Nothing Was the Same Nothing Was the Same

by Kay Redfield Jamison

  “And me?” I asked. I imagined an exotic reef fish, or a salmon fighting its way upstream.

  “An anchovy,” he said with a smirk.

  “I hate anchovies,” I replied. He knew this.

  “Yes, but I love them.” He smiled sweetly.

  “It’s not fair. I made you a rainbow trout.”

  He laughed and said, “But I am a rainbow trout.”

  And he was, of course.

  Deciding on a tree was easy. He was a weeping cherry: graceful and gentle, complexly branched. I was an aspen, he said: tall, resilient, and “seasonally ablaze.”

  It all made great sense at the time, in the context of dinner and wine and laughter. And I think still, when I can think of it, that Richard was early May, a rainbow trout, and a weeping cherry.

  LILACS AND A ROMAN RING

  Richard and I got married in the autumn of 1994, midway between our meeting and his dying. After a short but surpassingly happy honeymoon in Venice and Rome, we returned to Washington, Richard to his science and me to revising a book that was to be published in a year’s time. The honeymoon, insofar as it signaled a time away from the concerns of the world, was over. The book I had written, an explicit account of my manic-depressive illness, guaranteed this.

  Richard was unambiguous that I should write about my bipolar illness. Of course there would be consequences, he said. Some would be obvious and others would not. My disclosures would make me an easy target of criticism and would no doubt be of some embarrassment to him. The book might be a critical and financial failure. Still, he said, it was the right thing to do. People who suffered from mental illnesses, and their families, needed every voice they could get. As a scientist who studied schizophrenia, a long-time mental health advocate, and a doctor who treated severely ill patients, he knew, as much as anyone could, the need for public discussion. At a more personal level, he was the husband of someone with manic-depressive illness and had seen its damage firsthand. He also had seen how I and others had been hurt by discriminatory policies and shaken by unkind, if inadvertent, remarks made by our colleagues in private practice and in academic medicine.

  He made it clear that he would do whatever was necessary to provide emotional and financial support. The former was critical, the latter not inconsequential. I had been financially independent since leaving high school and had worked my way through college and graduate school. Later I had worked absurdly long hours to pay off my student loans and medical bills, as well as to retire the colossal debts incurred during my free-spending days of mania. I was used to being independent. I did not want to rely upon Richard financially, but, given the alternative, I was grateful for his offer. He believed, and made me believe, that love would see us through, that we were doing the right thing and doing it together. I would not have written An Unquiet Mind without Richard’s encouragement to tell the truth of my life. To the extent that others may have been helped by that, it is to him that a debt is owed.

  The decision to write about my illness had been difficult. I am a clinical psychologist who holds licenses to practice in California and in the District of Columbia, and I had privileges at the Johns Hopkins Hospital. I am someone who studies and writes about the illness I have, and I knew that as a result of my disclosure my work would be subject to questions of objectivity by my colleagues. The deeply personal nature of my book would require that I give up my clinical practice, at least for the foreseeable future. The professional and financial consequences of doing this were substantial. I had spent long years in clinical training and had been treating patients for nearly two decades. I enjoyed broad clinical responsibilities when I was director of the UCLA Affective Disorders Clinic and had maintained active private practices, first in Los Angeles and then in Washington. Not seeing patients would be a loss, and a decision I knew I would regret. I loved clinical work and was reluctant to give it up.

  I was as well a teacher of young doctors and graduate students and, like most people, had been brought up to be private about personal matters. My father, an Air Force officer and a pilot, kept to the military code that strength of character demanded silence and forbearance in the presence of difficulty. My mother, a warm woman, was similarly reserved in dealing with personal problems. Both assumed, as they assumed the presence of the air, the undeniable correctness of the WASP ethic that one kept one’s problems to oneself, admitted no weakness. Being an Episcopalian didn’t help. The Frozen Chosen had thawed over the years but still veered toward immoderate discretion. I kept my fears hidden and grew up sealed tightly as a vault. I did not confess, concede, or admit. It wasn’t done.

  I liked and believed in this view of the world. The people I most admired embodied these values: they complained rarely and got on with life. They didn’t deposit their private struggles into the public domain. Their beliefs, which gave them an edge in assurance and ascendancy, made it difficult to acknowledge pain or personal failings. These matters were nonnegotiable and, in their certainty, they exacted a toll. But they were the only beliefs I knew.

  Such values were suited for a simpler world than the one in which I found myself as a young woman contending with a sick mind. My innocence, which had decayed alongside my sanity, never quite came back. Experiences I had as an adult made scant sense in the context of my childhood ethic. I had been brought to my knees by madness and despair, my values shaken beyond easy restoration. I was a clinician and an academic, unavoidably aware of the devastation experienced by those with mental illnesses such as my own. I looked inward and then around me: it did not take much to grasp that privacy and reticence, however admirable, made life more difficult than it needed to be. Silence about mental illness bred a quiet ugliness and set in place the conditions for unnecessary suffering and death.

  I found my own silence about manic-depressive illness increasingly intolerable. True, my parents had taught me to keep private matters private, but they also had taught me to think for myself and to have a sense of responsibility toward others. I felt myself a hypocrite, a repellent state that gradually wore down my instincts for professional self-preservation and concealment. I had studied and written about depression and bipolar illness for twenty years, had founded and directed a large clinic specializing in these diseases, and was a full professor at a major university teaching hospital. My illness had been under good control for many years. If I couldn’t be public about it, it was scarcely reasonable to hope that others would.

  I asked family, friends, and colleagues for advice. My mother and brother felt strongly that it was a bad idea to go public with my illness; they believed I had been through enough pain and that I would be personally and professionally vulnerable in unforeseen and damaging ways. My father, who himself has manic-depressive illness, encouraged me to write honestly about what I had been through. It was the courageous and right thing to do, he said, and I ought not to censor anything I wrote about him. Friends and colleagues were divided on the matter. Those not clinically trained were more inclined to think that openness was a good thing, in part because it might benefit others with mental illness and in part because they believed honesty to be intrinsically freeing. This was a far from universal view. Some were adamant that criticism was likely to be withering and the professional repercussions severe. Just as things had begun to settle in my life, they pointed out, I was risking additional instability. Those who were clinicians were even less sanguine about my being open about my illness. They, like I, had seen the prejudice and actions taken against colleagues in clinical fields; they had few illusions about tolerance within the profession.

  I discussed the decision at length with my psychiatrist, Daniel Auerbach, a first-rate clinician who has been my doctor since my first psychotic break as a young assistant professor at UCLA. Together we weighed the potential damage of disclosure against its possible benefits. I was wary of being labeled by my academic and medical colleagues as a manic-depressive psychologist, rather than being seen as a psychologist who happened to have manic-depressi
ve illness. I knew that for many the question of professional impairment would be a critical issue. This would be a completely legitimate concern. Those who specialized in psychology or psychiatry would present a special set of problems: I risked newly vigilant eyes observing my actions and appraising my moods, newly honed ears listening for skips in reason, real or imagined anger. It was an unattractive prospect.

  My psychiatrist, who understood my desire to be direct about my illness, talked with me about the ramifications of openly discussing psychosis, suicide, and my initial reluctance to take medication. He, more than anyone, knew the cost to me of living in silence. But he also knew that once I had discussed my illness openly, my pride would take a sharp body blow. Pride had been a costly but sustaining force for me since childhood. Pride had kept me going when other things did not. I would be giving live ammunition to competitors, or to anyone I had irritated over the years.

  His counsel was thoughtful, circumspect, and protective. It was without condescension. If I thought I could do it and had reasoned it through, he said, I could do it. He made the indisputable point that it would be hard, and it was. He did not say it would be insurmountably hard, and it wasn’t.

  I knew that my account of my illness and my life would have to be explicit, or there would be no point in writing it. This meant reliving, describing, and making public a troubled and contradictory life. I had hallucinated and been delusional on more than one occasion, been paralytic with depression for months on end. My behavior at times had been bizarre and disturbing. By anyone’s standards, I had been severely ill. I had tried to kill myself and had nearly died from a massive overdose of lithium, the same medication I had written about in medical journals and strongly advocated that others take. In the early stages of my illness, I had taken it only fitfully and reluctantly. One could hope for understanding, but not assume it.

  I spoke with the then chairman of my department at Johns Hopkins, Paul McHugh, in part because I respected his judgment and in part because I had to. I told him I hoped it might be helpful to others to write about my oddly intersecting worlds—those of researcher, clinician, teacher, and patient—but that I did not want to put the Department of Psychiatry or the Johns Hopkins Hospital in an awkward position. We both knew the inevitability of the “Who’s in charge of the asylum?” quips. More substantively, there were very real legal, educational, and clinical issues. And no one could predict what the reaction of the public and the media would be.

  My chairman listened carefully as I laid out my concerns. When I had finished, he looked at me thoughtfully and said, “You know, Kay, you have it completely backward.” He mentioned the legendary surgeon William Halsted, who was the first chief of surgery at Hopkins. “It was known that Halsted was a cocaine and morphine addict,” he said. “When he was impaired, his colleagues took it as their responsibility to protect Professor Halsted’s patients. But they also looked after Professor Halsted as best they could, so that he could continue to do his research, write, and train young surgeons.” He paused long enough for me to take this in. “If Hopkins can’t do that for you,” he said, “Hopkins has no business being in business.”

  He could not have been more understanding. He made it clear that I had his unequivocal support and that I should let him know if anyone on the faculty or the house staff made it difficult for me. He arranged for me to have lunch with the president of the Johns Hopkins Hospital, who likewise gave me his complete backing. He reiterated my chairman’s statement that Hopkins should be at the forefront of lessening the stigma against those with psychiatric illnesses; he hoped my being open about my own illness would make it easier for doctors and other clinicians to seek out, receive, and give good medical care. Both he and my chairman were unambivalent in their message that they would back up my decision in whatever way they could.

  They gave me the blessing of a great teaching hospital. I am not so naive as to think this is usual in medical schools and hospitals. I know that it is not. But it is exemplary. And it is from the exemplary, not from that which is done badly, that one learns and moves forward.

  Inevitably, it was Richard whose advice and support were most important to me. He encouraged me to write my book, nudged me on when I balked, and took me into his arms when things were hard. He wasn’t one to give up when life was difficult, and he did not give up on me.

  I decided to disclose my mental illness in an article that was published in the spring of 1995 in the Washington Post; my memoir An Unquiet Mind came out that fall. Not long after the Washington Post story was published, Richard and I attended the annual meeting of the American Psychiatric Association. Most of our colleagues, although shocked to learn that I had bipolar illness, were supportive of my decision to talk and write about it, and generous in their remarks. More than a few, however, seemed acutely uncomfortable. They averted their eyes, drew away, said nothing. I have never harbored the illusion that psychiatrists are uniquely compassionate or able to find the right words in awkward circumstances, yet I was struck by the silence. It was bone-chilling. There was a sense from some that I should be embarrassed by my revelations and, when I was not, that they were embarrassed for me.

  That winter, after my book had been published, I went to a medical conference in Stockholm. One of my Danish colleagues said, “No Danish doctor would write what you wrote.” It was not meant as a compliment. Walking back to my hotel, I saw cut tulips in a store window, scarlet and beautiful against the northern darkness, and felt again the loneliness I had known years ago as a young woman at scientific conferences. Meetings tended then to be very male in nature and were hallmarked by territorial rattlings and simian battles of dominance. To preserve myself against this, I often bought flowers for my hotel room: a splash of color, a trace of beauty, a private femininity.

  Now, many years later in Stockholm, that sense of vulnerability, of exposed separateness, was back. I went to a flower shop and bought an armful of red tulips for my room and put them on my bedside table, an antidote to one male colleague’s remark. Most of the Swedish, Danish, and Norwegian doctors at the conference had gone out of their way to be kind to me; they had been warm in their support. But one chance remark, not ill intended, threw me back in time, yanked me down.

  For every coldness or drawing back by my colleagues, however, there have been far more acts of kindness and drawing in. At meetings in Dublin, my Irish colleagues were fabulous. The dean of St. Bartholomew’s Hospital toasted me with a glass of champagne to congratulate me on my “personal courage,” and colleagues from Trinity and University College Dublin were kind beyond reckoning. One of the consulting psychiatrists gave me a book of poems by Yeats, with a note that said simply, “Thank you.” Another sent a breathtaking bouquet of tangerine poppies and wild cornflowers to my room. After dinner and an easy flow of wine, two other colleagues, professors of psychiatry in Dublin, took me to the General Post Office, heart of the 1916 Easter Uprising, and pointed to the statue of the dying Cúchulainn. We thought you might like to see this, they said, laughing. He had it really hard.

  My private life was now exposed to all and sundry, and I found it hard to live with the new reality. As a child I had been quiet and invisible when troubled; as an adult, I had hidden my mental illness behind an elaborate construction of laughter and work and dissembling. Now, my mind and heart and their respective pathologies were brightly lit on a page, behind a lectern, on a television screen. Yet, despite this, it felt good to be honest, to be a part of the community I until recently had kept to the edges of. I was no longer just a re-searcher and a clinician answering questions about diagnosis and treatment; I could talk of my own madness and fears, feel not so distant, not so hypocritical.

  I was overwhelmed by the many thousands of letters I received in response to the publication of An Unquiet Mind. Most were generous; many were disturbing. Religious diatribes were common. I received hundreds of letters from fundamentalist Christians berating me for turning my back on God and abandoning my Christian fa
ith, which I had not been aware I had or had not done. Others thought my illness just deserts for not having truly accepted the Lord Jesus Christ into my heart, or for not having prayed often or sincerely enough. I had left my mind open to Satan, and he had entered in. Madness and despair were precisely what I deserved and would have in this world and in the next. I should expect to burn throughout eternity. I got more than a taste of the intolerance and hatred religious extremity harbors toward those with mental illness; it was unpleasant and frightening.

  I was taken aback by the medieval quality of some of the beliefs held, modern incarnations of demons and possession, and by the viciousness of the attacks. One woman, who included a prayer card with excerpts from the Bible, wrote that it was a good thing I hadn’t had children as I had at least “spared the world of one more crazy manic-depressive.” There were several variations on this theme. “You are clearly unaware of the pain and suffering you and other manic-depressives cause,” wrote one person. “How could you have even considered having children, bringing another psychotic into existence?”

  There is a large and politically powerful contingent that is virulently opposed to the use of any kind of medication to treat psychiatric illnesses; they weighed in often and with frightening vehemence. Individuals who enjoyed their manias or regarded their ecstatic psychoses as a gift castigated me for colluding with the medical establishment by recommending medication. Others, a smaller group, felt I had written with too much affection about my manias.

  Some people questioned whether my psychotic experiences were not in fact perfectly sane, simply visionary states or another, more enlightened form of consciousness. A trip I had taken to Saturn during one of my manic episodes and that I had described in my book seemed to me, when compos mentis, quite clearly psychotic. I soon found I was a piker when it came to inter-galactic travel. Scores described their trips to Mars and Saturn and star clusters far beyond. Some regarded their planetary voyaging as a manifestation of illness, others as a useful extension of their usual mental lives. One person’s madness is another’s perceived gift.