By studying the link between artistic creativity and mood disorders, psychologist Kay Jamison has worked to make the world safer for people with manic-depressive illness. Now, she's about to find out whether she's succeeded.
(Part 1 of 3)
Kay Jamison slouches her lanky frame over the lectern, looks up through her blond bangs, and delivers a bold second opinion on the medical condition of a world-renowned patient. Her insights come about a hundred years too late for the patient himself -- author Robert Louis Stevenson -- but not a moment too soon for the capacity crowd at the Johns Hopkins auditorium.
"He was a courageous man," she says, "who continued to write under psychological and physical conditions that would have defeated anyone else." While Stevenson's death was caused by tuberculosis, Jamison insists that the battle of his life was with an inherited psychiatric problem, which she has diagnosed as a mood disorder. Jamison is preaching to the converted, over 750 people who treat, or are being treated for, such disorders: major depression and manic-depressive illness. They are members of the regional group that may be the best-informed of America's roughly 7 million mood disorder sufferers, the pioneering, if badly named, Depression and Related Affective Disorders Association, or DRADA. Jamison has made a career studying and treating these illnesses, particularly manic-depressive illness (the term she prefers to the trendier "bipolar disorder"). She is co-author of the definitive textbook on the subject and she has taught at UCLA, Oxford and now Johns Hopkins. She is also therapist or pal to many of the most internationally prominent people who suffer from her specialty.
But it is lectures like this one that have made the 48-year-old Washington-based psychologist and psychiatry professor such a cerebral celebrity in the world of mental health. At all your better psychiatric symposiums, and an increasing number of literary conferences, it is invariably Kay Redfield Jamison who is brought in for tragicomic relief, to give one of her library of talks on the link between manic depression and creativity. She can do van Gogh, she can do Lord Byron, she can do Edgar Allan Poe. In a pinch for a suicide crowd, she can do Hemingway. And, of course, she can do Stevenson, who, she argues, drew on some deep understanding of bipolarity to write The Strange Case of Dr. Jekyll and Mr. Hyde.
Jamison rediagnoses these artists from beyond the grave -- turning their demons into what she believes they really were, symptoms -- and uses their art to evoke feelings the clinical literature can't even begin to describe. Instead of dry language and pie charts, her slides include writings from some of the dead poets, writers and composers, and images from the work of deceased visual artists, nearly 200 in all, whom she has identified as having probable mood disorders. On her list is everyone from Michelangelo to Mark Rothko, William Blake to Anne Sexton, Herman Melville to William Faulkner, and Tchaikovsky to Charlie Parker. She identifies them not by analyzing the content of their art so much as by applying psychiatry's diagnostic criteria to letters and other biographical material.
In doing so, she has figured out a way to make mood disorders a little less . . . depressing and a lot more approachable. She is engaged in the intellectual merchandising of manic depression. Some feel that her enterprise over-romanticizes mental illness, and could make all the non-geniuses with mood disorders even more bummed out. But it also enables her message to cross over to a public that, generally, doesn't think it needs to care about serious mental illness. It's a public that doesn't really appreciate the difference between people who get counseling for "problems of living" and people who need medication and supportive psychotherapy because they have problems living -- as a diabetic would without insulin.
When Jamison finishes her presentation, the stage is prepared for the day's grand finale -- the reason the annual DRADA conference at Johns Hopkins has taken on cult status in mental health circles. The symposium always ends with a talk by a "celebrity consumer" -- the term "consumer" now being preferred over "patient." This is where Dick Cavett, Mike Wallace, William Styron, Frances Lear and others have "come out," or come much further out, with their psychiatric histories. Today's featured consumer will be Clinton aide Bob Boorstin, a former New York Times reporter who has been hospitalized twice for manic episodes and is becoming increasingly public and political about his illness. At 35, he is, by 20 or 30 years, the youngest public figure to take the DRADA challenge. Most celebrities speak out when there's less left to lose.
With a microphone clipped to his lapel, Boorstin speaks with wit and passion about his illness, including the pros and cons of being "out." As he talks, Jamison watches from a seat in the second row -- the last row of doctors before the first row of consumers, a boundary delineated with yellow tape. Jamison and Boorstin are friends, and she has listened to him talk privately about his illness dozens of times. Nothing he is saying is news to her. Yet, she is leaning far forward in her chair, chin in hand, intensely examining Boorstin's every move.
She knows it is only a matter of time before she's up there doing the grand finale herself.
I FIRST MET Kay Jamison over a year ago, after hearing about her from a friend who has manic-depressive illness and considers the textbook she co-wrote with former National Institute of Mental Health director Frederick Goodwin to be, literally, the bible. When my friend's symptoms are particularly bad, she reads passages of "the Goodwin-Jamison" over to herself -- invariably the sections Jamison wrote, which include many patient anecdotes -- to remind herself that what she feels is at least normally abnormal.
The illness -- which is believed to afflict 2 1/2 million Americans -- is known for its long, severe mood swings from the tortured depths of depression to the thought-racing, hyperactive, deluded heights of mania, punctuated by periods of relative mood stability, which occur naturally, although they are best maintained by medication. The Goodwin-Jamison book explores more of the subtleties of symptoms, such as the all-too-brief periods of "hypomania" or "mild mania," the one silver lining among the disease's many thunderous clouds. During hypomania, patients experience "increased energy, expansiveness, risk taking and fluency of thought" that often lead to periods of superhuman productivity (and, if you're an artist, a lot of art). Unfortunately, the brain's accelerator eventually pushes past 80, and the patient spins out of control. So people with manic depression can come to distrust their happiest moments for fear of what they'll lead to.
My friend also recommended Jamison's 1993 lay book Touched With Fire: Manic-Depressive Illness and the Artistic Temperament, which is a sort of survey course of the research on artists she began doing at Oxford in the early '80s that reprises as much of the information from the textbook as a non-professional needs. I decided to write about her because she was about to do her third public television special on mental illness and the arts -- following "Moods and Music" in 1990 and "To Paint the Stars: The Life and Mind of Vincent van Gogh" in 1991. This one was to be about Byron. It would bring together her research on his life and work with new findings about the genetics of mental illness, which is being studied by one of her Johns Hopkins colleagues, Raymond DePaulo, and by James Watson, the co-discoverer of DNA. Jamison and I got together in Philadelphia, where she was giving her general art and mental illness talk -- the Kay Sampler -- at Friends Hospital. We met for coffee in the lounge of the Four Seasons Hotel, where I arrived with the breaking news of Kurt Cobain's death. She didn't know much about Cobain -- she's not really the Nirvana type. But she said she wouldn't be surprised if he had manic depression. (It later turned out that he had received such a diagnosis, but like too many people, couldn't stay on his medication -- lithium, about which he had once written a song.) Jamison recalled that at the mood disorders clinic at UCLA she helped found in 1977, "we used to get a lot of rock musicians, a lot of drugs, a lot of manic-depressive illness." Then she sighed. "The thing that doesn't get emphasized enough is the fact that manic-depressive illness kills people. There's an extremely high suicide rate attached to it . . . It's the most important thing about the illness."
When she talks, Jamison has a way of being both engaging and skittish -- a dynamic nervousness. She explained that she was an Air Force brat, the youngest of three children, who had spent many of her formative years in the Washington area though her father's career -- he was a pilot and meteorologist -- took the family to Florida, Puerto Rico and Tokyo. They settled in Southern California, where her father took a job with the Rand Corp. and her mother taught elementary school.
Jamison went to UCLA to be a veterinarian. She switched to psychology because she didn't think she had the temperament for medical school, and then gravitated back toward the physiological, medical side of the field -- eventually teaching in the psychiatry department, and taking a minor in comparative psychopharmacology. She fell in with William McGlothlin, who, along with Timothy Leary, was doing the pioneer research into altered mood states using now-illegal drugs. Her dissertation was on LSD and heroin abuse.
I asked how she had become interested specifically in manic-depressive illness. She said there was some incidence in her family. When I asked for details, she said, "Well, I pass on that, okay?" Pressed, she said, "I know that being more open is destigmatizing, but this is also about issues of privacy, and I don't feel I can talk on behalf of my family." I asked her to give it some thought. She said, "I'll think about it, but . . . I am surrounded by manic-depressive illness all the time, and I am well aware of what my patients go through and my family members go through and my friends go through and my colleagues go through. Being open is the sort of thing that I advise people to think very long and hard about. It's one thing if you're independently wealthy. It's another thing if you're out in the real world."
So we went back to annotating her resume as a clinician, researcher and writer. The story was counterpointed by her cyclically difficult private life. Her parents had divorced and her father remarried and started a second family. Jamison's first marriage, during graduate school, ended in divorce. She then fell in love with a British army officer named David Laurie, a psychiatrist 13 years her senior, with whom she planned to settle down and "have a houseful of kids." But in 1979, he died suddenly of a heart attack, and she was left to throw herself into her work.
She hooked up with Goodwin, a towering figure in both biological psychiatry and mood disorders, and began the textbook -- which took 10 years and included all the work she was doing on lithium, suicide and psychotherapy. On the side, she began publishing papers on an unorthodox subject: the "positive experiences" associated with mood, or, as they were then usually called, "affective" disorders. (Continued in Part 2)