Writing The Wrongs Of Mental Illness Christine Rowett ----------------------------------- Homewood News and Information Professor and author Kay Redfield Jamison remembers going to Paul McHugh, chairman of Hopkins' Psychiatry Department, to let him know she had plans to document her own history and battle with mental illness. "I told him, 'The only real qualm I have at this point is that I don't want to embarrass Hopkins,'" she said. "'You know, we'll hear all the standard jokes that people are going to say about crazy shrinks.'" McHugh, Jamison said, told her that he believed Hopkins has obligations to protect and care for both its patients and its doctors. "He said, 'If Hopkins can't do that for you, Hopkins has no business being in business,' " Jamison recalled. "It's hard to say what that kind of support means. "This is the first time I've had a chance to publicly acknowledge Paul," she said, addressing McHugh Thursday evening in the Mountcastle Auditorium. "I'd like to thank you." Jamison spoke to an audience of more than 200 as part of a series of five seminars sponsored by the JHMI Office of Cultural Affairs featuring authors describing their own illnesses. Her 1990 book, Touched by Fire: Manic-Depressive Illness and the Artistic Temperament, was named the most outstanding medical book in biomedical sciences by the Association of American Publishers. But An Unquiet Mind, published last year, is a personal and at times painful account of Jamison's own dealings with manic depressive illness, including honest descriptions of euphoric feelings of mania and the following bouts of depression that resulted in thoughts of suicide. "She's played a number of vital roles in getting the rest of us here at Hopkins to think about mental illness," Humanities Center director Richard Macksey said in his introduction of Jamison. "She has reached both the professional community and the community of patients." Jamison opens An Unquiet Mind with a chilling account of how, as the daughter of an Air Force pilot, she watched as an Air Force jet lost control and crashed just beyond the playground where she and her elementary schoolmates stood in horror. The jet pilot, killed in the fiery accident, was later remembered as a hero for his successful efforts to avoid crashing directly into the playground. "The memory of the crash came back to me many times over the years," she wrote, "as a reminder both of how one aspires after and needs ideals and of how knowingly difficult it is to achieve them." She recalled a normal, happy childhood in her talk on Thursday. During her senior year of high school, she had feelings of high confidence and ecstasy, but they didn't last. "I had total certainty, total enthusiasm," she said. "But then I crashed, and I got psychotically depressed." Her condition was not discussed in her self-described "WASP military family." She struggled through school, as an undergraduate and graduate student at the University of California, Los Angeles, with a yearlong stint studying at the University of St. Andrews, in Scotland. In 1974, Jamison was named an assistant professor of psychiatry at UCLA. "I had my first raving psychotic attack about three months after joining the faculty," she said, "which says something about joining a faculty." After a subsequent episode in which she hallucinated, seeing frightening images of herself wearing a floor-length evening gown and covered with blood, Jamison called a colleague at UCLA and accepted his help. "The single most impressive thing through my denial was that this colleague--a psychoanalyst--didn't believe in medication, didn't believe in drugs," she said. "He said, 'You need drugs. You're really out of control.' Coming from him, that made a deep, lasting impression." But she was reluctant; fear and embarrassment initially kept her from treatment, she said. She also recalled an intense anxiety that left her shaking as she contemplated seeing a psychiatrist for the first time. "I shook for what he might tell me, and I shook for what he might not be able to tell me," she said, quoting from An Unquiet Mind. "Character building, no doubt. But I was beginning to tire of all the opportunities to build character at the expense of peace, predictability and a normal life." Her initial consultation included standard physician queries. "The questions were familiar, but I found it unnerving to have to answer them, unnerving to realize how confusing it was to be a patient," she said. Her psychiatrist diagnosed her as manic depressive and gradually, she said, helped her, with his respect, caring and confidence in her ability to get well. During her treatment, however, her doctor repeatedly suggested she check into a psychiatric hospital, but she refused. "I was horrified at the idea of being locked up, being away from familiar surroundings, having to put up with all of the indignities and invasions of privacy that go into being on a psychiatric ward," she said. "I was working on a locked ward at the time, and I didn't relish the idea of not having a key." In her research and writing, Jamison focused on depressive illnesses, medications and their side effects, and suicide, all topics she came to know firsthand. "The disease that has, on several occasions, nearly killed me, does kill tens of thousands of people every year: most are young, most die unnecessarily, and many are among the most imaginative and gifted that we as a society have," she said. Twenty percent of people who have manic depression and go untreated kill themselves, Jamison said. Those with depression also have high rates of suicide. "If you had that kind of rate from tumors or heart disease, specialists might focus their energies on exploring the causes of those statistics," she said. "Somehow suicide always seems a bit more idiosyncratic. It's almost much easier to make it more poetic and romantic than it often is. It's often just as wired into somebody who has manic depressive illness as a heart attack is to somebody who's got cardiovascular disease." Jamison described the effects of mania that may cause patients to stop taking prescribed anti-depressants; heightened energy, optimism and a sense of awareness. It is hard to make others understand the feelings of mania, she said, or the desire to cling to them. "The intensity, glory and absolute assuredness of my mind's flight made it very difficult for me to believe, once I was better, that the illness was one I should willingly give up," she said. "If you have had stars at your feet and the rings of planets through your hands, it is a very real adjustment to blend into a three-piece suit schedule, which is new, restrictive, seemingly less productive and maddeningly less intoxicating." Jamison once discontinued her own lithium against medical advice; an episode of severe depression followed. In addition to the support she received from her colleagues at Hopkins, Jamison was encouraged by the staff and administration at UCLA. But that, she said, is not the norm. "In fact, since I've written my book, I've gotten hundreds of letters from medical students, residents, graduate students and faculty who have been thrown out of programs," she said. "I know that I am unusual in the support that I have gotten." Jamison said she has questioned her objectives since writing the book, citing her loss of privacy as a casualty of the process. She may soon, however, have even less; her book is scheduled to be made into a screenplay and film starring Annette Bening, she said. She no longer sees individual patients and said she is not sure if she will return to practice. She spends her time as an author, an executive producer for a public television series on manic depressive illness and a professor in the Department of Psychiatry. "I am a great fan of Johns Hopkins," she said. "I regard it a great privilege to teach here." The authors and their illnesses series continues on March 28. All seminars will be held in the Mountcastle Auditorium; they are free and open to the public.
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