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Question: When did you first realize you were manic depressive?

Kay Redfield Jamison: Well I suppose it's funny, it's a little like the waves of grief. I think you have waves of awareness and one of the things that I found with grief was actually -- I was well prepared for it by the cyclicality of my manic depressive illness because I was used to things coming and going and so forth. So I think that my awareness of having bipolar illness really—I was 17, I got very, very depressed and I was psychotic and I didn't have any energy and I was totally—I just—but I didn't have the words. People didn't talk about it at that time and people certainly didn't have the words “bipolar illness” or “manic depressive illness.” So I just was terrified. I had no idea what had happened to me and I was very frightened and I was frightened it would come back, but I got well and then I did what everybody, or most people do when they get well, I sort of put it behind me again. Then it would come and hit me again and again.

So I knew there was something wrong. I started to see a Psychiatrist, tried to see a Psychiatrist when I was in college and I ended up just running away and I couldn't tolerate the idea of doing that. But then when I was—I took out my degree and I joined the medical school faculty at UCLA, I became ragingly manic and very psychotic, hallucinating, delusional. I didn't have any choice. It's the great advantage of having an illness as severe as mine is that you are automatically brought in to the medical care system. If you have—as long as it was milder, I could kind of get by with actually without to face what I was—the severity of my problem. I knew the person I wanted to see, it was somebody I had trained with. He was my clinical supervisor and I had seen with patients and I had seen that he was tough and smart and compassionate and humanize, but also knew science and medicine.

So I went to him terrified and he was just absolutely firm in his diagnosis; he just never wavered and he just said that's the way it is. But he was kind about it, but he didn't back off from it and he was a great Psychotherapist. So one of the things I've tried to do in my professional life, like a lot of my colleagues, is to emphasize that medications just aren't enough for many people with these illnesses because, exactly what you are saying, how do you become aware of an illness. You become aware of an illness by understanding yourself and understanding the meaning that that illness has in your own life, symbolically and, more importantly, quite literally.

Question: What was it like to be psychotic?

Kay Redfield Jamison: Well, I primarily have been in the psychotic [state] when manic, which is not uncommon with mania, and it's been mostly when I've been manic it's been a very exhilarating sort of thing, including the hallucinations. I've went around the solar system, I went to Saturn in my mind's eye. I went through star fields. It was a glorious sort of ecstatic experience, which is frequently the case with mania. When you think about a lot of the great religious ecstasies is a very manic quality to that and a very grandiose as they tend to be very universal, cosmic, related to everything is related to everything. But I also had some very bad ones. I've been hallucinating myself as dead or just covered with blood. Mania can be as terrifying as it gets. It is certainly as insane as one gets and so it's frightening when it gets out of control, but there are periods of mania when it can be extremely attractive.

Question: What were your depressive states like?

Kay Redfield Jamison: In depression, your capacity to feel just flattens and disappears and what you feel is pain and a kind of pain that you can't describe to anybody. So it's an isolating pain, a completely isolating pain. It's for people with bipolar illness in particular, it is a deadening lethargy coupled with an agitation and restlessness at times, but it’s the sense of having no energy, no interest, no passion, no life.

So, for me, like everybody else who gets severely depressed, there comes a point when you say, "OK. If I can't feel, if I can't care, if I can't think, I can't concentrate, I can't remember, I can't read, if I can't love, where am I? Who is in there? Where is the humanity? It's gone." And the pain is agony, it just is unrelenting. In my case, I had stopped my medicine, my lithium, and I had gotten wildly manic and then I got paralytically depressed for 18 months. There was not a time during those 18 months that I can remember feeling OK. At some point I tried to kill myself. I think, again, it's very hard to describe the kind of pain that goes on in severe depression because it's just the words are not there.

Recorded On: September 30, 2009

Image: Allucinazioni Veneziane / Venetiation Hallucinations, lo.ren.zo

 

Descent into Madness

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