WASHINGTON -- She has lived her life dangerously close to the edge, soaring at times to the heights of creativity and pleasure, then crashing precipitously into the depths of despair and madness. More than most, Kay Redfield Jamison, a woman of great accomplishment, knows what it's like to teeter on cliffs of violent, terrifying, uncontrollable emotion.
And, more than most, she knows what it feels like to lose your footing and fall.
"Losing your mind is far and away the most terrifying thing you can experience," Kay Jamison says now, recalling a particularly bad episode of "madness" that occurred in her late 20s. "You are your mind. You are your emotions. And when your emotions are out of control and your mind is gone, there's nothing of you left. And I felt absolutely terrified.
"I knew who I was, but nothing had meaning for me. My thoughts were going so fast I couldn't keep up with them. I would be a few words into a thought and then I couldn't remember anything. When you see hallucinations, things that are not there, that's terrifying but for me, this was even worse."
Six months ago, Kay Jamison would not have been so open about her feelings of "going mad."
Six months ago, the 49-year-old psychologist and psychiatry professor at the Johns Hopkins University School of Medicine had not yet revealed a secret she had kept hidden for decades: her own lifelong battle against manic-depressive illness, the very disease that she has for years researched, studied and treated in her patients. Indeed, Dr. Jamison's work on manic-depressive illness -- she co-authored the definitive medical text on the subject -- has earned her an international reputation and something approaching celebrity status in the field.
But now Dr. Jamison has "come out" about her personal experience with the disease. In her riveting new book, "An Unquiet Mind: A Memoir of Moods and Madness," she boldly writes an insider's view of the extreme terrors ushered in on the arm of manic-depressive illness.
An honest, unflinching account of her struggle with this life-threatening disease -- which is believed to affect some 2.5 million Americans -- the book chronicles her journey from a "mild mania" stage in high school through her uncontrollable spending binges, promiscuity, mania and depression, her suicide attempt, her "war" with lithium treatment and the toll all this took on her personal life.
It also quietly notes how, even in the midst of all this turmoil, Kay Jamison somehow managed to earn her Ph.D in psychology at the University of California, Los Angeles and then rise through the ranks to tenured professor, director of UCLA's Affective Disorders Clinic, clinical therapist and now a full professorship in the Hopkins School of Medicine.
The decision to write a book revealing the secret she'd kept for so long from all but family and a few close colleagues was a risky one. For one thing, Dr. Jamison feared her work, both past and future, might now be perceived as "biased" because of her personal experience with the illness she was studying scientifically. And there was also the serious concern that revealing her illness, an illness that could interfere with her clinical judgments, might result in the loss of licensing and hospital privileges.
For those very reasons, family members and some colleagues cautioned her against writing the book. "I had many reservations, both for her personally and, even more, professionally," says her brother, Dean Jamison. "I thought it could affect her relations with Hopkins and her professional privileges. But I made it clear to her she had my complete support if she decided to write a book."
The chairman of her department at Johns Hopkins, who knew of Dr. Jamison's illness, was most concerned about what effect her revelations might have on her patients. "She's a very effective therapist," Paul McHugh says. "And I was particularly worried that if she revealed so much about herself and her illness, her patients might worry about her."
Others close to her, however, encouraged her to go public. "Kay's work has been the prime effort in this country to remove the stigma of mental illness," says Frances Lear, former publisher of Lear's magazine, who was diagnosed as manic-depressive in the early 1970s. "And I told her, 'You must remove it by erasing the stigma of your own perception of yourself.' When I came out, about 10 years ago, people knew very little about the illness. But Kay's work has opened that up."
In the end, Dr. Jamison decided it was not enough to devote just her professional life to the task of recognizing and treating manic-depressive illness. After years of promoting, through concerts, books and lectures, the connection between creativity and manic-depression and encouraging well-known professionals to speak publicly about their histories of manic-depressive illness, she was feeling "like a hypocrite." Then two years ago a chance remark by a friend set the book into motion.
"Someone made an extremely unkind remark about my having manic-depressive illness," Dr. Jamison recalls. "It was along the lines of 'How do you know you're not going to go on just having breakdowns?' The remark was designed to provoke. And it provoked. I felt a combination of being furious and devastated simultaneously. It just agitated me. So I started walking and walking and walking. Then I sat down and started writing."
A 'gripping story'
"Kay's book turned out to be an absolute page-turner," says Hopkins' psychiatrist Paul McHugh. "An absolutely gripping story. I've been asking patients who've read it what they thought -- and they all say, 'It's a comfort to me to know that a person as competent as she is could go through this and come out all right at the other end.' "
A page-turner, indeed. When Kay Jamison stopped walking and started writing "An Unquiet Mind" she did not write in the intellectually and emotionally objective voice of a researcher. In this book Kay Jamison is her illness, and she allows the reader to join her inside the burning fire and desperate blackness that accompanies manic-depressive illness.
Here she is, writing of the violence that could accompany both her manias and her depressions:
"Being wildly out of control -- physically assaultive, screaming insanely at the top of one's lungs, running frenetically with no purpose or limit, or impulsively trying to leap from cars -- is frightening to others and unspeakably terrifying to oneself. In blind manic rages I have done all these things. I have been physically restrained by terrible, brute force; kicked and pushed to the floor; thrown on my stomach with my hands pinned behind my back; and heavily medicated against my will."
And here is her description of how she lived shortly after her appointment to the UCLA faculty:
"Books, many of them newly purchased, were strewn everywhere. Clothes were piled up in mounds in every room, and there were unwrapped packages and unemptied shopping bags, as far as the eye could see. My apartment looked like it had been inhabited and then abandoned by a colony of moles. There were hundreds of scraps of paper as well... . Soon my rooms were further strewn with records, tapes, and album jackets as I went on my way in search of the perfect sound."
It is difficult to reconcile this written picture of a violent, out-of-control, chaotic Kay Jamison with the real-life woman.
Seated in a beige silk chair in her spacious, uncluttered, glacially-elegant living room, she is dressed in a loose-fitting gray sweater and long black skirt. A willowy blonde whose bangs brush the tops of her eyebrows, she wears little or no makeup. There's no trace in this Kay Jamison of the woman described in the book, the one who during manic periods favored seductive clothing and overdone makeup.
Nor is there any hint of the florid behavior that controlled Dr. Jamison's life for so many years. Instead, her manner is cool and cordial, almost as formal as the twin crystal chandeliers in her living room. Perhaps there is a slight impatience implicit in her rapid style of speaking, but she listens, as all good therapists do, with the utmost patience.
Such calculated observations of her style and demeanor, of course, are precisely what Kay Jamison worries about: that people will begin to watch her for signs of moods, of disharmonies, of a speeding up or slowing down that will link her to the manic-depressive woman in the book.
In the end, it seems what the book may take away from her is not her professional privileges but her right to express her personality without fear of being judged.
"Frankly, the book has changed my life a whole lot," she says. "It's hard having people who didn't know I had manic-depression -- who just took me in stride -- it's hard all of a sudden to have them wondering how much of that was a bit manic? Or a bit depressed? I don't like losing my humanity in that sense."
Being on display in this fashion, she agrees, is almost a prescription to fake an equipoise of moods that, in reality, few people possess. And, she says, sometimes she does fake it. But not often.
"Mostly I'm much less inclined to do that because I've been very reserved for many years, trying to keep people from having any semblance of a notion about my illness," Dr. Jamison says. "So I don't feel that kind of restraint anymore. However, just the awareness that so few of my colleagues seemed to have had any idea that I had manic-depressive illness makes me think a little bit about how things I say or do are going to be interpreted. In some ways I don't care. In some ways I care very much."
Going public with her illness has cost her her privacy. So much so that she is contemplating giving up her private practice in Washington. "I have written a very personal book," she says. "About my relationships as well as my illness. And I think that psychotherapy is a profession that requires privacy on the part of your therapist's life. I don't think patients are in the office to deal with my past."
But it is not only patients who may have to deal with what she's revealed in the book; there's also her family's privacy at stake and that of her husband, Dr. Richard Wyatt, a schizophrenia researcher at the National Institute of Mental Health.
"You know, a lot of other people have to deal with the consequences of this book. Not just me. All of a sudden everybody else's privacy is on the line. I had real concerns about my dad," she says. Both her father and sister, she writes, have suffered from manic-depression, an illness she says is "definitely genetic. I went back in my family history, and I've got it all over my family, coming and going."
Her father read the book in manuscript form and immediately called her up. "I love the book," he told her, "and I think what you have done is really, really gutsy."
"Dead," says Kay Jamison immediately, when asked about where she would be without lithium treatment. "I know I would be dead."
By suicide? "Yes." She pauses. "The only other possibility is I would be progressively worse and more and more insane. If I stayed alive."
Although her first bout of manic depression occured in high school in Southern California, the illness went undiagnosed and untreated for 10 years. At first there were some periods of what she calls "white manias" -- euphoric highs that infused her with creative energy and enthusiasm and the ability to get by on three hours of sleep a night -- but these episodes gradually turned into agitated depressions and suicidal thoughts.
By the time she entered college at UCLA, she was careening through moods that ranged from extreme depression to seductive mania to terrible agitation. In graduate school at UCLA, she calmed down for a time. She married a Frenchman, a painter, during this period. They separated and later divorced. In 1974 she received her Ph.D. in psychology from UCLA. She was now "Dr." Kay Jamison.
Of that time, she writes: "I was hired as an assistant professor in the UCLA Department of Psychiatry, got good parking for the first time in my life, joined the faculty club posthaste and began to work my way up the academic food chain. I had a glorious -- as it turns out, too glorious -- summer, and, within three months of becoming a professor, I was ravingly psychotic."
"I was totally disturbed and totally sick," Dr. Jamison says now of that period. "I lost my mind. It was very frightening." Despite that, she still refused to seek help. She had been brought up, after all, in a military family -- her father was an Air Force pilot and meteorologist -- and was taught that when things went wrong, you handled them yourself.
It took a good friend, someone who stayed by her side and helped her through this desperate period, to persuade her to go to a psychiatrist. "This is the best thing that ever happened to you," he told her. "Because you've never had to struggle with the issue of being up against a situation where you needed help from somebody else. Now you have no choice but to get help."
"At first I was deeply offended," recalls Dr. Jamison. "But he was absolutely right. It took something that dramatic to make me really say, 'I can't handle this.'"
At his insistence she sought out a psychiatrist, and after being diagnosed with manic-depressive illness was put on lithium, the drug most widely used to treat the disease. And while not everyone with the illness responds to lithium, Kay Jamison was lucky. She did. But like so many patients on medication -- and despite her medical knowledge of the disease -- she would stop taking it as soon as she felt better.
For one thing, the high dosages used in the early 1970s had serious side effects. But more important, she missed the mild manias -- the pleasant highs that gave her confidence and energy. During such times, she felt "irresistibly charming" and often dressed more provocatively.
"Kay would be the belle of the ball," says her close friend Robert Faguet, recalling Dr. Jamison's personality during her mild manic states while on the UCLA faculty. "People in those kinds of phases are the natural attractant in any circle of people. She was bright, quick, lively. She would make contact with everybody."
Such periods, however, were short-lived. A succession of destructive manias, followed by a deep depression which lasted for 1 1/2 years led her to an almost-successful suicide attempt. It was during this time that a small group of friends, who knew of her desperate state of mind, formed a "suicide watch." Among those friends was Dr. Faguet, a psychiatrist Kay Jamison describes in her book as an "extraordinary friend" who "looked after me during my absolute darkest days."
Although her psychiatrist suggested hospitalization at one point, Kay Jamison refused. She was fearful of the consequences that hospitalization might have on her career. Some of her friends agreed she should try to stay out of the hospital.
"I did my utmost to keep her out of the hospital," Dr. Faguet says of that dark period when suicide seemed a possibility. "I was worried that hospitalization and more public exposure would really strike a blow to her self-esteem. In retrospect that might not have been the best thing. As she describes her struggles it may have been better for her to have confronted the illness earlier. I hold myself partially responsible because of the fear I had that she might be stigmatized."
Despite her friends' vigilance, Kay Jamison, after a fight with a lover and in a highly disturbed state, attempted to end her life by taking a massive overdose of lithium. She was 30 at the time.
"I had been depressed for month after month after month," she says now. "And it was agitated in my case because I had combined mania and depression. And it was intolerable, and I thought there was no point in subjecting anyone else to it any longer."
A phone call from her brother in Paris saved her life. "It was not so much what she said but the sound of her voice," recalls Dean Jamison. "She just sounded completely scared, completely out-of-control." He immediately phoned her psychiatrist in Los Angeles.
Later, Kay Jamison would go back and read the note made by her psychiatrist on the day before the suicide attempt. It read: Severely depressed. Very quiet.
Eventually, with the help of her psychiatrist and a lowered dose of lithium, Kay Jamison began to work her way back to stability. For the last dozen years or so she's been on a daily dose of lithium -- with no side effects. "I still have my ups and downs," she says. "But not profound ups and downs. It's been a long time, several years, since that happened."
Saved from herself
First: Given the fact that Kay Jamison has worked among mental health professionals for most of her life, why did her illness go un
"I think some of it is that I was fortunate to get pulled out of public situations when I was manic by very close friends who had a lot of judgment. When you're manic, you have no judgment -- and I trusted these friends enough to allow them to make decisions," she says. "The depression was not as much a problem. I think the normal temperament in many academic departments, perhaps particularly in psychiatry, is a little bit depressive anyway. So if you're depressed, you don't stand out that noticeably."
Second question: Looking back, how is it possible to build such a stellar career, given the incapacitating nature of the illness?
"It is amazing," Dr. Jamison says. "And it's not amazing. I think the people you don't hear about who have manic-depressive illness are the people who have been successful. Because they keep quiet. There are rare exceptions. Ted Turner's an exception to that. Frances Lear's an exception. But you don't hear about it often because those people don't come forward."
In the past, there has been mild criticism of some of Kay Jamison's views of manic-depressive illness; charges that she "glamorizes" or "over-romanticizes" it in her talks about the many creative people and celebrities who've had the illness. Her well-received 1993 lay book, "Touched With Fire: Manic-Depressive Illness and the Artistic Temperament," studied the link between creative genius and mood disorders. Some contend that focusing on such super-achieving manic-depressives only serves to make all the non-super-achievers with mood disorders feel even more depressed. This kind of criticism irks her.
"I resent the notion that it's 'romanticizing,' " she says. "Because it is a part of advocacy to say, 'Look, there's a lot of interesting people who have had this.' It's part of destigmatizing the disease. And I preface every one of my talks about this by saying, 'This is a lethal illness. It kills people. It's destructive.' "
Still, her own memoir carries a slight aura of glamour about it: In addition to a harrowing portrayal of manic-depressive illness, it conveys a life filled with romantic affairs with --ing, intelligent men, sabbaticals at Oxford, apartments in London and the like. Of certain aspects of her illness she herself writes: "These fiery moods were, at least initially, not all bad: in addition to giving a certain romantic tumultuousness to my personal life, they had, over the years, added a great deal that was positive to my professional life."
However, in conversation, she rejects such an interpretation and bristles at the very suggestion her life has been "glamorous."
"Well, I've had an interesting life, if that's what you're saying. Lots of people have interesting lives. And it's like, 'You can't have an interesting life if you have a mental illness.' If you're not totally laid low 100 percent of the time, then you don't have the illness or you're 'glamorizing' it. This is a treatable disease. And some people with manic-depressive illness have interesting lives. And a lot don't. A lot of people are devastated by it."
Her book is an immediate success, both critically and commercially. It recently jumped onto several best-seller lists. And now there's talk of making it into a movie, a development about which Kay Jamison has very mixed feelings. She's still feeling the invasion of privacy that comes with such a personal book.
"I don't even want to think about a movie," she says. "It's enough of a problem dealing with the book."
Still, she's been "delighted" by the reception she's received on her book tour. "I don't know what I was expecting, but I certainly was dreading doing it. But the interviewers have all read the book and have all been very positive and very thoughtful."
There's still one hurdle to get past: the reaction of her colleagues when she returns on a regular basis to her work at Hopkins. So far, so good. "My colleagues have been wonderful," she says. "But I know I'm going to have my credibility questioned. Some people who love doing that sort of thing just as sport will question my credibility."
At the moment Kay Redfield Jamison's life is in good working order. She's made her peace with the lithium and enjoys all the pleasures of a good marriage, a good job, a best-selling book and a future that looks unlimited. Still, she admits there is a part of her mind always preparing for the worst.
"I'm fortunate because I have a disease that responds very well to lithium," she says. "But there are no guarantees I'm not going to get sick again. I mean, I know the illness. And I know it can come back.
"And I also know, although it's very unlikely, that I could stop responding to the medication. Or for some medical reason be unable to take it. Who knows? I don't see this as a disease you get over. You don't. And I think anybody who thinks that you do is whistling Dixie." She pauses. "But I think I have very good reason to be optimistic."