(Part 3 of 3)
"But, more important, she has equated creativity with manic-depressive psychosis . . . Her thesis is an overstatement. I don't deny for a minute that a number of creative individuals may have manic-depressive illness. But you can have hysteric states because something wonderful has happened to you and can get depressed because of something you have not gotten -- to deny such situational events and call them manic depression . . . to say that individuals who have moods are manic-depressive, that's ridiculous . . . that's extreme, that's medically unsound." Rosenzweig regards much of modern biological psychiatry as a reductionist fad. And Jamison regards Rosenzweig as a psychoanalyst of the school whose training would put him at odds with her own, more biological predisposition. She concedes that there are some built-in methodological problems in her studies of artists. "You'd have to be completely stupid or crooked to say otherwise," she has said. "Any study anywhere in which there's a combination of science and art is going to be flawed . . . but if you have a group of studies . . . all using dissimilar methods, different groups of artists and writers, and they're all coming up with the same finding . . . you have to ask, Is it just chance?' "
But she is irked by the charge of reductionism. It sometimes comes up during question-and-answer periods, where Jamison has been accused of "reducing the mystery and wonder of artistry to genetics and brain chemistry," according to Johns Hopkins Magazine.
"I gave a talk on Poe recently," she says, "and I went out of my way to say that he was obviously a complicated, interesting man, but I was only going to address one aspect of his life -- the moods he had," she says. "A guy comes up to me afterwards and says, You reduced everything in the world to biology.' I was so ticked. I said, Yeah, it's because I'm a reductionist pig. I don't believe in complexity.'
"The assumption is if you don't make things complicated you are incapable of understanding complexity. One of the reasons people with manic depression have had a bad time in treatment is because their dreams and experiences are so interesting. There's enough fodder there to fuel any theory, any psychological theory . . . Look, the thing the writers who have had the illness can do is to describe the feelings, and that's important. But if you're treating somebody, you have an obligation to find out what's wrong with them. If you're treating somebody with cancer, of course you want to know what the experience is like. But first and foremost you want to find out what the tumor is and whether it will respond to radiation. Nobody says they're reductionist because they want to find the tumor. Somehow in psychiatry if you try and be precise and match your treatments with a diagnosis, that's seen as less complex, less humanistic."
Another, more subtle criticism of Jamison's work comes from a researcher whose professional politics are closer to her own -- E. Fuller Torrey, a bestselling author and outspoken schizophrenia researcher at St. Elizabeths Hospital. Torrey, ever since his 1972 book, The Death of Psychiatry, has been a lightning rod for controversy and an outside political agitator. There are similarities between his attempts to draw attention to schizophrenia -- which his sister has -- and Jamison's efforts. It could be argued that the difference between them is the difference between the severity of the two illnesses, and the cultures that have sprung up around them. (There's a reason that when Bob Boorstin was hospitalized a second time for a manic episode, he hung a sign over his bed reading "thank God I'm not schizophrenic.")
But Torrey has some concern about secondary symptoms caused by her work. "I think there's a real danger in what Kay does," he says. "The danger is the romanticizing of serious mental illness . . . Our tendency is to romanticize Sylvia Plath or someone like that without asking whether, if they hadn't had the disease, they wouldn't have produced better things over time."
Jamison agrees that there is a danger in romanticizing mental illness, and throughout her work she raises the question of what these artists might have produced if they had been treated. But she is less certain than Torrey about one big issue: whether these artists would still be artists if they hadn't had the disease at all. It may be, she speculates, that the illness somehow enables the art, while at the same time destroying the artist. And it may be that the art itself springs from something as dramatic as composers and visual artists trying to re-create their psychotic experiences -- or from something as subtle as writers using their abnormal range of emotional experiences to observe human nature in a unique way.
During her talks, Jamison often asks whether we would lose our artists if their manic depression was properly treated. The politically correct answer -- because no responsible clinician would dissuade a patient from treatment -- is "no, we wouldn't lose them." And that's what she says publicly. But privately she admits that the truth is not so easy. There are trade-offs, and Jamison knows from her patients and friends -- as well as from her own experiences -- that medications can dampen more than just the troublesome symptoms. Sometimes the choice almost seems to be between quality of life and quantity of life. At any rate, Jamison seems to respect our need for the artist and the art somewhat more than Torrey, who says, "Hey, I would quite happily lose a van Gogh to treat the disease."
Even Bob Boorstin says he understands why some people criticize the effect of Jamison's work, if not the work itself. "I think that she has done a great service by addressing these historical figures . . . and finding that link between creativity and the illness," he says. "And her books make it very clear that you can have this illness and contribute to society. On the other hand, her work does distort the illness.
"Why? Pretty simply, the only people who left records were the creative people. There must have been hundreds of thousands of middle-class folks who lived alongside Byron and van Gogh who had these illnesses, and we don't know about them because they didn't leave letters or diaries. There are millions of people in this country who are not celebrities who have these illnesses . . . In a way, Kay has glamorized this illness. And for people who deal with it on a day-to-day basis, who don't have the money, who don't have access to the best treatment, this is not a glamorous thing. This is something that ruins their lives."
In 1987, Jamison moved to Washington to be closer to Richard Wyatt, and joined the faculty at Johns Hopkins. A year later, she produced a much grander version of the "Moods and Music" concert. This time it was a gala evening held at the Kennedy Center and taped for a PBS special. The concert was sponsored by the NIMH, the Johns Hopkins psychiatry department and the foundation Jamison had set up to increase public awareness of mood disorders. The concert board included Patty Duke, Katharine Graham, Armand Hammer, Sens. Orrin Hatch and Edward Kennedy, National Gallery Director J. Carter Brown, James Watson and Frances Lear, who donated over $250,000.
The advisory board included a number of the leading lights of psychiatry, including Mogens Schou, the Danish researcher who did the important studies that established lithium as a treatment for manic depression (and, as far as Jamison is concerned, saved her life). Among the co-sponsors were most of the major mental health advocacy groups, including the "consumer"-run National Depressive and Manic-Depressive Illness Association, where Jamison is on the board, and the more politically powerful National Alliance for the Mentally Ill, which had been started by parents with adult children suffering from schizophrenia before branching out into lobbying for all serious mental illnesses.
The PBS special didn't air until 1990. That same year, the Goodwin-Jamison Manic-Depressive Illness textbook was published. The first comprehensive book on the subject in decades, it was greeted with dizzyingly positive reviews. (It was named "Most Outstanding Book" in the biomedical sciences by the Association of American Publishers.) At the same time, Jamison was putting together another PBS special. "To Paint the Stars: The Life and Mind of Vincent Van Gogh," which brought together many of her same supporters, had its premiere at the National Gallery of Art. The program, of course, only added to the century-old debate over van Gogh; fewer people are fighting over Schumann and Handel.
By this time, besides her teaching at Johns Hopkins and her private psychotherapy practice, Jamison was working on expanding her chapter on creativity in Manic-Depressive Illness into an entire book. It was to include all her published research on the subject, as well as bring together pieces like an afterword she wrote for a book in which the author diagnosed Virginia Woolf's manic-depressive illness. Touched With Fire was published by Free Press in 1993, and while she was giving interviews and lectures to support it, she was also working on the Lord Byron program, "Taint of Blood," for public television. (The filming in Britain and at James Watson's molecular biology lab in Cold Spring Harbor, N.Y., has been completed, but the show is still in post-production.)
It was during this time that she started seriously considering a memoir of her illness -- encouraged by Erwin Glikes, her editor at Free Press. She decided to "come out," she says, because she spends so much time encouraging patients to feel they can talk about their illness. "Part of my efforts are to increase the quality of medical care that people receive for this illness and get the public aware that the illness is treatable and so forth. But a good chunk of my time goes into destigmatization, because the stigma attached to mental illness is such a serious problem, and I think people should be . . . able to talk about it.
"I also hope my book will bring the illness out of the closet for professionals. There are a lot of lawyers and doctors and clinical psychologists who don't get treated for fear of hurting their clinical privileges. Or they keep it so much on the sly that they don't cover themselves. I heard about a surgeon who was manic and just kept cutting: The surgical team had to land on him. If that surgeon gets treatment, and other people know about it, and can pull him off early enough, and he's a good surgeon, then . . . well, why should he be judged by anyone else?"
Jamison and Boorstin have talked a lot about how she'll be judged. "I tried to show her the upside and the downside," he says. "I discouraged her from coming out' in terms of how it will affect her position within the scientific community. I'm sure I said they won't take you as seriously,' because psychiatrists are notorious as the least sensitive people towards illness in a certain way . . . the closer you get to mental illness, the more you see how thin the wall is between sanity and insanity and how easy it is to leap that wall. Because psychiatrists are exposed to this, they become better at denying -- they're experts at denial. And that's a problem that Kay will face."
The problems of mental health professionals with treatable mental illnesses are still only whispered about, although there was a telling scene at the most recent convention of the American Psychiatric Association. At a panel discussion on stigma and celebrity -- in which Art Buchwald, Rod Steiger, Suzanne Somers and Cathy Cronkite told of suffering in the closet -- a psychiatrist rose during the question-and-answer period and announced that he had been treated for depression and was tired of the prejudice. The audience of psychiatrists gave him the loudest round of applause of the day.
Jamison's book has been written during a period that might test anyone's mood. Last spring, Richard Wyatt was in and out of the hospital with heart problems. (After his second hospital stay in six months, the couple eloped to Scotland.) Then her editor at Free Press died suddenly, just as she was about to finish up the book. After recovering from the shock, she realized that her extremely personal book now had no editor with an extremely personal attachment to it. She vacillated between finishing it, or turning into an academic memoir that didn't include her illness. Instead, a literary agent helped her quietly test the interest of more commercial publishers.
The book was recently sold, for an advance far higher than Free Press ever would have paid, to Knopf. It is scheduled to be published in the fall. The tentative title is An Unquiet Mind.
When it comes out, Jamison will get something more profound than just book reviews. By making the leap from writing about the psychiatric problems of dead people to writing about her own psychiatric problems, she will get a chance to see firsthand just how successful her attempts at destigmatizing the illness have been. She will find out if she has really made the world a safer place to have manic-depressive illness. It's a rare opportunity that is perhaps rare for a reason. The book has already caused a major change in her life. She doesn't feel that "coming out" in and of itself should prevent a mental health professional from doing psychotherapy. But An Unquiet Mind will explore so much of her private life -- the sections I've read are painful, revelatory, moving -- that she isn't sure she can be a blank enough slate any longer. She plans to continue to do clinical teaching at Johns Hopkins and consult on patients hospitalized there, but she has stopped taking new patients and is considering terminating her psychotherapy practice.
"These are totally uncharted seas," she says. "Most people will be understanding and some people will say, What on earth is she saying all this for, whatever happened to the days of privacy and discretion?' -- all those things I hear from my childhood. You don't have any idea how many years I've thought about doing it, and whether the benefit would outweigh the disadvantages. I don't like people knowing about my psychiatric illness . . . it's a very disturbing thought."
At least she will no longer have to worry that someone will realize that some of the "patient" excerpts she uses in teaching and writing are, in fact, from her own journals.
At the beginning of one textbook chapter, for example, she includes an excerpt in which she identifies herself as a "patient with manic-depressive illness." Addressing her therapist, she writes: "I remember sitting in your office a hundred times during those grim months, and each time thinking, what on earth can he say that will make me feel better or keep me alive. Well, there never was anything you could say . . . {just} your granite belief that mine was a life worth living . . . you taught me that the road from suicide to life is cold and colder still, but -- with steely effort, the grace of God, and an inevitable break in the weather -- that I could make it."
It's the ultimate doctor-patient relationship. "I have thought several times over the years, What if somebody recognizes the stylistic similarities?' " she says. "When I would use those excerpts in teaching, I would be concerned that my level of intensity while reading something very personal would show through. And it would be apparent to people. I was honored at a DRADA dinner recently, and I ended my talk with a passage that a patient' had written. I was convinced that everyone there had to know I was talking about myself."
Stephen Fried is a contributing editor at Vanity Fair. He last wrote for the Magazine about adverse reactions to prescription drugs.
CAPTION: Kay Jamison, opposite page, and some of her better-known "patients"; artist Vincent van Gogh; writers Virginia Woolf and Robert Louis Stevenson and jazz saxophonist Charlie Parker. CAPTION: Jamison and her husband, Richard Wyatt, an NIMH schizophrenia researcher. CAPTION: Kay Jamison (cover )
