An Unquiet Mind – A Book Review

Bipolar disorder often involves debilitating effects on individuals and their families. Different accounts reveal the true danger of potentially uncontrollable mental states. One girl was driven by depression to cut her own forearms and to take a week’s worth of medicine in one night. This girl found herself lying on the ground the next day in her vomit and excrement, disappointed to still be alive. Another night, she had been driven by her mania to restlessly walk alone for miles along a busy highway at night.[1] Bipolar is fascinating, prevalent, and has been the focus of much research and public health initiatives. However, like many mental illnesses, it is widely misunderstood and often stigmatized.

According to a recent survey, 90% of bipolar patients reported that they suffer social isolation due to the stigmas associated with bipolar disorder[2]. Many activists claim that bipolar disorder is a hoax. They assert that bipolar disorder dramatizes common feelings that everyone naturally experiences (severe mania and depression are considered such common feelings).[3] A better understanding of the disorder would help the general public’s perception, opinion, and attitude become less wrong. Even health care providers commonly misread their patients. While 82% of healthcare providers reported that their patients enjoy a good quality of life, only 56% of their patients agreed with the assessments.[4] As evident by the survey, health care providers may benefit from clearer conceptions of their patients’ experiences.

Because of the common misperceptions, misunderstandings, and resulting stigmatization of bipolar disorder, An Unquiet Mind is a very important book. The book is an autobiography by Kay Jamison, which chronicles her experience with bipolar disorder. The book provides the general public as well as researchers and clinicians with a personal and human look into such a potentially painful condition. Personal accounts of mania and depression, such as the ones in An Unquiet Mind, do well in enhancing understanding of bipolar disorder.

Perhaps current misconceptions stem from inadequatenesses in the healthcare community’s ability to convey the full story of bipolar disorder. The tool used in defining and diagnosing bipolar disorder is the Diagnostic and Statistical Manual – IV (DSM-IV). While physicians rely on the DSM-IV as the most updated method for diagnosing bipolar, it gives little insight on the disorder itself beyond the diagnosable symptoms. Contrasting Jamison’s vivid and passionate accounts in An Unquiet Mind with the dry description in the DSM-IV shows the importance of this book in improving our understanding of bipolar disorder and mental health issues in general.

The DSM-IV characterizes Bipolar disorder as a cyclic shift in moods ranging from varying levels of mania and depression. An episode of mania often includes inflated self esteem, decreased need to sleep, racing thoughts, higher level of talkativeness, distractibility, and excessive involvement in pleasurable activities that have risky consequences such as spending sprees and sexual indiscretions. An episode of depression often includes a depressed mood, lack of interest or pleasure in daily activities, loss of energy, inability to think or concentrate, and recurring thoughts of death or suicide.[5] Such a description is informational, but it lacks the vivid descriptions and human feelings that provide a better understanding. An Unquiet Mind provides such descriptions and feelings.

Kay Jamison is able to do so because she is in a unique position. She currently teaches psychiatry at Johns Hopkins University School of Medicine. Prior to her current position, she was head of the UCLA Affective Disorders Clinic, where she was selected as UCLA Woman of Science and was listed in Best Doctors in the United States.[6] She achieved all of her accomplishments while experiencing the very mental disorder that she studies and treats: bipolar disorder. She takes advantage of her special position as both physician and patient to provide understanding and bridge the gap between non-bipolar individuals and bipolar individuals with her personal account in An Unquiet Mind.

As mentioned above, the DSM-IV lists symptoms of mania without conveying adequate descriptions of the manic experience. As a result, mania is misunderstood by many as a natural feeling, which is exaggerated by psychiatrists.[7] In An Unquiet Mind, Jamison clarifies this misperception with a comprehensive description of her manic mind: “I raced about like a crazed weasel, bubbling with plans and enthusiasms, immersed in sports, and staying up all night, night after night… I felt I could do anything, that no task was too difficult.”[8] Here, Jamison provides a flow of consciousness that reveals the intricate thought process of a manic individual. One can see from her first person account that her mania puts her in and grandiose, uncontrollable, and potentially destructive mood, which is neither common nor natural.

During episodes of mania, many individuals engage in self-harming activity such as promiscuous sex or shopping sprees, which they cannot afford.[9] For one that does not suffer from the disorder, it is difficult to understand why one cannot just control themselves. Jamison’s book gives insight and understanding on how one thinks with a manic mental state that drives him/her to exhibit detrimental behavior such as reckless shopping sprees: “When I am high, I couldn’t worry about money if I tried. So I don’t. The money will come from somewhere; I am entitled; God will provide… so I bought twelve snakebite kits, with a sense of urgency and importance. I bought precious stones, elegant and unnecessary furniture…”[10] Such accounts give insight on the manic mind and give rise to better understandings of manic behavior.

Likewise, the depression experience is not properly described by the DSM-IV and is misunderstood as a natural feeling, which is exaggerated by psychiatrists.[11] In An Unquiet Mind, Jamison clarifies this misperception with a comprehensive account of her experience with depression: “My thinking, far from being clearer than crystal, was torturous. I would read the same passage over and over only to realize that I had no memory at all for what I just had read…Life’s run was only a short and meaningless one, why live? I was totally exhausted and could scarcely pull myself out of bed in the mornings.”[12] This account explains how debilitating depression is, and it enables one to understand why a depressed individual cannot just snap out of it and be happy. From Jamison’s accounts, we get insight and understanding of the commonly misunderstood phenomenon of mania and depression. Still, there are other common behaviors among bipolar individuals beyond mania and depression, which are often misunderstood by those who have not experienced the mental states.

One such misunderstood phenomenon that frequently occurs with bipolar individuals is incompliance with their medication. There are many cases where individuals with bipolar disorder stop their medications after their moods are stable and consequently relapse into a severe mania or depression. Even after multiple occurrences of medicine cessation and relapse, these individuals still continue to discontinue their medication.

Many without bipolar disorder do not understand reasons behind incompliance, and they express much frustration with such patients or loved ones. Such frustration is not healthy or helpful. Instead, compassion and understanding should guide people to learn reasons why bipolar individuals are prone to discontinue their medications. Jamison sheds light on this issue as she provides her own reasons for her incompliance: “Once the symptoms of an illness improve or go away, [taking medication] becomes even more difficult. In my case, once I felt well again I had neither the desire nor incentive to continue taking my medication. I didn’t want to take it to begin with; the side effects were hard for me to adjust to; I missed my highs…”[13] While many may express aggravation over incompliance, this book enables one to better understand the issue and potentially address it more appropriately.

Most importantly, Jamison addresses a very debilitating public misunderstanding: bipolar individuals are cursed with the inability to properly function in society. While severe episodes of depression or mania may disable one from functioning in society, individuals with bipolar disorder have been known to not only function, but to succeed and make astronomical contributions to society. Jamison attributes much of her own creativity and success to her unquiet mind.[14] Without her disorder, she would not have been able to contribute her book to society.

About 1% of American adults have been diagnosed with bipolar disorder.[15] The disorder is very hard for patients, loved ones, healthcare providers, and society as a whole. Such hardships of mental disorders on society have lead to rejection and stigmatization. We addressed the issue of mental illness stigmas in the beginning of the semester. The class consensus determined that such stigmas are not helpful, and are the largest obstacles to advancing better treatment. According to the Surgeon General “Promoting mental health for all Americans will require scientific know-how but, even more importantly, a societal resolve that we will make the needed investment. The investment does not call for massive budgets; rather, it calls for the willingness of each of us to educate ourselves and others about mental health and mental illness, and thus to confront the attitudes, fear, and misunderstanding that remain as barriers before us.”[16] An Unquiet Mind is a powerful tool in educating the public about bipolar disorder and in confronting the stigmas. I am hopeful that if enough people read Jamison’s book, society will better understand not only bipolar disorder, but all issues pertaining to mental health.

Comments

mental health from the inside [4]

Submitted by Paul Grobstein on Thu, 01/01/2009 - 1:43pm.

"to better understand the issue and potentially address it more appropriately"

I very much share your sense that books like Jamison's (for some other examples, see here) are needed to supplement (at least) things like the DSM for a better public understanding of mental health. The story "from the inside [5]" is not only richer but provides a quite different lens through which to see many mental health issues. And suggests ways to address them "more appropriately"? How, for example, should one deal with "non-compliance"?