A very narrow bridge


In 1995 Kay Redfield Jamison, Professor of Psychiatry at the Johns Hopkins University School of Medicine, published “An Unquiet Mind,” a breakthrough book on the subject of manic-depressive illness – today, most often referred to as “bipolar disorder.” What makes this book so special is that the author makes public her “private experience of madness” from a dual perspective: she tells her story from the subjective standpoint of a woman who has suffered from the disease for more than 30 years; at the same time she writes with the “objective” eye of a world-renowned expert in mood disorders in general and manic-depressive illness in particular.

Jamison experienced her first episode of manic depression in 1964, when she was a senior at Pacific Palisades High School on the west side of Los Angeles. After her first relatively mild manic high, during which she found herself completely unable to slow down her body or her mind, she crashed into the darkness of depression – “virtually inert, with a dead heart, and a brain as cold as clay.”

Gradually her manias began to escalate “wildly and psychotically out of control;” at such times she likened her rapid-fire and confused thoughts to “a neuronal pileup on the highways of my brain.”

As night follows day, Jamison’s manias were followed by ever deeper and ultimately suicidal depressions. Nevertheless, she somehow managed to complete her undergraduate studies, followed by a Ph.D. in Psychology at UCLA; in 1974, she joined the faculty of UCLA’s Psychiatry Department.

What I find most compelling in Jamison’s book is her ongoing “war with lithium,” which she first started taking in the fall of 1974, only – against the strong objections by her doctors – to stop taking it in the early spring of 1975. At first, she found the side effects of lithium intolerable; the medication made her nauseous and blurred her vision to the point that it was only with great difficulty that she was able to read.

Most significantly, lithium caused her to lose the creative edge she regularly experienced during her mild manias. As Jamison puts it, “I had become addicted to my high moods; I had become dependent upon their intensity, euphoria, assuredness, and their infectious ability in induce high moods and enthusiasm in other people … I found my milder manic states powerfully inebriating and very conducive to productivity.”

Unfortunately, her mild or “white” manias evolved into highly destructive “black” manias characterized by uncontrollable anger and violence, by an “inflammability” which “always lay just the other side of exaltation.”

As is often the case with people suffering from manic depression, Jamison’s refusal to take lithium on as regular basis led to her attempting suicide – ironically – by taking an overdose of lithium. After her recovery, she finally realized that she owed her life and her sanity to lithium, which – along with competent therapy and her own iron will not only to survive but to thrive – has kept her on that very narrow bridge over the troubled waters of mania and depression. Over time, under careful monitoring by her doctors, she has been able to lower the dosage to the point that she can “swing” a bit more into brighter, more creative territory, although at the expense of some “controlled darkness” at the other end of the mood spectrum.

Though for the most part Jamison avoids religious language, in many ways “An Unquiet Mind” is a profoundly religious book – certainly not in any narrow sectarian sense but rather in the author’s passionate attempt to find life-affirming meaning in the face of her devastating disease. As she writes on the very last page, “Even when I have been most psychotic – delusional, hallucinating, frenzied – I have been aware of finding new corners in my mind and heart … always, there were those new corners and – when feeling my normal self, beholden for that self to medicine and love – I cannot imagine becoming jaded to life, because I know those limitless corners with their limitless views.”

In her courageous struggle to maintain her balance, to keep from falling into the dark hole of her always threatening manic-depressive illness, Jamison seems to be echoing the teaching of the much beloved Hasidic rebbe, Nachman of Bratzlav (1772-1810), who, according to many scholars, suffered from undiagnosed manic-depressive illness: “The whole world is a very narrow bridge, and the main thing is not to be afraid at all.”

James B. Rosenberg (rabbiemeritus@templehabonim.org) is rabbi emeritus at Temple Habonim in Bar-rington.