Of Moods and Madness
Published Jan 1, 2016 8:00 AM
Kay Redfield Jamison knows depressive illnesses as both a patient and a doctor.
In 1995, Kay Redfield Jamison ’71, M.A. ’71, Ph.D. ’75, one of the world’s leading authorities on mood disorders, revealed that she herself had suffered from manic-depressive illness since she was a teenager. She made the revelation in the middle of a thriving academic and clinical career, in a book titled An Unquiet Mind: A Memoir of Moods and Madness. The co-founder of UCLA’s Mood Disorders Clinic, author of six books and recipient of a MacArthur “genius grant,” she is now a professor of psychiatry at Johns Hopkins University School of Medicine.
Q: When you first experienced depression, at age 17, you kept it to yourself. Why?
A: I was manic at the beginning, and didn’t think anything was wrong, I felt great. But when I got psychotically depressed, I knew something was very wrong. I didn’t say to myself, ‘You’ve got manic-depressive illness,’ but I knew I was sick.
Q: But you didn’t tell anyone?
A: Correct. Which is a very common response, actually.
Q: You feared the possible professional ramifications of revealing your illness, perhaps losing your academic standing, but you did it anyway. Why?
A: I felt hypocritical not doing it. I was tired of acting as though I had something to hide. I’ve been very fortunate, as have hundreds of thousands of people, to respond well to treatment. If people don’t go public, the world has no concept of how treatable these illnesses are. It’s helpful when people can say, look, I didn’t have to wall myself off. I could go out and compete and try to make a difference.
Q: How do you define depression?
A: First of all, it’s not one illness, but a group of illnesses with different causes, different treatments. One set of definitions is clinical and has clear diagnostic criteria and a lot of biological and therapeutic implications. But depression is also part of the human condition. It’s been around since people began describing human nature. The average age of onset is young; it often begins in adolescence or young adulthood. And it’s potentially lethal.
Q: What advances in the last 10 to 15 years offer more hope for these illnesses?
A: A lot of things can make a difference, such as brain scanning and genetic studies, which UCLA has been deeply involved in. Depression is recognized now as a treatable illness, and there are huge advances that make it more likely that the public will be interested in depression and that the government and private funders will back it. All those things are terribly important.
Q: You’ve written that manic-depressive (bi-polar) illness brings not only suffering, but sometimes extraordinary creativity. Is there a danger that people won’t seek help for fear of losing something positive?
A: Not everyone who is manic-depressive gets euphoric manias, but those who do are tempted to try to recapture that. The reality is that this is a potentially fatal illness that’s destructive to the individual, to society and to families. It’s complicated. People want something to be all bad or all good, but the fact is that some good things come out of mania. That’s just true. So you’ve got to deal with that. There is a legitimate issue of what are the effects of drugs on the imaginative mind. It hasn’t been studied enough. I do think productivity goes up if people are treated.
Q: Many college-age people get depressed or even suicidal. How can a campus address the issue effectively?
A: The ability of colleges and universities to treat depression and bi-polar illness is hugely variable in terms of quality and resources. A lot of places do next to nothing. It has to come from the top. The president or chancellor has to make a serious commitment to it. If it’s only student counseling services or student health committing to it, it’s like preaching to the choir. If you don’t put the resources in, commit to it and follow up, over and over and over again, it’s far less effective than it could be.
Q: What can be done to prepare students who are going off to college at an age when they may first experience depression?
A: It’s education. I have a colleague at Johns Hopkins who started a program in middle and high schools in which a doctor and nurse go out and talk to students, teachers and parents, and tell them what depression feels like and looks like. So when a young person encounters the symptoms later on, they may think, I remember that someone told me I might experience this, and they said it was treatable.
Q: What can parents do?
A: Be straight with their kids. One of the frustrations for a lot of us in the mental health field is when parents know that there is a family history of mania, or depression, or suicide, and they don’t talk to their kids about it. It’s very important to sit down and have a straightforward conversation and say, look, the odds are you aren’t going to get this, but if you do, it’s treatable, and we’re going to give you a list of doctors just in case you need somebody. And then keep the channels of communication open.
Q: Has the stigma of mental illness lifted any, because of books like yours and more open discussion?
A: I find the word “stigma” a little uncomfortable. It implies that there’s something to be stigmatized and, in a way, perpetrates it. I think people with mental illness actually are discriminated against. I do think there’s a little more understanding now. But I’ve learned in talking to college students who are depressed that what they see around them are a lot of very healthy kids, while they themselves can’t get out of bed, can’t think, can’t study, can’t compete. They feel different. Our responsibility is to get them into treatment.
Q: What is your take on UCLA’s Depression Grand Challenge?
A: It’s fantastic that UCLA is putting a focus on it. What’s wonderful about this initiative is that it’s vast, it’s ambitious. It’s not circumscribed or limited in its goals. Because of that, it’s much more likely to capture the imagination and find new ways to address depression and bipolar illness.
Q: What does UCLA in particular bring to a project like this?
A: UCLA is in the middle of a creative business, film and writing community. It would be wonderful to see a genuine collaboration between this community and UCLA’s experts in science, medicine, the humanities, arts, etc. That might lead to, for example, an ongoing series of seminars that could result in new ways to address depression and bipolar illness. The U.S. is blessed with a number of great medical schools and hospitals, but being in the middle of these creative communities is unique to UCLA.
Q: Do you know of anything similar to this in scale?
A: The genome project comes to mind, although far more money was involved. It was incredibly ambitious. So, of course, was the Manhattan Project. I think the ideas that take hold are those with vast ambitions, like going to the moon. Or Saturn.
Q: What is the most effective way to get people to think differently about depression and bipolar illness?
A: Make it interesting. The medical and public health communities have a remarkable capacity for making interesting topics dull. And yet these are fascinating illnesses; they’ve been around since we began as a species. I’m looking forward to seeing how this group of imaginative and highly educated people at UCLA, working with L.A.’s creative communities, can make a difference in how people think about it and what is done to address it.