It took almost 15 years for actress Patty Duke to understand the condition that had caused her so much pain and emotional turmoil: suicide attempts, fragmented relations with friends and family members. She would cry for days at a time -- or scream for hours until, exhausted, she simply had to stop. Her behavior was so erratic her young sons would become alarmed if she locked the door to the bathroom.
Magazine publisher Frances Lear endured three suicide attempts, three failed marriages and the same alarming mood swings -- times of extraordinary joy and the most inexpressible mental anguish.
For Ms. Duke, life did not change for the better until 1982, when a psychiatrist offered this diagnosis: She was manic-depressive. But far from being upset at the news, her reaction was simple joy. "They were the two best words I ever heard," she writes in her just-published book, "A Brilliant Madness: Living With Manic Depressive Illness" (Bantam Books). "They described how it felt to be me."
Now Ms. Duke, 45, has emerged as a national advocate for the diagnosis and treatment of manic depression. On her current tour to promote "A Brilliant Madness," she has appeared on several national talk shows, including yesterday's segment of "The Sally Jessy Raphael Show," which was centered around the theme of manic depression.
"My job is to tell some of what it felt like, because I have a facility for communication," the actress said in a recent interview in Washington. "And that's what I'm supposed to do -- to tell them how it felt, and to see if they feel similarly, and then [they could] head in this direction to a psychiatrist or a psychopharmacologist or certainly some kind of medical setting to get the right diagnosis."
Ms. Lear, too, was diagnosed as manic-depressive and, like Ms. Duke, she found help through therapy and medication. In her recently published memoir, "The Second Seduction," the publisher of Lear's also writes about her condition with great candor and hope for the future -- hers, and that of other manic-depressives.
"I live at the extremes," Ms. Lear acknowledged in an interview last month. "Manic-depressives do. Everything is black and white. Now that I am properly medicated, and monitored by a very capable psychiatrist, I see more gray. But all my life I have seen immensely happy pictures, or utter darkness."
That two such highly visible and successful celebrities as Ms. Duke and Ms. Lear are discussing their condition so openly -- and so positively -- is an indication that attitudes about manic depression are changing, say some mental health professionals.
"They're a real shot in the arm," says Gina White, media affairs director for the National Mental Health Association, of the books by Ms. Lear and Ms. Duke. "We certainly applaud them and encourage other people to speak out."
"It's great," agrees Kay Redfield Jamison, an associate professor of psychiatry at the Johns Hopkins University School of Medicine and a recognized authority on manic depression. "They have a credibility that no one in the medical community would have unless they are also manic-depressive."
About 20 million Americans are thought to suffer from affective, or mood, disorders. Of that number, about 2 million to 3 million are thought to have manic depression, which was first diagnosed at the turn of the century by Scottish psychiatrist Emil Kraepelin. There are many symptoms, including an unusual number of euphoric feelings, extreme irritability and sustained behavior markedly different from usual. Manic depression is thought to be genetically transmitted.
Due to the often dramatic symptoms of manic depression, it was, for many years, thought to be untreatable -- and quite exotic -- since some suspected sufferers were such creative minds as composers Robert Schumann and Gustav Mahler, writers Virginia Woolf and Edgar Allan Poe, and painter Vincent van Gogh.
However, since lithium was accepted about 40 years ago as a suitable medication to control the disease, attitudes about treating manic depression have slowly changed, Dr. Jamison says.
"It was always associated with being major-league insane, instead of its being a whole range of illnesses and temperaments," says Dr. Jamison, co-author of the 1990 book "Manic-Depressive Illness."
"Probably the most important thing is that once something pTC becomes treatable, it loses its stigma. With such drugs as lithium, manic depression has become remarkably treatable over the past 10 years."
Ms. Duke documented in harrowing fashion her tumultuous life in the best-selling 1987 memoir, "Call Me Anna." "A Brilliant Madness," co-written with medical writer Gloria Hochman, contains more of Ms. Duke's first-person accounts of living with manic depression and how it is treated, but also considerable information on the disease's history and how treatment of it has evolved. At the back is a list of organizations concerned with manic depression and other places where a reader could get more information.
"My job is not so much a spokesperson but a . . . I don't know, an example of both the horror and the 'ordinary' of manic depression," Ms. Duke said. "You know, I now have an ordinary life; I do ordinary things like take out the garbage like you do. I am no longer off the charts."
Ms. Duke also credits much of her recent tranquility to lithium, the most common medication used to treat manic depression -- "my little beige pill," she calls it affectionately in "A Brilliant Madness."
Though some patients complain of such side effects as lethargy and loss of memory, lithium has been remarkably effective, says Dr. Jamison. Still, for the approximately 30 percent of manic-depressive patients who do not respond to lithium, anticonvulsants, neuroleptics or antidepressants are often prescribed.
Ms. White cautions that although public attitudes toward manic depression have improved, "There's a long way to go. The association did a public opinion poll whose results were released in December 1991 . . . 43 percent of American adults still viewed depression as a weakness."
But Dr. Jamison remains encouraged. "It's amazing to me that I can go to a dinner party and that people can admit quite freely that they are on Prozac [a newer drug for depression] or other medication," she says. "Five years ago, people wouldn't have admitted that. Now they will."
The ups and downs
Manic depression involves episodes of serious mania and depression. These are some of the symptoms of mania:
*Increased energy, restlessness and rapid talking.
*Decreased need for sleep.
*Abuse of drugs, particularly cocaine and alcohol.
In a person's depressed cycle, symptoms may include:
*Feelings of emptiness.
*Loss of energy.
*Restlessness or irritability.
There are several organizations that offer information on manic depression and its treatment.
Depression and Related Affective Disorders Association Inc., founded in 1986 at Johns Hopkins. Call (410) 955-4647.
National Depressive and Manic-Depressive Association, 730 N. Franklin St., Suite 501, Chicago, Ill. 60610. Call (800) 826-3632.
National Mental Health Association, 1021 Prince St., Alexandria, Va. 22314. Call (703) 684-7722.
National Institute of Mental Health (Depression Awareness, Recognition and Treatment Program), 5600 Fishers Lane, Room 10-85, Rockville 20857. Call (301) 443-4140.