Tuesday, April 14, 2009
Kay Jamison PhD is without equal in articulating the points of view of both an expert and a patient, with the co-authorship of the definitive text on bipolar and the leading bipolar memoir to her credit. But what makes Dr Jamison truly worth listening to is the simple fact that she is leading a successful life.
My friend Cristina Romero was present last year when Dr Jamison addressed a DBSA group on the east coast. Over to you, Cristina ...
Thank you, John.
Dr. Jamison spoke about many thought-provoking subjects as they relate to mental illness, one of which I’d like to share with you here. The subject here is getting treatment to develop a stable ecosystem within a brain that suffers from mental illness.
Dr. Jamison read from her classic memoir, "An Unquiet Mind," in which she recalls her pre-lithium highs:
"The ideas and feelings are fast and frequent, like shooting stars, and you follow them until you find better and brighter ones. Shyness goes. The right words and gestures are suddenly there, the power to captivate others a felt certainty."
But when the mania turns into manic psychosis, she wrote:
"The fast ideas are far too fast and there are far too many. Overwhelming confusion replaces clarity. Memory goes. Humor and absorption on friends’ faces are replaced by fear and concern. Everything previously moving with the grain is now against. You are irritable, angry, frightened, uncontrollable and enmeshed totally in the blackest caves of your mind. You never knew those caves were there."
“I don’t know that anybody really knows how the brain mutates and changes over the years," Dr. Jamison acknowledged in response to a question from her audience.
"I would say at the most simplistic level is that if you took a scan of your brain on one manic episode, you would prefer to have that brain than the brain on five or six or seven manic episodes."
The cumulative effect on the brain of repeated manias, she said, is "one of the most compelling arguments for staying on your medications and being aggressively treated."
"You can’t keep having heart attacks," she emphasized. "You can’t keep having strokes. You can’t keep having depression and you can’t keep having manias, without paying a biologic cost.”
The longer the brain is stable, Dr. Jamison went on to say, the longer it stays stable:
"The brain is like a pond. It’s like an ecosystem. You want to get the ideal ecosystem and then you don’t want to disturb it very much. So you don’t want to be messing around with drugs. You don’t want to be messing around with sleep. You don’t want to be messing around with alcohol. You want to really create a stable environment."
Dr. Jamison said the early manias "were absolutely intoxicating states.” “It took me far too long to realize that lost years in relationships cannot be recovered. The damage done to oneself and others cannot always be put right again and the freedom from the control imposed by medication loses its meaning when the only alternatives are death and insanity.”
“The major problem in treating bipolar illness from a clinical perspective is not that there are no effective medications, because there are. It is, rather, that patients so often refuse to take them. Worse yet, because of lack of information, poor medical advice…or fear of personal or professional reprisals, they do not seek treatment at all.”
“But once you’ve figured that out – the combination of medications, psychotherapy, lifestyle routine, and so forth – then you have a real shot at having a stable life. It’s really very frustrating, because that initial period has a level of difficulty.”
Dr. Jamison takes lithium. For many years, because she was on high doses of lithium, she suffered serious side effects. Standard practice is now lower doses, on which she has fewer side effects now. Her first two rules of her "Rules for the Gracious Acceptance of Lithium into Your Life" are: “1) Clear out the medicine cabinet before guests arrive for dinner or new lovers stay the night. 2) Remember to put lithium back into the cabinet the next day.”