An Unquiet Mind

Jamison begins this section focused on Jim Watson, the Nobel Prize winner and coauthor of the paper explaining the structure of DNA. Watson exhibits the same kind of manic energy the author often experiences, and recently (at the time of her writing) had turned toward investigating manic-depressive illness. The illness has a rather well-defined genetic component, and in her meeting with Watson, the two examined numerous family trees demonstrating the connection.

At one point during the meeting, Jamison thinks about a conversation she had had with Mogens Schou, who is primarily responsible for the introduction of lithium as a treatment for manic-depressive illness. The two had once skipped a day of American Psychiatric Association conferences at their annual meeting in order to enjoy New Orleans, and the conversation had turned to Jamison’s interest in mood disorders. She was initially hesitant, but he explained that his interest stems from the prevalence of the illness in his own family; this caused her to open up about her own illness, which led to the creation of a similar family tree in which she noted that her mother’s side seemed to be free of manic-depressive illness while her father’s side was filled with it. She considers that she owes her life to the fact that Schou’s family tree looked similar, which pushed him to find a treatment (190).

Jamison then describes her experience with a physician recommended by a colleague many years prior. In discussing her illness, the physician had condescendingly informed her that, due to her illness and its genetic component, she should not have children. This made her feel “sick, unbelievably and utterly sick, and deeply humiliated” (191); however, she retained her composure, eager to avoid giving him further fuel. “Brutality takes many forms,” she writes, “and what he had done was not only brutal but unprofessional and uninformed. It did the kind of lasting damage that only something that cuts so quick and deep to the heart can do” (191). After all, she writes, even in her “blackest depressions,” she had “never regretted having been born” (191). Jamison, however, never did have children, as Richard already had three children from a previous marriage by the time they married; she writes that this “is the single most intolerable regret of [her] life” (192).

From there, she considers what finding the genes for manic-depressive illness might mean. On the one hand, earlier detection might be beneficial to those who do suffer from the illness. On the other, she wonders if parents will simply choose to abort children who test positive for the gene; further, she fears that eliminating manic-depressive illness might serve only to make society more homogeneous. She argues that “manic-depressive illness can confer advantages on both the individual and society,” as it “appears to convey its advantages not only through its relationship to the artistic temperament and imagination, but through its influence on many eminent scientists, as well as business, religious, military, and political leaders” (194). 

Although Jamison has often, and until this point, experienced kindness and compassion when divulging her illness, she writes here about a former colleague, whom she calls “Mouseheart,” who did not show her such kindness. While living in Los Angeles, the two would frequently get coffee or lunch together, and as she grew closer to him, she felt it was important to tell him, as “Not talking about [it], if only to discuss it once, generally consigns a friendship to a certain inevitable level of superficiality” (200). Upon telling him, she discovered that he was angry with her for having attempted suicide, and that “His pain at hearing that [she] had manic-depressive illness was […] far worse than [hers] at actually having it” (200). He then questioned her ability to handle academic life, which, as she pointed out, she had already been handling for some time, by some measures considerably better than he was. Although he attempted an apology the next day, the damage had already been done.

Following this anecdote, Jamison discusses her further concerns with divulging her illness, in particular around the professional concerns thereof. Initially, she was concerned that she would not be granted a medical license if it came to light that she was manic-depressive; she built in safeguards for herself to ensure she’d be able to argue a strong case against this, but then feared that her “residents and interns may, in deference to what they perceive to be [her] feelings, not say what they really think or not ask the questions that they otherwise should” (203). Further, she is concerned that writing about her illness would make other researchers believe she is biased in her academic writing about the illness. Lastly, she wonders if, as “Mouseheart so artfully managed to” ask, if she believes “someone with mental illness should be allowed to treat patients” (204).

All of these concerns hung over her head when she applied for clinical privileges at Johns Hopkins, as part of the application asks if the applicant is “suffering from, or receiving treatment for any disability or illness” (205). Rather than answer outright on the application, she wrote that she would discuss that personally with the chairman; however, fortunately, the chairman already knew about her illness, then asserted that their faculty would be much smaller and much more boring if it had no manic-depressives (209). 

In this final chapter, Jamison ruminates on what it means to have lived her life with manic-depressive illness. In particular, she considers the bittersweet nature of such a life, her “longings for an earlier age” when she was “gliding through starfields and dancing along the rings of Saturn,” balanced with her current “comfortable and settled present existence” (211). She reckons that her memories are akin to a soldier’s memories of war in their vividness and discomfort: she does not “feel compelled to re-create the intensities,” yet still feels that “the seductiveness of these unbridled and intense moods is powerful; and the ancient dialogue between reason and the senses is almost always more interestingly and passionately resolved in favor of the senses” (212). Though she is “optimistic about remaining well,” she also evaluates the psychiatric wards at other hospitals and ranks them just in case she ever does slip again (212-13).

“We all build internal sea walls to keep at bay the sadnesses of life,” she writes, “and the often overwhelming forces within our minds […] through love, work, family, faith, friends, denial, alcohol, drugs, or medication”; the trick is to build them at just the right height so as to simultaneously keep people out and let them in when necessary (214-15). In writing this book, she has begun to understand that it’s less about moods or illness and more about “love as sustainer, as renewer, and as protector” (215). 

Jamison concludes by posing the question of “whether, given the choice, [she] would choose to have manic-depressive illness” (217). She acknowledges that she can afford to pose this question at least in part because lithium is available and does work for her. She believes that “would not go through an extended [depression] again” as “There is nothing good to be said for it” (217). She dispels the idea that others who “have gone through a divorce, lost a job, or broken up with someone” know what depression is like because “these experiences carry with them feelings” whereas depression “is flat, hollow, and unendurable” (218). However, she also believes she has “felt more things, more deeply; had more experiences, more intensely; loved more, and been more loved” as a result of her manic-depressive illness (218). Because of the depth of her experiences while manic, she feels, she “cannot imagine becoming jaded to life, because [she knows] of those limit corners, with their limitless views” (219).