An Unquiet Mind Analysis

An Unquiet Mind is a memoir of the manic-depressive illness written from a dual perspective of the healer and the healed by Kay Redfield Jamison, the Professor of Psychiatry at the Johns Hopkins School of Medicine. This memoir uses vivid imagery and technically deft writing to bring life to the internal experience of those afflicted with bipolar disorder. This alone makes the memoir capable of educating even those people who might have been formerly unsympathetic to the suffering of people with mental disorders.
As a child, Jamison is intensely emotional. At age fifteen, Jamison visited St. Elizabeths Psychiatric Hospital, and was both frightened and fascinated with the eccentricity of the patients and the atmosphere. Jamison did, however, “instinctively reached out, and in an odd way understood” the pain expressed in the eyes of the patients (p. 25). Jamison recounted “everything in my world began to fall

apart” when her family moved to California due to her father's retirement from the Air Force and new employment in California (p. 30).
In addition to the difficulties in adjusting to California, Jamison’s father showed signs of manic-depressive illness and abused alcohol. Sought to escape from the turmoil at home, Jamison spent increasingly more time with her friends “drinking, smoking…through the night, and engaging in passionate discussions about…the hows and whys of death” (p. 36). By the age of sixteen, like her father, Jamison was also “given to black and chaotic moods” (p. 35). Although Jamison “knew something was dreadfully wrong”, she pretended to be “normal” as she “had been brought up to believe that you kept your problems to yourself” (p. 39). Jamison recounted the confusion from the chaotic moods that she suffered on her own as a “terrible wounds to both my mind and heart” (p. 39).
Jamison graduated from high school and attended UCLA, where her mood swings worsened and became costly. Jamison was forced by her high enthusiasms and engaged in impulsive buying without any limits which she could not afford. In the periods of total despair with terrible agitation, unable to identify her mental illness, Jamison could only dilute her exceedingly restless and irritable mood by “[pacing] back and forth across [her] room like a polar bear at the zoo” (p. 45). Yet, the undergraduate education at UCLA provided her opportunities to do research that later sparked her interest and decision of pursuing a Ph.D. in psychology. Despite her clinical training in the graduate school, Jamison “never put [her] mood swings into any medical context”, which she later recounted it as her “denial and ignorance” of manic-depressive illness (p. 59). Completed with the graduate education, Jamison was hired and became a professor in the UCLA Department of Psychiatry.
In the wake of her broken marriage and unbearable frightening hallucinations, Jamison recognized the seriousness of her mood problems, met a psychiatrist and these kinds with lithium for the diagnosis of manic-depressive illness. Jamison was deeply embarrassed at “finding [herself] with the roles reversed” (p. 85), however; this gave her “a new respect for psychiatry and professionalism” from the perspective of the healed (p. 86).
At times Jamison would refuse the lithium medication due to her fundamental denial of the diagnosis. Jamison also identified her addiction of being lively, productive, outgoing and effervescent in the mildly manic state was hard to give up (p. 92). With lithium slowing down her high enthusiasms, Jamison had “horrible sense of loss for who I had been and where I had been” (p. 91). This fear was reinforced by her sister who claimed that Jamison had lost her personality and was “a shell of [her] former self” due to the medication (p. 99). Once Jamison “felt well again [she] had neither the desire nor incentive to continue taking [her] medication” and “felt normal again, it was easy for [her] to deny that she had an illness that would come back” (p. 101). The associated side effects strengthened the resistance to taking medication, which included severe nausea and vomiting, and impairment in concentration, attentional span and memory (Jamison, p. 93-95). Despite her expert belief that “it is malpractice to treat [manic-depressive illness] without medication” (p. 102), Jamison later recounted the refusal of medication was based on “blind stupidity and pride” that she “ought to be able to handle whatever difficulties came my way without having to rely upon crutches such as medication” (p. 99-100).
With the consistent refusal of medication, the severity and duration of her manic-depressive symptoms increased: “A floridly psychotic mania was followed, inevitably, by a long and lacerating, black, suicidal depression” (Jamison, p. 110). Jamison’s psychiatrist noted that “Patient reluctant to be with people when depressed because she feels her depression is such an intolerable burden on others” (p. 112). Before the “contagious madness” taken over her mind and body completely, Jamison attempted suicide by taking an overdosing lithium to reduce “the turmoil [she] was inflicting upon [her] friends and family” (p. 113-115):
Like the pilot whom I had seen kill himself to save the lives of others, I was doing the only fair thing for the people I cared about; it was also the only sensible thing to do for myself. One would put an animal to death for far less suffering (Jamison, p. 115).

Fortunately, Jamison’s brother called her on the telephone, noticed her slurred speech and alerted her psychiatrist. Jamison recounted it was a debt that she can never pay back for the understanding and support from her psychiatrist, friends, and family: “What God put asunder, an elemental salt, a first-rank psychiatrist, and a man’s kindness and love could put almost right again” (Jamison, p. 140). Along with a lower dosage of lithium, Jamison was able to regain her sense of self and to feel a range of emotion and noted: “Life had become worth not losing” (p. 163). With the received kindness and regained hope, Jamison was able to embrace her mental illness as “a disease that both kills and gives life” (p.123).
An Unquiet Mind is a memoir filled with some educational value. The firsthand account of her experience with bipolar disorder is helpful in providing some brief notions of what the individuals with mental disorders are going through. I agree with Dr. Jamison’s belief that: “I have become fundamentally and deeply skeptical that anyone who does not have this illness can truly understand it” (p. 174). Still, the metaphors used in describing herself as different kinds of animal, such as white rat and polar bear, aided my comprehension of her confusion and frustration with her moods. She is trapped in a cage named bipolar disorder and, like the animals in the zoo, cannot escape by herself without the help of others. Furthermore, her stage from denial to acceptance and fully embrace of the mental illness provide an insight into the reasons for the resistance to medication, how the suicidal thoughts stemmed from the mental illness, and the significance of kindness and support in the recovery progress.
This book focused on how bipolar disorder affects Dr. Jamison’s life, such as interpersonal relationships and academic life. Jamison used medication and love as protectors from her mental disorder. She mentioned the importance of combining medication and psychotherapy in treating mental disorders, hence I would like to learn the details of how the psychotherapy sessions helped in her recovery progress. I would like to know more about how she brings her personal experience as a patient into her professional practice in treating patients with mood disorders. Nevertheless, this memoir encourages others who are living with mental disorders to use their voices raising public awareness and to get the help they need to live well.
The problem of identifying mental disorder is also an issue discussed in An Unquiet Mind. In one of personality theory class, Jamison’s professor held up some Rorschach cards and asked the class to write down their responses. After finishing the Rorschach test, Jamison felt her responses were “humorous” and some were “simply bizarre” (p. 46). At that time, Jamison was “acutely aware of just how disturbed [she] really was” and assumed that her psychotic problems were obvious to that psychologist (p. 46). Unexpectedly, that psychologist commented that her responses to the Rorschach were “creative” (p. 47). In her graduate training, Jamison administered similar psychological tests to her former husband and whose responses she found “a level of [unseen] originality” (p. 60). Yet, Jamison’s supervisor label those responses as “sociopath” who was “deeply disturbed, conflicted, and filled with rage” (p. 61). For these kinds of psychological testing, the diagnosis is based solely on the examiners’ interpretation. The examiners were measuring the same set of responses yet having different diagnoses, thus resulting in low reliability in these psychological testing.
The gender bias can also lower the diagnosis reliability for manic-depressive illness. Although “manic-depressive illness occurs equally often in women and men” (Jamison, p. 123), manias in women are often misdiagnosed due to gender role:
Depression, somehow, is much more in line with society’s notions of what women are all about: passive, sensitive, hopeless, stricken, dependent, confused rather tiresome, and with limited aspirations. Manic states, on the other hand, seem to be more the provenance of men: restless, fiery, aggressive, volatile, energetic, risk taking, grandiose and visionary, and impatient with the status quo.

Not only the bias in examiner can lower the diagnosis reliability, the environment where the clinicians examining the individuals’ behaviors can be a bias factor in the evaluation.
In “On Being Sane in Insane Places”, Rosenhan conducted an experiment to determine the validity of psychiatric diagnosis.

Pseudopatients pretended to have symptoms of mental disorders and admitted to various mental hospitals. Rosenhan assumed that if pseudopatients were discovered to be normal and released from the hospitals, sanity could be distinguished from insanity and terms like “mental illness” and “manic-depressive” would be reliable. Surprisingly, all pseudopatients were admitted to the hospitals. Although the patients in the hospitals were able to “‘detect’ the pseudopatients’ sanity”, clinicians and nurses often attributed those normal behaviors to the labeled insanity (Rosenhan, p. 181). Rosenhan found “physicians are more inclined to call a healthy person sick … than a sick person healthy” (p. 181), and “behaviors that are stimulated by the environment are commonly misattributed to the patient’s disorder” (p. 182). Therefore, Rosenhan concluded the psychiatric diagnosis is not reliable, and “we cannot distinguish insanity from sanity” (p.

184).