disorder
For sure. You don't want to... consider happiness and joy to be a symptom of psychopathology, you know? Right. You want to go through life with a full range of emotions. One of the things that people do, my colleague at UCLA, David Miklos, does with adolescents, for example, is to and their family members, is to make people more aware of when their moods are getting up.
Short Wave
Unpacking Bipolar Disorder
So if somebody's starting to buy more things, or somebody's staying up too late, or somebody's starting to clean the house, which is a very common sort of thing. The earlier you can catch mania, incipient mania, the easier it is to treat, and the less damage and harm
Short Wave
Unpacking Bipolar Disorder
Well, I think writing 1,400 pages of very fine, double-columned textbook, it was very therapeutic in many respects to just find out what's known in the field and what's not known. But when I decided to write about my own experience, I was terrified for a lot of obvious and a lot of not-so-obvious reasons. I was very concerned about my...
Short Wave
Unpacking Bipolar Disorder
state licenses in California in the District of Columbia, and how my colleagues would think about me, whether I'd lose my job. But the writing of An Unquiet Mind was actually very easy and very pleasurable. I've always loved reading and writing. I mean, I think I had been very fortunate when I was in high school to have a high school teacher that
Short Wave
Unpacking Bipolar Disorder
took me very seriously and I think understood that I was having a breakdown, but never said anything, but just gave me some books to read. And among them was Robert Lowell, great American poet. And his life, his courage, the complexity of his thinking and problems and his 20 hospitalizations with mania were to me, Just an extraordinary gift to my life.
Short Wave
Unpacking Bipolar Disorder
I mean, there are pieces of music and literature that you cannot believe. can be so beautiful. I mean, I don't sit around putting Beethoven on when I'm depressed and get a chirpy. But I do find the very fact that it exists when I'm feeling normal a remarkable, sustaining thing.
Short Wave
Unpacking Bipolar Disorder
Mainly, he's just remarkably kind, funny, loving. person who respects privacy. And I couldn't be luckier. I wake up every morning and say, I'm the luckiest woman in the world.
Short Wave
Unpacking Bipolar Disorder
And all of a sudden, I not only had no energy, I was morbid. I wanted only to die. I had never had any of these thoughts before. which is not uncommon. Some people have kind of pre-morbid personalities that are consistent with this. Other people are just like I am. It's like a bolt out of the blue, and you have no idea what's going on.