(Part 2 of 3) This led to her 1984 study of 47 living British artists and writers, which found that 38 percent had been treated for depression or manic depression -- much higher than the 1 percent to 6 percent of the population normally affected. Her results echoed the findings of the one earlier major study in this area, by Nancy Andreason, author of the first lay manifesto of biological psychiatry, The Broken Brain.

During this time, Jamison was trying out some of this material at annual Christmas lectures for the staff at the UCLA mood disorders clinic. In her talks, she would synthesize the clinical literature with the works and letters of poets and composers who, she felt, described disordered moods particularly well, whether they meant to or not. Among the quotations from Byron and the music of Handel, Schumann, Berlioz and Mahler -- all of whom she would later determine suffered from mood disorders -- she also included selections from a less classical source: the musical "Barnum." She felt that some of the musical's numbers captured the experience of the focused frenzy of hypomania so well that she even met with "Barnum's" male lead, Jim Dale, when the show was playing in Los Angeles.

She was soon inspired to make a Barnum-esque attempt to draw attention to mood disorders. She decided to do the biographical research to formally, posthumously diagnose the suspected mood disorders of a group of composers, and then produce a concert devoted to "Moods and Music," which would mix performance with short talks about the composers and the illnesses. When she floated the idea around her department, it was suggested she get the UCLA doctors' orchestra. She, instead, persuaded the Los Angeles Philharmonic to do it. And she persuaded her new friends Norman and Frances Lear to help sponsor the 1985 concert, although, because of a quirk in UCLA fund-raising rules, Jamison ended up paying for most of the show, with $25,000 of her savings. "I'm delighted I did it," she said, "even though it wasn't a very sensible thing to do."

We stopped the interview at the mid-'80s because she had to go, and we made plans to speak again at her Washington office, which is in the home she shares with NIMH schizophrenia researcher Richard Wyatt. Several days later she called to ask if we could have an off-the-record conversation.

She told me she has manic-depressive illness herself. Only her family and some of her closest friends and colleagues knew this, she said, but she had plans to go public. Besides her biography of Byron, she had been writing a memoir of her own mental illness. And although it wasn't to be published for some time, she expressed a willingness to be "outed" first. To some, her disclosure would be a shock; to others, it would be nothing more than a confirmed assumption. But it was likely to be a big deal in psychiatric circles, where the fear of being perceived as crazier than one's patients is very real and very stigmatizing, and clinical privileges can be jeopardized for political rather than medical reasons.

She only asked that the story not be published until the people who had to know -- her close colleagues, her patients -- could be forewarned.

JAMISON'S MANIC-DEPRESSIVE illness first manifested itself when she was 16. The early symptoms generally run to one extreme of the mood scale, but they can also be present as more of a "mixed state" with a jumble of manic and depressive symptoms -- the most dangerous combination being the agitation and impulsiveness of mania along with the suicidal thoughts of depression. Psychosis, or disordered thought, once associated only with schizophrenia, can be a secondary symptom of depression and mania -- the hallucinations and delusions often appearing when the mood disturbance is at its worst.

"I was psychotically depressed, I was delusional," Jamison says of her first "breakthrough" symptoms. She is sitting in her dark wood-paneled office, the seriousness of which is undercut by the small animal sculptures -- a polar bear here, a skunk there -- that occupy every surface not covered with books or papers. "All I wanted to do was die. I couldn't function. I couldn't function, but I did function -- there's an interacting shell you present to the world. But I had no fun, which for me was inconceivable. Life, to me, was fun. Then, all of a sudden I had no pleasure in doing anything. I had no name for it, no notion of what it was. Several of my teachers called me aside and said I looked terrible. But they didn't say depressed.' Back then, nobody thought people in high school were capable of feeling like that."

The depression broke after several months -- even untreated, the mood eventually swings back, although the depressive periods generally last much longer than the manic ones -- and Jamison recovered quickly. "When you recover, you're so normal," she says. "It's one of the things that can be deceptive. It's like having a very bad flu, during which you promise that you'll do this, that and the other thing, and you're going to appreciate life more when you feel better. I'm amazed at how rapidly one feels normal and takes it for granted." (Left untreated, a person with manic depression can expect to have at least 10 manic or major depressive episodes in a lifetime. Treatment is believed to help shorten the episodes and lessen the severity of symptoms.)

Although she had several other depressions and mild manias during college, it wasn't until after graduate school that Jamison began having floridly manic episodes. They started with the joys of hypomania, "which is very productive, and I would be zipping around like Crusader Rabbit," she says. "I would be crazy with my boyfriend, who was a very straight arrow and thought it was great, up to a point." But the symptoms gave way to more agitation and racing thoughts, and crested with textbook hallucinations, grandiosity, bad judgment and hyper-shopping -- the kind of experiences that can sometimes make for amusing stories afterward (if you make it to the afterward).

"Most of the jewelry and furniture are things I continue to enjoy, actually," Jamison says with a slight grin. "I do remember once whipping around a drugstore, convinced there was a major rattlesnake problem in the San Fernando Valley. As it turns out, there is a problem, but not something to worry about. I got worried about it. They had these snakebite kits, very portable, and I knew every one of my friends would want to have one. So I bought all of them, a shopping cart full of them . . . My brother is an economist for the World Bank -- he helped me pick up after my manic sprees, when I was hopelessly in debt."

"This can be one of the funniest illnesses," says Bob Boorstin. "There is limited humor about physical illnesses, cancer, but illnesses of the mind make for greater humor. The delusions in and of themselves are hilarious."

For 12 years Jamison refused to get help. "The hallucinations and delusions would last for a while, and I would sit outside the student health service thinking I should go in," she recalls. "I knew I was really disturbed. But I was from a very WASP military family. You figure it out for yourself . . . You just go on . . . Which is probably why I spend a lot of time in my life in churches . . . I also walked endlessly, which is what I still do. There are lots of ways, but you have to handle it.

"I was lucky I never got into drugs. And, although for a brief period in high school I would put vodka in my orange juice before I went off in the mornings, I never got into alcohol. Something like 50 to 60 percent of people with manic-depressive illness have substance-abuse problems because they self-medicate.' I had alcoholism in my family, and it was just something that frightened me. But the times that I have had anything to drink was when I got manic, to bring myself down again."

Ever since college she had been surrounded by mental health professionals, but her illness escaped detection. "People are remarkably intolerant of mental illness and remarkably tolerant of deviance," she says. "You can do some very strange things, especially at a university, and not get picked up for it. People give people a very wide berth . . . and I've never been struck that people are terribly observant about psychological pain."

After years of studying and working with psychiatrists, Jamison finally saw one at age 27. He put her on the mood stabilizer lithium, which, at that time in the early '70s, had only recently come into common use. It was revolutionizing the diagnosis and treatment of manic depression (making it easier to distinguish from schizophrenia), and also offered the nascent world of psychopharmacology its best model for a "maintenance drug" to treat a serious mental illness. Jamison was lucky in one respect: Her illness responded to lithium. Not all manic depression does, and it is now known that there are many variations of the illness. Lithium responders are more likely to have the "classic," long swings of full-blown mania and depression. But those who experience "mixed states" or "rapid cycling" of moods (over hours or days rather than months) are less likely to respond to lithium. And it wasn't until very recently that several anti-seizure medications proved useful for them as primary mood stabilizers (to which antidepressants, antipsychotics and other medications can be added when necessary).

Although lithium worked for her, Jamison, for many years, had the common problems staying on her medication -- as soon as patients feel better, they often stop taking the drugs that make them feel better, or, in the jargon, they become "noncompliant." And she has experienced some of lithium's more extreme side effects, especially before she realized that her mood could be stabilized with a lower, less debilitating dose. For more than a decade, what turned out to be an unnecessarily high dose of lithium left her essentially unable to read. "It's a rare side effect," she explains, "a form of neurotoxicity that causes blurred vision mixed with some inability to concentrate. I had to work very slowly, rereading over and over again. It was a period of enormous frustration and throwing books against the wall."

Jamison has never been hospitalized for her illness -- partly because during her worst periods she had doctor friends who took care of her at home so she wouldn't have to be treated among her own patients. Avoiding the hospital, she now says, "was a stupid thing to do, and it's what people do all the time. It's what my colleagues {who have the illness} do . . . at all costs. It's barbaric. You should be able to just check into the hospital and get well. It's bad enough to have the disease -- why should you also have to wonder what it will cost you personally and professionally?"

She says she has tried to kill herself only once, a year or two after she began treatment, with a deliberate lithium overdose (coupled with an anti-emetic to keep her from throwing up.) But she has had more than her share of what is called "suicidal ideation": self-murderous thoughts that spring not from dire circumstances but, seemingly, from the illness itself. She offers a striking example of the difference between depressing things happening in your life, and the onset of a suicidal depression. Recalling her late fiance, she says, "David Laurie's death was so much easier than depression. It was devastating to my future and my dreams, I was very unhappy. But it never once occurred to me to kill myself then, not for a second or half a second."

She has kept her illness hidden from everyone except those who needed to know -- and has made sure there was always someone there to flag her if a problem arose. Those who had to know were generally supportive. "I remember when we were trying to put together the mood disorders clinic," she says. "My chairman at UCLA could have had some problems with that: I mean, I was a woman, only a PhD, and manic-depressive, any one of which was not a great calling card for heading a clinic. My chairman came up to me one day and said, Kay, I understand you've got some problems with moods. Well, just keep taking your lithium and make sure you're doing that and you'll be okay. It's a treatable illness.' I remember bursting into tears. I mean, it is a treatable illness, but his kindness and his way of seeking me out . . . it was very clear he thought I would be just fine."

In the past 10 years, since she has been taking lithium without fail, her illness has been under control. There have been no long incapacitated periods, "although there have been some terrible days for sure." If she falls into another deep depression, her psychiatrist, who lives in California, is under orders to prescribe her electro-convulsive therapy. She has never had the treatment -- which, in its new, more humane version, is making a comeback as an adjunct or alternative to antidepressant medications -- but wishes it had been more popular when she experienced the worst of her depressions in her twenties and thirties.

The suicidal ideation has become just part of the fabric of her life. "It's an unnecessary early death," she says, "but I'm not just being philosophical when I say I might die that way . . . I don't go around talking about it, but it's common to me. I talk about it to myself a lot."

IN THE MEDICAL community, diagnosing famous dead people is like a parlor game that can't necessarily be won. It is commonly played at conferences or in journals after the more serious papers have been presented. But Jamison takes the game seriously. Because she isn't just trying to make a better diagnosis than her colleagues. She is trying to use the enterprise as a way to draw attention to the unfolding science of manic-depressive illness -- the NIMH estimates that roughly 95 percent of what is known about the brain has been learned in the past 10 years -- and to improvements in psychiatric care. She is using long-dead celebrities to endorse new approaches to diagnosis and treatment. (See story, opposite page.)

Game or no game, posthumous diagnosis is a tricky business. And an active one: Vincent van Gogh, for example, has had over 100 different posthumous diagnoses. Over the years, his work has been cited as a possible "silver lining" for conditions ranging from glaucoma to epilepsy to tinnitus (ringing in the ears.) And, each time, there has been debate on the accuracy of the diagnosis and the implications of linking art to disease. But there is more at stake when trying to make a psychiatric diagnosis stick, because psychiatry carries a stigma that, say, neurology doesn't (even though the line between the two is getting thinner). The mental health field is still trying to battle the impression that its diagnoses are "softer" than those in other health care specialties -- a view that's held even by some psychiatrists and psychologists, who resist the "medicalization" and standardization of mental health care as antithetical to treating the individual problems of individual patients. In traditional psychoanalysis, once the preferred treatment for all mental illness, a diagnosis was what you worked toward, instead of what you started with.

Jamison's work on creativity thrusts her into the middle of the very political science of mental health care. At the theoretical level, there is still a battle being waged between nature and nurture, a battle that too easily breaks down into biology versus psychology or pills versus psychotherapy. At an economic level, psychiatrists, psychologists and social workers are all fighting for the psychotherapy dollar while psychologists are lobbying for a piece of the psychiatrists' prescription-writing privileges. Advocacy groups for the different psychiatric illnesses compete as well. It may seem benign to want to call attention to an illness that, according to the Department of Health and Human Services, will cost the average untreated 25-year-old woman nine years of life, 12 years of normal health and 14 years of activity (including job and child-rearing). But, in the current mental health environment, nothing is benign.

The strongest public attack on Jamison's work has come from a Freudian medical psychologist who sees Touched With Fire as a well-written, thoughtful piece of "propaganda" for modern biological psychiatry. In a 1993 Washington Post review of the book, Saul Rosenzweig, a professor emeritus of psychology and psychiatry at Washington University in St. Louis, called Jamison's medical diagnoses "dubious." He accused her of having a "genetic bias about the origin of manic-depressive illness" and criticized her dependence on "the assumption of a genetic, inherited, unitary disease." (Continued in Part 3)