An Unquiet Mind Manic Depressive Illness

The Chinese believe that before you can conquer a beast you first must make it beautiful. In some strange way, I have tried to do that with manic-depressive illness. It’s been a fascinating, albeit deadly enemy and companion; I have found it to be seductively complicated, a distillation both of what is finest in our natures, and of what is most dangerous. In order to contend with it, I first had to know it in all of its moods and infinite disguises, understand its real and imagined powers. When Kay was 18, she reluctantly started her undergraduate studies at the University of California Los Angeles. For her, college was a constant pattern of shifting moods, from violent and dreadful lows to intoxicating and seductive highs. At first, everything seemed so easy. She felt great. Not just great, she felt really great. Her mind seemed clear, focused. Not only did everything make perfect sense, but it all began to fit into a marvelous kind of cosmic relatedness. But her mercurial moods and recurrent, very black depressions took a huge personal and academic toll during those college years. I need help. Kay was not only very ill when she first called for an appointment, she was also terrified and deeply embarrassed. She had never been to a psychiatrist or psychologist before, but she had no choice. She had completely lost her mind and if she didn’t get professional help she was quite likely to lose her job, her already precarious marriage, and her life as well. Kay’s psychiatrist prescribed lithium in the fall of 1974. Her war with it began not long after she started taking it. There was never any question that lithium worked very well for her, but the drug strongly affected her mental life. She found herself beholden to a medication that also caused severe nausea and vomiting many times a month. She often slept on the bathroom floor with a pillow under her head and her woolen gown tucked under her. When the lithium became particularly toxic, she would start trembling, become ataxic, and walk into walls, and her speech would become slurred. It also impaired her ability to read and learn, something she had always enjoyed doing. Because of the side effects of lithium, I began to refuse to take it on a consistent basis. My psychotic mania was eventually followed by a long, black, suicidal depression. I was completely miserable. I couldn’t find any joy or enthusiasm anywhere. I saw death everywhere. I was seeing my psychiatrist two or three times a week. I was afraid to leave his office, I hadn’t slept in days. I was desperate. I remember seeing a note the day before that I attempted suicide. All it said was: severely depressed. Very quiet. Kay decided upon a solution that seemed to her to be poetic in its full-circledness. Lithium, although it ultimately saved her life, at that particular time, was causing her no end in grief and sorrow. So she decided to take a massive overdose. I took a handful of pills, curled up on my bed, and waited to die. What I hadn’t thought about was the fact that a drugged brain reacts differently than an alert brain. So when the phone rang, I must have called semi-comatose to answer it. It was my brother calling from Paris, and after hearing my slurred voice, he immediately knew something was wrong. He then called my psychiatrist to come check on me. The lithium helped me control my moods, and I was able to spend more time focusing on teaching, and more specifically, gaining tenure. The chairman of UCLA didn’t see my illness as a reason to revoke my clinical and teaching licenses. He actually encouraged me to use that to find better treatments and to help others. But I saw a lot of medical students and interns, who, because of their psychiatric illnesses, were denied permission to continue studying. I was constantly worried that I too, would have my teaching privileges removed if someone found out about my illness. Looking past her fears of explaining her illness to her fellow colleagues, Kay remembers a day when a Danish psychiatrist who, more than anyone, was responsible for the introduction of lithium as a treatment for manic-depressive illness. She was able to tell him about her struggles with her illness and, in turn, he explained to her about the personal motives driving his research on manic-depressive illness. Many years ago when I was living in Los Angeles, I went to a physician recommended to me by a colleague. He asked me whether or not I planned to have children. Of course I do. No, you shouldn’t have children. You have manic-depressive illness. I had never thought about not having kids just because I have manic-depressive illness. It’s the biggest regret of my life. Kay left the University of California in the winter of 1986 to return to Washington and apply to the Department of Psychiatry for a faculty appointment at John Hopkins Medical School. After telling him that she was treated for manic-depressive illness and that she needed to discuss the issue of her hospital privileges with him, he put his hand on hers, and said: “Kay, dear, I know you have manic-depressive illness. If we got rid of all the manic-depressives on the medical school faculty, not only would we have a much smaller faculty, it would be a far more boring one.” I still long for the intensity and passion of the high moods of my past. It’s not an easy transition from a life of seduction and euphoria, dancing on the rings of Saturn, to one so human and mundane. The countless hypomanias, the mania itself, all have brought into my life a different level of sensing, and feeling, and thinking. Even when I had been most psychotic, I’ve been aware of finding new corners of my mind and heart. Some of those corners were incredible and beautiful and took my breath away. Some of them were grotesque and ugly and I never wanted to see them again. But always, there were those new corners, and I can’t imagine becoming jaded to life because I know of those limitless corners, all with their limitless views.

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