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An Unquiet Mind

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on 26 November 2013

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Transcript of An Unquiet Mind

An Unquiet Mind
Kay Redfield Jamison
About the book
An
Unquiet Mind
was written by Kay Redfield Jamison, who is a clinical psychologist who has bipolar disorder. This book is about her personal experience growing up with bipolar disorder and how it affected her professional and social life both positively and negatively.

DSM vs Subjective Experience
Must meet criteria for:
A manic episode-a distinct period of abnormally and persistently elevated, expansive, or irritable mood that lasts at least one week (or less than a week if hospitalization is necessary). During the period of disturbed mood, three or more of the symptoms must be present (four if the mood is only irritable)
& A major depressive episode-At least one of the symptoms is either depressed mood or loss of interest or pleasure. Symptoms can be based on your own feelings or on the observations of someone else. You must have five (or more) of the symptoms over a two-week period.
Effects
Personal Life
Conclusion: Importance for Social Work
Stigmas of Mental Illnesses...
About the author
The author is a brilliant Ph.D. researcher and academic, currently Professor of Psychiatry with Johns Hopkins University and previously a professor at her alma mater UCLA where she founded and ran the Affective Disorders clinic.
In her career, she has done nodal work of case studies and direct patient research on those with mood disorders and primarily Bipolar Disorder with which she, herself, is diagnosed.
Jamison is also a child of a military father who suffered from manic-depressive illness
“There is a particular kind of pain, elation, loneliness, and terror involved in this kind of madness. When you're high its tremendous.The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there. The power to captivate others a felt certainty....But, somewhere, this changes. The fast ideas are far too fast, and there are far too many;overwhelming confusion replaces clarity. Memory goes. Humor and absorption on friends faces are replaced by fear and concern....You are irritable, angry, frightened, uncontrollable and in the blackest caves of the mind. You never knew those caves were there. It will never end, for madness carves its own reality.”
Normal vs. Abnormal
Feelings that what is normal to others is an abnormal "stable" state which requires effort and medication
"As I gradually entered into the world of more stable moods and more predictable life, I began to realize that I knew very little about it and had no real idea of what it would be like to live in such a place"
Others' reactions to abnormal (episodic) behavior
"it never occurred to me that I was ill, my brain never put it in those terms"
Never knowing what reality will present to you at any given time
"and always, when will it happen again? Which of my feelings are real? Which of the me's is me? The wild impulsive, chaotic, energetic, and crazy one? Or the shy, withdrawn, desperate, suicidal, doomed and tired one?
Increased goal-directed activity (either socially, at work or school, or sexually)
"my intellectual interests were widely and absurdly scattered during my early years on the faculty. I was, among other things, starting up a research project on hyraxes, elephants and violence (a lingering remnant of the chancellor's garden party); writing up findings from the LSD, marijuana and opiate studies I had done in graduate school; contemplating a study, to be done with my brother, that would examine the economics of dam-building hehavior in beavers; conducting pain research and studies of phantom breast syndrome with my colleagues in the anesthesiology department; coauthoring an undergraduate textbook on abnormal psychology; acting as co-investigator onn a study of the effects of marijuana on nausea and vomiting in cancer chemotherapy patients and trying to figure out a legitimate way to do animal behavior studies at the Los Angeles Zoo."
Feelings of worthlessness or excessive or inappropriate guilt nearly every day
Depressed mood most of the day, nearly every day, such as feeling sad, empty or tearful; Diminished interest or feeling no pleasure in all — or almost all — activities most of the day, nearly every day
Decreased need for sleep (for example, you feel rested after only three hours of sleep)
"summer, a lack of sleep, a deluge of work, and exquisitely vulnerable genes eventually took me to the back of beyond, past my familiar levels of exuberance and into florid madness"
Inflated self-esteem or grandiosity
"My recollection of the situation was that I was perhaps a bit high, but primarily I remember I was talking to scads of people, feeling that I was irresistibly charming, and zipping around from hors d'oeuvre to hors d'oeuvre, and drink to drink
Doing things that have a high potential for painful consequences — for example, unrestrained buying sprees, sexual indiscretions or foolish business investments
"credit cards revoked, bounced checks to cover, explanations at work, apologies to make"
"I imagine I must have spent far more than thirty thousand dollars during my two major manic episodes and God only knows how much more during my frequent milder manias
Unusual talkativeness; Racing thoughts; Distractibility
"it goes on and on, and finally there are only others' recollection of your behavior-your bizarre, frenetic, aimless behaviors-for mania has at some grace in partially obliterating memories"
Insomnia or increased desire to sleep nearly every day
"i occasionally slept in the same clothes I had worn during the day because I was too exhausted to undress"
Either restlessness or slowed behavior that can be observed by others; Fatigue or loss of energy nearly every day
"profound melancholia is a day-in, day-out, night-in, night-out almost art level of agony. It is a pitiless, unrelenting painthat affords no window of hope, no alternative to a grim and brackish existence and no respite from the cold undercurrents fo thought and feeling that dominate the horribly restless nights of despair"
Diminished ability to think or concentrate, or indecisiveness, nearly every day
"I lost all interest in my schoolwork, friends, reading, wandering, or daydreaming."
Recurrent thoughts of death or suicide, or a suicide attempt
"one day I bought a gun, but, in a transient wave of rational thought, I told my psychiatrist"
"after a terrible row, and in a very agitated and violent state, I took handful after handful of pills [lithium]"
MANIA
MAJOR DEPRESSION
"I could not stand the pain any longer, could not abide the bone-weary and tiresome person I had become, and felt that I could not continue to be responsible for the turmoil I was inflicting upon my friends and family.
"i would wake up in the morning with a profound sense of dread that I was going to have to somehow make it through another entire day"
Discussion Questions
“The debt I owe my psychiatrist is beyond description. I remember sitting in his 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 he could say, that's the funny thing. It was all the stupid, desperately optimistic,condescending things he didn't say that kept me alive; all the compassion and warmth I felt from him that could not have been said; all the intelligence, competence, and time he put into it; and his belief that mine was a life worth living. He was terribly direct, which was terribly important, and he was willing to admit the limits of his understanding and treatments when he was wrong.”
For those that have it, bipolar is a lot more than a disorder; it is an entirely different framework for life, starting at onset
There is an incredible amount about being the patient that you cannot understand unless you experience it first hand, which was hopefully shown to some extent with the case examples
Bipolar Disorder doesn't have to be be a debilitating illness, it can be a functional illness; some of the greater masterminds over time are said to have struggled with bipolar disorder (long before lithium was introduced)
Don't assume that your normal is the normal that a patient seeks or desires...
"my friends and family expected that I would welcome being 'normal,' be appreciative of lithium, and take in stride having normal energy and sleep. But if you have had the stars at your feet and the rings of planets through your hands, are used to sleeping 4-5 hours a night and now sleep 8, are used to staying up all night for days and weeks in a row and now cannot, it is a very real adjustment to blend into a three-piece-suit schedule, which, while comfortable to many, is new, restrictive, seemingly less productive, and maddeningly less intoxicating."
How would you feel as a social work if your co-work was bipolar? Do you think it would be necessary to report them?
How does Dr. Jamison's experience with bipolar differ from the stereotypical behavior of bipolar patients?
Do you think it was a good idea for her to come out and tell her story in such a public way?
Do you believe that Jamison's being a part of the mental healthcare system helped or hindered her coming to grips with her illness.
...of needing help
...of needing medication
...of keeping it a secret
Professional Life
Countertransference of client
Manic behavior at professional functions
Take time off of work
Delusions
Side effects of Lithium
Divorce
Relied heavily on family
Loans taken out for debt
Suicidal
Full transcript