An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison

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Reading Group Guide

1. "The long and important years of childhood and early adolescence... were to be an extremely powerful amulet, a potent and positive countervailing force against future unhappiness"[p. 15]. What aspects of Jamison's early life and upbringing helped to provide her with emotional support on which to draw years later?

2. What benefits did the conservative military lifestyle led by the Jamisons confer upon the young Kay Jamison? With what disadvantages did that same culture, with its stiff-upper-lip creed, afflict her in her battle with mental illness?

3. In graduate school, Jamison writes, "Despite the fact that we were being taught how to make clinical diagnoses, I still did not make any connection in my own mind between the problems I had experienced and what was described as manic-depressive illness in the textbooks"[p. 58]. Why did she refuse to acknowledge the obvious? Why didn't she question the "rigid, irrelevant notions of self-reliance"[p. 101] she had been taught?

4. "Being open is the sort of thing that I advise people to think very long and hard about, "Jamison has stated. "It's one thing if you're independently wealthy. It's another thing if you're out in the real world"(Washington Post Magazine, 4/16/95). Why did Jamison avoid bringing her illness into the open for so many years, and what made her finally decide to do so?

5. Jamison worries that we could "risk making the world a blander, more homogenized place if we get rid of the genes for manic-depressive illness"[p. 194]. On the other hand, E. Fuller Torrey, a well-known author and schizophrenia researcher, says he "would quite happily lose a van Gogh to treat the disease"(WashingtonPost Magazine, 4/16/95). Which point of view do you endorse? Can you sympathize with both sides of the issue?

6. With her book Touched with Fire and her public television specials on artists like Byron, van Gogh and Schumann, Jamison has been accused by some of her colleagues of romanticizing manic-depressive illness by associating it with creative genius. Does this accusation seem reasonable or unreasonable to you?

7. "Lithium moderates the illness, "Jamison observes, "but therapy teaches you to live with it"(Time, 9/11/95). Has she convinced you that drugs plus psychotherapy is the answer for mental illness? In that case, might not psychotherapy benefit people suffering from any debilitating illness, not just a mental one?

8. Some physicians wonder whether the increased use of mood-regulating medications might lead to a society-wide practice of chemically altering personality, with the result of making people blander and more conformist (the widespread use of the anti-depressant Prozac has helped fuel this debate). "Which of my feelings are real?"Jamison asks. "Which of the me's is me"[p. 68]? Jamison's sister discouraged her from taking lithium, saying that her "soul would wither if [she] chose to dampen the intensity and pain of [her] experiences by using medication"[p. 99]. How much of personality do you believe to be intrinsic, and how much is a result of biological impulses and chemicals? Is such a question even answerable?

9. Her work, and her own illness, convinces Jamison of "the total beholdenness of brain to mind and mind to brain. My temperament, moods, and illness clearly, and deeply, affected the relationships I had with others and the fabric of my work. But my moods were themselves powerfully shaped by the same relationships and work"[p. 88]. Jamison expresses anger against physicians who draw a distinction between "medical illnesses"and psychiatric illnesses [p. 102]. Does she imply that there is, in actuality, no difference? If there is a difference, of what does it consist?

10. "Depression, somehow, is much more in line with society's notions of what women are all about.... Manic states, on the other hand, seem to be more the provenance of men"[p.122]. What might the results of this stereotyping be when it comes to giving treatment?

11. After David's death, Jamison reflects that "grief, fortunately, is very different from depression"[p.150]. How can you explain the essential difference between the two? Is it more possible to cope with the "real"causes of grief than with the impalpable causes of depression?

12. Through bitter experience Jamison comes to recognize the value of emotional steadiness in a relationship, but "somewhere in my heart, "she writes, "I continued to believe that intense and lasting love was possible only in a climate of somewhat tumultuous passions"[p. 170]. Is this feeling peculiar to Jamison and her temperament, or does it reflect certain assumptions in our society? How is the importance of love and friendship demonstrated again and again in the story? How does each of the three principal men in Jamison's life help her to seek a cure?

13. Jamison worries that her work may now be seen by her colleagues "as somehow biased because of my illness, "while admitting that "of course, my work has been tremendously colored by my emotions and my experiences"[p. 203]. Does this make her work less viable than strictly "objective"work, or more so?

14. "My major goal has been to really try and make a difference in how the illness is seen and treated"(Philadelphia Inquirer, 9/18/95). Has she succeeded, so far as you are concerned? Which of your preconceptions were changed by reading her account?

15. "Do I really think that someone with mental illness should be allowed to treat patients?"[p. 204] Jamison asks. She ultimately answers the question in the affirmative. What would your own answer be?

Read an Excerpt

Into the Sun

I was standing with my head back, one pigtail caught between my teeth, listening to the jet overhead. The noise was loud, unusually so, which meant that it was close. My elementary school was near Andrews Air Force Base, just outside Washington; many of us were pilots' kids, so the sound was a matter of routine. Being routine, however, didn't take away from the magic, and I instinctively looked up from the playground to wave. I knew, of course, that the pilot couldn't see me-I always knew that-just as I knew that even if he could see me the odds were that it wasn't actually my father. But it was one of those things one did, and anyway I loved any and all excuses just to stare up into the skies. My father, a career Air Force officer, was first and foremost a scientist and only secondarily a pilot. But he loved to fly, and, because he was a meteorologist, both his mind and his soul ended up being in the skies. Like my father, I looked up rather more than I looked out.

When I would say to him that the Navy and the Army were so much older than the Air Force, had so much more tradition and legend, he would say, Yes, that's true, but the Air Force is the future. Then he would always add: And-we can fly. This statement of creed would occasionally be followed by an enthusiastic rendering of the Air Force song, fragments of which remain with me to this day, nested together, somewhat improbably, with phrases from Christmas carols, early poems, and bits and pieces of the Book of Common Prayer: all having great mood and meaning from childhood, and all still retaining the power to quicken the pulses.

So I would listen and believe and, when I would hear thewords "Off we go into the wild blue yonder," I would think that "wild" and "yonder" were among the most wonderful words I had ever heard; likewise, I would feel the total exhilaration of the phrase "Climbing high, into the sun" and know instinctively that I was a part of those who loved the vastness of the sky.

The noise of the jet had become louder, and I saw the other children in my second-grade class suddenly dart their heads upward. The plane was coming in very low, then it streaked past us, scarcely missing the playground. As we stood there clumped together and absolutely terrified, it flew into the trees, exploding directly in front of us. The ferocity of the crash could be felt and heard in the plane's awful impact; it also could be seen in the frightening yet terrible lingering loveliness of the flames that followed. Within minutes, it seemed, mothers were pouring onto the playground to reassure children that it was not their fathers; fortunately for my brother and sister and myself, it was not ours either. Over the next few days it became clear, from the release of the young pilot's final message to the control tower before he died, that he knew he could save his own life by bailing out. He also knew, however, that by doing so he risked that his unaccompanied plane would fall onto the playground and kill those of us who were there.

The dead pilot became a hero, transformed into a scorchingly vivid, completely impossible ideal for what was meant by the concept of duty. It was an impossible ideal, but all the more compelling and haunting because of its very unobtainability. The memory of the crash came back to me many times over the years, as a reminder both of how one aspires after and needs such ideals, and of how killingly difficult it is to achieve them. I never again looked at the sky and saw only vastness and beauty. From that afternoon on I saw that death was also and always there.

Although, like all military families, we moved a lot-by the fifth grade my older brother, sister, and I had attended four different elementary schools, and we had lived in Florida, Puerto Rico, California, Tokyo, and Washington, twice-our parents, especially my mother, kept life as secure, warm, and constant as possible. My brother was the eldest and the steadiest of the three of us children and my staunch ally, despite the three-year difference in our ages. I idolized him growing up and often trailed along after him, trying very hard to be inconspicuous, when he and his friends would wander off to play baseball or cruise the neighborhood. He was smart, fair, and self-confident, and I always felt that there was a bit of extra protection coming my way whenever he was around. My relationship with my sister, who was only thirteen months older than me, was more complicated. She was the truly beautiful one in the family, with dark hair and wonderful eyes, who from the earliest times was almost painfully aware of everything around her. She had a charismatic way, a fierce temper, very black and passing moods, and little tolerance for the conservative military lifestyle that she felt imprisoned us all. She led her own life, defiant, and broke out with abandon whenever and wherever she could. She hated high school and, when we were living in Washington, frequently skipped classes to go to the Smithsonian or the Army Medical Museum or just to smoke and drink beer with her friends.

She resented me, feeling that I was, as she mockingly put it, "the fair-haired one"-a sister, she thought, to whom friends and schoolwork came too easily-passing far too effortlessly through life, protected from reality by an absurdly optimistic view of people and life. Sandwiched between my brother, who was a natural athlete and who never seemed to see less-than-perfect marks on his college and graduate admission examinations, and me, who basically loved school and was vigorously involved in sports and friends and class activities, she stood out as the member of the family who fought back and rebelled against what she saw as a harsh and difficult world. She hated military life, hated the constant upheaval and the need to make new friends, and felt the family politeness was hypocrisy.

Perhaps because my own violent struggles with black moods did not occur until I was older, I was given a longer time to inhabit a more benign, less threatening, and, indeed to me, a quite wonderful world of high adventure. This world, I think, was one my sister had never known. The long and important years of childhood and early adolescence were, for the most part, very happy ones for me, and they afforded me a solid base of warmth, friendship, and confidence. They were to be an extremely powerful amulet, a potent and positive countervailing force against future unhappiness. My sister had no such years, no such amulets. Not surprisingly, perhaps, when both she and I had to deal with our respective demons, my sister saw the darkness as being within and part of herself, the family, and the world. I, instead, saw it as a stranger; however lodged within my mind and soul the darkness became, it almost always seemed an outside force that was at war with my natural self.

My sister, like my father, could be vastly charming: fresh, original, and devastatingly witty, she also was blessed with an extraordinary sense of aesthetic design. She was not an easy or untroubled person, and as she grew older her troubles grew with her, but she had an enormous artistic imagination and soul. She also could break your heart and then provoke your temper beyond any reasonable level of endurance. Still, I always felt a bit like pieces of earth to my sister's fire and flames.

For his part, my father, when involved, was often magically involved: ebullient, funny, curious about almost everything, and able to describe with delight and originality the beauties and phenomena of the natural world. A snowflake was never just a snowflake, nor a cloud just a cloud. They became events and characters, and part of a lively and oddly ordered universe. When times were good and his moods were at high tide, his infectious enthusiasm would touch everything. Music would fill the house, wonderful new pieces of jewelry would appear-a moonstone ring, a delicate bracelet of cabochon rubies, a pendant fashioned from a moody sea-green stone set in a swirl of gold-and we'd all settle into our listening mode, for we knew that soon we would be hearing a very great deal about whatever new enthusiasm had taken him over. Sometimes it would be a discourse based on a passionate conviction that the future and salvation of the world was to be found in windmills; sometimes it was that the three of us children simply had to take Russian lessons because Russian poetry was so inexpressibly beautiful in the original.

Once, my father having read that George Bernard Shaw had left money in his will to develop a phonetic alphabet and that he had specified that Androcles and the Lion should be the first of his plays to be translated, we all received multiple copies of Androcles, as did anyone else who got in my father's flight path. Indeed, family rumor had it that almost a hundred books had been bought and distributed. There was a contagious magic to his expansiveness, which I loved, and I still smile when I remember my father reading aloud about Androcles treating the lion's wounded paw, the soldiers singing "Throw them to the lions" to the tune of "Onward, Christian Soldiers," and my father's interspersed editorial remarks about the vital-one could not stress enough how vital-importance of phonetic and international languages. To this day, I keep a large ceramic bumblebee in my office, and it, too, makes me laugh when I remember my father picking it up, filled to the brim with honey, and flying it through the air in various jet maneuvers including, favoritely and appropriately, a cloverleaf pattern. Naturally, when the bee was turned upside down on its flight, the honey would pour down all over the kitchen table, leaving my mother to say, "Marshall, is this really necessary? You're egging on the children." We would giggle approvingly, thus ensuring a few more minutes of the flight of the bumblebee.

It was enchanting, really, rather like having Mary Poppins for a father. Years later, he gave me a bracelet inscribed with words from Michael Faraday that were engraved over the physics building at UCLA: "Nothing is too wonderful to be true." Needless to say, Faraday had repeated breakdowns, and the remark is palpably untrue, but the thought and mood are lovely ones, and very much as my father could be, in his wondrous moments. My mother has said, many times, that she always felt she was in the shadow of my father's wit, charm, intensity, and imagination. Her observation that he was a Pled Piper with children certainly was borne out by his charismatic effect upon my friends and the other children in whatever neighborhood we found ourselves. My mother, however, was always the one my friends wanted to sit down and talk with: we played with my father; we talked with my mother.

Mother, who has an absolute belief that it is not the cards that one is dealt in life, it is how one plays them, is, by far, the highest card I was dealt. Kind, fair, and generous, she has the type of self-confidence that comes from having been brought up by parents who not only loved her deeply and well, but who were themselves kind, fair, and generous people. My grandfather, who died before I was born, was a college professor and physicist by training. By all accounts, he was a witty man, as well as inordinately kind to both his students and colleagues. My grandmother, whom I knew well, was a warm and caring woman who, like Mother, had a deep and genuine interest in people; this, in turn, translated into a tremendous capacity for friendship and a remarkable ability to put people at their ease. People always came first with her, as they did with my mother, and a lack of time or a busy schedule was never an excuse for being thoughtless or unavailable.

She was by no means an intellectual; unlike my grandfather, who spent his time reading, and rereading, Shakespeare and Twain, she joined clubs instead. Being both well liked and a natural organizer, she unfailingly was elected president of whatever group in which she became involved. She was disconcertingly conservative in many ways-a Republican, a Daughter of the American Revolution, and very inclined to tea parties, all of which gave my father apoplexy-but she was a gentle yet resolute woman, who wore flowered dresses, buffed her nails, set a perfect table, and smelled always of flowered soaps. She was incapable of being unkind, and she was a wonderful grandmother.

My mother-tall, thin, and pretty-was a popular student in both high school and college. Pictures in her photograph albums show an obviously happy young woman, usually surrounded by friends, playing tennis, swimming, fencing, riding horses, caught up in sorority activities, or looking slightly Gibson-girlish with a series of good-looking boyfriends. The photographs capture the extraordinary innocence of a different kind of time and world, but they were a time and a world in which my mother looked very comfortable. There were no foreboding shadows, no pensive or melancholic faces, no questions of internal darkness or instability. Her belief that a certain predictability was something that one ought to be able to count upon must have had its roots in the utter normality of the people and events captured in these pictures, as well as in the preceding generations of her ancestors who were reliable, stable, honorable, and saw things through.

Centuries of such seeming steadiness in the genes could only very partially prepare my mother for all of the turmoil and difficulties that were to face her once she left her parents' home to begin a family of her own. But it has been precisely that persevering steadiness of my mother, her belief in seeing things through, and her great ability to love and learn, listen and change, that helped keep me alive through all of the years of pain and nightmare that were to come. She could not have known how difficult it would be to deal with madness; had no preparation for what to do with madness-none of us did-but consistent with her ability to love, and her native will, she handled it with empathy and intelligence. It never occurred to her to give up.

Both my mother and father strongly encouraged my interests in writing poetry and school plays, as well as in science and medicine. Neither of them tried to limit my dreams, and they had the sense and sensitivity to tell the difference between a phase I was going through and more serious commitments. Even my phases, however, were for the most part tolerated with kindness and imagination. Being particularly given to strong and absolute passions, I was at one point desperately convinced that we had to have a sloth as a pet. My mother, who had been pushed about as far as possible by allowing me to keep dogs, cats, birds, fish, turtles, lizards, frogs, and mice, was less than wildly enthusiastic. My father convinced me to put together a detailed scientific and literary notebook about sloths. He suggested that, in addition to providing practical information about their dietary needs, living space, and veterinary requirements, I also write a series of poems about sloths and essays about what they meant to me, design a habitat for them that would work within our current house, and make detailed observations of their behavior at the zoo; if I did all this, he said, my parents would then consider finding a sloth for me.