Welcome everybody to this wonderful Chancellor's lecture and I want to welcome so many of my faculty, students, staff, colleagues, and particularly members of the community who are energized and curious and find their way to these great lectures on our campus. Let me just say a few words about our speaker who I just really want to thank her personally for coming to our university, particularly at this moment in our time. Our speaker is Dr. Kay Redfield Jamison. professor of psychiatry at the Johns Hopkins University School of Medicine and Dalio family professor in mood disorders she holds her bachelor's and master's degree in psychology a candidate in philosophy and a PhD with emphasis in clinical and comparative psychology and psychopharmacology from UCLA.
In addition to being the recipient of a MacArthur Award, yes, commonly known as we have a genius in the room, Kay is perhaps by any measure this country's most famous writer and prominent researcher about manic depressive illness. Her books and articles include, and I would recommend that... You all read them and buy them multiple times and give them away to as many friends and family members as you possibly can.
They don't have all the cures, but they operate in many ways, like palliative care and a vaccine for people, I think, who read her work. An unquiet mind, night falls fast, nothing was the same, and manic depressive illness, which serves as a standard medical text. I jumped out of my bed with joy as I was reading a book review on another book on hearing voices. And it mentioned Robert, I'm blanking now.
Yeah, Robert Lowell, the great poet, and mentioned her forthcoming work on Robert Lowell. And I told her, I'm at the front line in Jeff Bezos'little shop to buy a number of those books. Because I think...
I think they'll make a difference in my lives and the lives of many others. Despite her diagnosis, she, while working in an academic medical center, had the courage to go public with her diagnosis. And this was something that followed on teenage years where so many young people are experiencing characteristic, exhilarating highs and crushing lows. depression and too often are wrongly diagnosed or not diagnosed and given care and so Kay has really kind of summoned the courage to go public with her diagnosis and just the absolute need for the correct treatments including as we were discussing in my office this wonderful salt called lithium Through her selfless act of bravery and her path-breaking research and teaching, she has not only helped scores of patients and their families, she has importantly raised the consciousness of society and the current world. of many others.
As many of you know, our Vanderbilt community is currently engaged in efforts, which I hope are welcome and loving and supportive, to elevate the discussion around mental health. to nurture a non-discriminatory environment where everyone feels comfortable to express how they are faring and especially to share with someone when they are not feeling well. This, hopefully, these conversations and this visibility we're giving this is simply a prelude to what I would like to see, which is Vanderbilt having the very best, the most caring, loving, supportive mental health health programs in the nation for our faculty, our staff, and students, and to be in a virtuous circle of developing new care, new treatment to help so many people in our own community and across the globe.
She has said, when public figures remain silent about depression, there is a cost to the rest of society. Silence contributes to the misperception that successful people do not get depressed. and it keeps the public from seeing that treatment allows many individuals to return to competitive professional lives.
It is a tremendous honor to have Kay with us tonight, and I think it's a wonderful opportunity to learn from her insights and hopefully follow her lessons. Please join me in welcoming Kay Jamison. Kay?
Thank you so much. It's a delight to be back to Vanderbilt and very wonderful to hear about the programs and the total backing of the Chancellor's Office in trying to do something about the difficult problem of mental illness in students. And one of the things that I have tried to emphasize in my advocacy work is that after I...
published in An Unquiet Mind, you know, there's the kind of book tour from hell, and then what comes out in paperback, another book tour from hell, and I asked my publisher, I said, you know, could you please send me to college campuses instead of upmarket independent bookstores, not because I don't love independent bookstores, because I really, really do, but it's students who are at the age of risk, the average age of onset of bipolar illnesses, 17, 18, 19. psychiatric illnesses, all of the major psychiatric illnesses are illnesses of youth. So it's not like cardiac disease. It's not like dementias. It's not like cancer that disproportionately hit older people.
All of the major psychiatric illnesses disproportionately hit the young, and particularly at college age. So what I'd like to do is just give a very brief overview of what we mean by mood disorders and then talk from my own experience, and then leave quite a bit of time for questions. I was talking to a wonderful group of Vanderbilt students at noon today, and one of the things I was trying to encourage them to try and wrap their mind around is that depression and mania are ancient diseases, and one of the things that tends to be, somehow pervade the sociologic circles and... and society is that psychiatric illnesses are somehow for the soft and the 20th century sensibilities, the 19th century sensibilities, the vapors and so forth, and they're not really serious diseases. In fact, long before Hippocrates in 500 BC, who actually described mania extremely well, diagnostic criteria and all of it, and melancholia very, very well, long before that, it was described...
Both mania and depression were well described in the Persian and Chinese literature. These are ancient diseases. They've been around for a long time, and that has a real implication for us, both as members of society and creating individuals, but also people who suffer. So let me describe a little bit about what I mean by depression, a little bit what I mean by mania. These are actually illnesses that are quite well described and reasonably well understood.
in psychiatry and psychology and the diagnostic criteria actually given that diagnostic criteria in psychiatry are well and justifiably open to a certain amount of skepticism in fact for the mood disorders for depression and mania they're pretty pretty reliable criteria and so when you talk about mania or depression you're really talking about two major categories of mood disorders one major depression alone the other bipolar disorders where you have a history of major depression but you also have a history of mild to moderate to severe mania it turns out that if you have a particular kind of depression a very recurrent depression that for all intents and purposes that is bipolar illness in many many respects in terms of family history in terms of response to treatment in terms of symptoms pathology and so forth so until we have the genetics better worked out than we do, it's kind of an arbitrary distinction between recurrent depression and bipolar illness. So when we talk about these illnesses, we're not just talking about illnesses of mood, we're talking about illnesses of energy and sleep and kind of vital sense of and cognition, the ability to think clearly, the ability to reason. So there are major disruptions in sleep and mood and energy.
Mood during depression is, I think, generally pretty well understood by people. It's hopeless, irritable, apathetic. It's not so much sad as apathetic and irritable.
The depressed person is usually unable to experience pleasure in the ordinary way and to keep his or her engagement. In the world, the intellectual world, the world of ordinary pleasures, the world, the social world, profound tiredness is very common. In fact, many people who have depression go first to their GPs or their family practitioners or internists with complaints of sleep disorder or exhaustion, not with depression. The problem with concentration and the ability to learn new things is a very severe one in depression, and it's particularly problematic on college campuses where people, the essence of what you're doing, well, part of what you're doing, is learning. And you have illnesses that disrupt that capacity to learn, and it can be very, very frightening when that happens.
Suicidal thinking is not uncommon, and unfortunately, suicide is not that uncommon. But mania On the other hand, is really kind of the isomer, kind of the opposite in most ways from depression, not in all ways, but in most ways. People engage the world whether or not the world wishes to be engaged. So that any of you who have been around anyone who's manic will appreciate those 2 o'clock in the morning phone calls when somebody wants to share an idea that's really, really, really important. And that's really quite the opposite of depression, where people withdraw into their own worlds.
The poet Robert Lowell, the chancellor was kind enough to push my book, but it's about the great American poet Robert Lowell, who was hospitalized about 20 times for mania, a very severe form of illness. And he once said that depression was an illness for oneself, and mania an illness for one's friends. pretty much puts them in their place. When people are manic, they have an incredible amount of energy, and this is in many ways a disorder as much of energy and vitality as anything else. They think and speak quickly.
They need far less sleep than usual. They're restless, irritable, and they show astonishingly bad judgment. They spend a lot of money they don't have, and they impose their enthusiasms and convictions on others.
They're impulsive, reckless, and they impetuously start new projects and new relationships. And this, again, you can go back to, there was a great writer in Greece in the first century A.D., Aretas of Cappadocia, who is known as the Doctor of Mania, and he described his patients in the first century as going around, getting involved in relationships. Sexually hyper, impulsive, violent, and so forth. And mad, delusional, hallucinating.
Mania, in short, is a high voltage state. Again, both of these illnesses, mania, bipolar disorder, and depression, are illnesses of youth. They usually first occur in late adolescence, early 20s, and they're very common. I mean, really, really common. Approximately one person in 100 will develop the severe classic form of bipolar illness, and another 2% or 3% will experience a milder form.
15% to 20% of the population will have at least one episode of major depression. So these are not rare, mondo bizarro diseases. These are common. Depression is known as the common cold of psychiatry for good cause.
Both depression and bipolar illness. particularly bipolar illness, are genetic. They run in families.
And they are the major illnesses that underlie suicide. The great majority of people who commit suicide had depression or bipolar illness. Men and women are equally liable to bipolar illness. Women are about twice as likely to get depression alone. Alcohol and drug abuse are very, very common.
Highest comorbidity in psychiatry is with bipolar illness and alcohol and drug abuse. And finally, and most importantly, just to end the didactic part here, these illnesses are treatable. And it's really, really important to get treated because if you don't get treated, it gets harder to treat. The risk of suicide is substantial.
These illnesses are not good for the brain. And they are treatable with medication, medication and psychotherapy, sometimes psychotherapy alone, in the case of depression, not always. One of the things that we tell our medical students at Johns Hopkins every year is, look, depression is really common.
A lot of you are going to get depressed. That's just life as it is on this planet. Nobody signs up for depression, you just, you're gonna, a lot of you are gonna get it. We will do everything we can to get you well and there's no reason to expect that you won't get well because it is treatable, but we will not tolerate impaired doctors. So what we try and do is make the gradient so that people get treatment, the incentive is to get treatment, rather than to avoid treatment.
Because one of the things that we know about medicine is that women doctors are five times as likely to kill themselves as the general population. And male doctors are about twice as common. And they end up self-medicating, they end up avoiding treatment, they treat themselves, which is often catastrophic. So what we...
try and do is get our medical students aware of what this illness looks like very early on, that it's common, and that if they don't get it, one or two or many of their friends are going to get it, and to keep a wing out. So I would encourage all of you to do the same. Again, just to keep a wing out and to take into account that these are really painful disorders, but again, very treatable. So let me just turn to my own situation, which was that when I was a senior in high school, when I was 17 years old, I went, I had my first breakdown.
And as I was telling students earlier, there was nothing to suggest, other than a very extensive family history that I didn't know anything about because nobody talked about it. Other than that, there was nothing suggested things wouldn't just go. Tomorrow is a gone today, which is to say I was really happy.
I was very outgoing, very athletic, lots of friends, loved school, loved life, couldn't wait to get up in the morning. Happy is the proverbial clam, albeit a rather high voltage clam. But when I was in the early part of my senior year, I started speeding up.
Quite a bit. A lot of enthusiasm, not much sleep, but it didn't go over the top. I didn't get psychotic, but I did get, after that was over, I got psychotically depressed. And it was terrifying. I had no idea what it was all about.
I came from a very wasp family and a very military family, and I was a pilot's daughter and a scientist's daughter, and nobody talked about these things. It really just wasn't done. I mean, I had great parents, great family, but it just wasn't done.
People didn't talk about these things. And people didn't know that much. I mean, this is still when woolly mammals roamed the earth. It's a while back.
Not so many excuses now, but then. So then I kind of zagged along and zigged along and up and down, up and down through. college and graduate school, and then I joined the psychiatry faculty at UCLA, and within three months I was psychotically manic, by which I mean I was hallucinating, delusional, completely out of control, and it was a medical emergency. And as a result of it being a medical emergency, I got into treatment, thank God, which I'd been able to avoid for so many years, and I got very good treatment, and I was put on lithium and responded very, very well.
And that was great if it stayed there, but it didn't stay there because, like, the majority of people with this illness, I was convinced I didn't really need medication, that, you know, it was just a fluke, it was stress, it was this, that, and the other thing, and with a bit of will, that wouldn't happen again. Wrong. I stopped my lithium, got very manic, got depressed, went through that cycle a few times, and...
Finally, after a nearly lethal suicide attempt, decided to keep taking my medication, which I have been on since. So let me just start by reading a few excerpts from a book that I decided to write about my own illness, An Unquiet Mind. When it's two o'clock in the morning and you're manic, even the UCLA Medical Center has a certain appeal.
The hospital, old ordinarily a cold clotting of uninteresting buildings, became for me that fall morning many years ago, a focus of my finely wired, exquisitely alert nervous system. With vibrissae twinging, antennae perked, eyes fast forwarding and fly faceted, I took in everything around me. I was on the run.
Not just on the run, but fast and furious on the run, darting back and forth across the hospital parking lot. trying to use up a boundless, restless, manic energy. I was running fast, but slowly going mad.
The man I was with, a colleague from the medical school, had stopped running an hour earlier and was, he said impatiently, exhausted. This, to a saner mind, would not have been surprising. The usual distinctions between day and night had long since disappeared for the two of us, and the endless hours of scotch brawling and falling about in laughter had taken an obvious, if not yet final toll.
We should have been sleeping or working, publishing, not perishing, reading journals, writing in charts, or drawing tedious scientific graphs that no one else would read. Suddenly a police car pulled up. Even in my less than totally lucid state of mind, I could see that the officer had his hand on the gun as he got out of the car.
What in the hell are you doing running around the parking lot at this hour, he asked. My few remaining islets of judgment reached out to one another and linked up long enough to conclude that this particular situation was going to be hard to explain. My colleague, fortunately, was thinking far better than I was and managed to reach down into some deeply intuitive part of his own and the world's collective unconscious and said, we're both on the faculty in the psychiatry department.
The policeman looked at us, smiled, went back to his squad car and drove away. Being professors of psychiatry explained everything. Within a month of signing my appointment papers to become an assistant professor of psychiatry at UCLA, I was well on my way to madness.
Within three months, I was manic beyond recognition and just beginning a long, costly personal war against a medication. that I would in a few years time be strongly encouraging others to take. My illness and my struggles against the drug that ultimately saved my life and restored my sanity had been years in the making. For as long as I can remember, I was frighteningly, although often wonderfully, beholden to moods.
Intensely emotional as a child, mercurial as a young girl, first severely depressed as an adolescent, and then... Unrelentingly caught up in the cycles of mania and depression by the time I began my professional life. I became both by necessity and intellectual inclination a student of moods.
It's been the only way I know to understand indeed to accept the illness I have. It's also been the only way I know to try and make a difference in the lives of others who also suffer from mental illness. The disease it has on several occasions nearly killed me. does kill hundreds of thousands of people every year. Most are young, and most die entirely unnecessarily. But my manias, at least in their early and mild forms, were absolutely intoxicating states that gave rise to great personal pleasure, an incomparable flow of thoughts, and a ceaseless energy that allowed the translation of new ideas into papers and projects.
Medication not only cut into these fast-flowing, high-flying times, They also brought with them seemingly intolerable side effects. It took me far too long to realize that lost years in relationships cannot be recovered, that damage done to oneself and others cannot always be put right again, and that the freedom from the control imposed by medication loses its meaning when the only alternatives are death and insanity. The war I waged against myself is not an uncommon one.
The major clinical problem in treating bipolar illness is not that there are not effective medications. There are. It is, rather, that patients so often refuse to take the medications. Worse yet, because of a lack of information, poor medical advice, terrible stigma, or a fear of personal and professional reprisals, they do not seek treatment at all.
Bipolar illness distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. Is an illness as biological as its origins, genetic, yet one that feels psychological in the experience of it? An illness that is unique in conferring some advantage and pleasure, yet one that brings in its wake almost unendurable suffering, and not infrequently suicide. I am fortunate that I have not died from my illness.
Fortunate in having received the best medical care available, fortunate being able to afford to pay for that medical care, and fortunate in having the friends, colleagues, and family that I do. Because of this, I have in turn tried as best I could to use my own experiences of the disease to inform my research, teaching, clinical practice, and advocacy work. I had many concerns about publicly discussing my illness. Clinicians have been for obvious reasons of licensing and hospital privileges, reluctant to make their psychiatric problems known to others.
These concerns are well warranted. I had no idea what the long-term effects of discussing such issues so openly would be on my personal and professional life. But whatever the consequences, they were bound to be better than continuing to be silent.
I was tired of hiding. Tired of misspent and knotted energies, tired of the hypocrisy, and tired of acting as though I had something to hide. One is what one is, and the dishonesty of hiding behind a degree or a title or any manner and collection of words is still exactly that, dishonest. Necessary, perhaps, but dishonest. I continue to have concerns about my decision to be public about my illness.
But one of the advantages of having had this illness for so many years, is that very little seems insurmountably difficult. Much like crossing the Bay Bridge when there's a storm over the Chesapeake, one may be terrified to go forward, but there's no question of going back. I find myself taking a certain solace in Robert Lowell's essential question, yet why not say what happened?
Writing and talking in a personal way about bipolar illness began for me with teaching. For years I had been director of the mood disorders clinic at UCLA, and it soon became clear to me and to the other faculty teaching in the clinic that the psychiatry residents and clinical psychology interns were not on intimate terms with the subjective experience of mania, depression, or their treatments. Diagnosis, yes. which drugs to prescribe generally, yes, but not what psychiatric illness actually feels like to those who have it.
So I wrote two brief paragraphs, passages several years ago, anonymously, of course, at the time, for the residents and other trainees in our clinic. I limited each of the passages to approximately two paragraphs, as I assumed that was about the limit of the resident's attention span. It's a generous estimate, as any of you will appreciate if you've taught residence. One was a general overview of bipolar illness, and the other, a description of some of the less than altogether delightful aspects of taking lithium.
So the first is just sort of a very short summary of what bipolar illness feels like, at least to one person. There's a particular kind of pain, elation. Loneliness and terror involved in this kind of madness.
When you're high, it's tremendous. The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. The right words and gestures are suddenly there. The power to captivate others, a felt certainty. There are interests found in singularly uninteresting people.
Feelings of ease, intensity. power, well-being, and euphoria pervade one's marrow. But somewhere this changes.
The fast ideas are now far, far too fast, and there are far, far too many. Overwhelming confusion replaces clarity. Memory goes. Humor and absorption on friends'faces are replaced by fear and concern.
Everything previously moving with the grain is now against. You are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind. You never knew those caves were there. It will never end, for madness carves its own reality.
It goes on and on. And finally, there are only others'recollections of your behavior, your bizarre, frenetic, aimless behaviors. For mania has at least some grace in partially obliterating memory. What then, after all of the medications, the psychiatrist, the despair, the depression, the nearly lethal overdose, all those incredible feelings to sort through, who is being too polite to say what?
Who knows what? What did I do? Why?
And most hauntingly, when will it happen again? Then, too, are the bitter reminders. Medicine to take, resent, forget, take, resent, and forget, but always to take. Credit cards revoked, balance checks to cover, explanations do at work, apologies to make, friendships gone or drained, a ruined marriage, and always, when will it happen again?
I wrote as well for the residents about the difficulties in taking medication because many young doctors in our clinic found it incomprehensible and simply infuriating that patients would stop taking drugs that so clearly worked against such devastating illnesses. I was treated in the early days of lithium and the early days of lithium were You were kept on very high doses, I mean really high doses. Walk in the wall, into walls, slurred speech, end up in the emergency room on intravenous feedings, blah, blah, blah, high doses.
Now, people are kept at a much lower level of lithium, and far fewer side effects, and many people have no side effects at all. There are also other medications available, although lithium... by far remains the gold standard in the treatment of the severe forms of bipolar illness.
This is something I wrote at the time called Rules for the Gracious Acceptance of Lithium in Your Life. One. Clear out the medicine cabinet before guests arrive for dinner or new lovers stay the night. Two, remember to put the lithium back into the cabinet the next day.
Three, don't be too embarrassed by your lack of coordination or your inability to do the sports you once loved and did with such ease. Four, nod intelligently and with conviction when your physician explains to you the many advantages of lithium and leveling out the chaos in your life. Five, be patient when waiting for this leveling off.
Very patient. Reread the book of Job. Continue being patient.
Contemplate the similarity between the phrases being patient and being a patient. Six, try not to let the fact that you can't read without effort annoy you. Be philosophical. Even if you could read, you wouldn't remember most of it anyway. Seven, accommodate to a certain lack of enthusiasm and bounce you once had.
Try not to think about all the wild nights you once had. Probably best not to have had those nights anyway. That's not true.
I put that in for my husband. Eight, always keep in perspective how much better you are. Everyone else certainly points it out often enough, and annoyingly enough, it's probably true. Nine, be appreciative. Doctors love patients who are appreciative.
Be appreciative. Don't even consider stopping your lithium. 10. When you do stop, get manic, get depressed, expect to hear two basic themes from your family, friends, and healers. But you were doing so much better, I just don't understand it. I told you this would happen.
This was actually a big sir, ravishingly beautiful night, really manic. People go mad in idiosyncratic ways. Perhaps it was not surprising that as a meteorologist and pilot's daughter, I found myself in that glorious illusion of high summer days, gliding, flying, now and again lurching through cloud banks and ethers past stars and across fields of ice crystals.
Even now I can see in my mind's rather peculiar eye an extraordinary shattering and shifting of light. Inconstant but ravishing colors laid out across miles of circling rings. And the almost imperceptible, somehow surprisingly pallid moons of this Catherine wheel of a planet.
I saw and experienced that which had been only dreams. Or fitful fragments of aspiration. Was it real?
Well, of course not. not in any meaningful sense of the word real. But did it stay with me?
Absolutely. Long after my psychosis cleared and the medications took hold, it became part of what one remembers forever, surrounded by a Proustian melancholy. Long since that extended voyage of my mind and soul, Saturn and its icy rings took on a private beauty to me, and I don't see Saturn's image to this day. without feeling an acute sadness as being so far away from me, so unobtainable in so many ways.
The intensity, glory, and absolute assuredness of my mind's flight made it very difficult for me to believe, once I was better, that the illness was one I should willingly give up. Even though I was a clinician and read the research literature and indeed wrote some of it, And I knew the inevitable bleak consequences of not taking lithium. I, for many years after my initial diagnosis, was reluctant to take my medication as prescribed.
Why was I so unwilling? Why did it take having to go through more episodes of mania, followed by long suicidal depressions, before I would take lithium in a medically sensible way? Certainly there were real and unpleasant, not to say highly disruptive, side effects. Some of my reluctance, however, stem from the fact that I didn't believe what I had was really a disease. This is a common reaction that follows rather counterintuitively in the wake of early episodes of mania and severe depression.
Moods are such an essential part of the substance of life, of one's notions of oneself, that even psychotic extremes in mood and behavior can somehow be seen as temporary, even understandable reactions. to what life has dealt. It was difficult to go up the high flights of mind and mood, even though the depressions that inevitably followed nearly cost me my life. The seductiveness of these unbridled states and intense moods is powerful.
I should explain that 50% of people who get manic have these expansive, euphoric, grandiose states. Other 50% have only paranoid, irritable states. So it's for people who have these grandiose and very expansive and euphoric states like I do, who actually clinically are most likely to respond well to lithium, and also clinically are least likely to take lithium. So it's one of God's little treasures there.
The ancient dialogue between reason and the senses is almost always more interestingly and passionately resolved in favor of the senses. I reaped a bitter harvest from this refusal to take lithium on a consistent basis. A floridly psychotic mania was followed inevitably by a long and lacerating suicidal depression. It lasted more than a year and a half.
From the time I woke up in the morning until the time I went to bed at night, I was unbearably miserable and incapable of any kind of joy or enthusiasm. Everything, every thought, word, movement was an effort. Everything that once was sparkling now is flat. I seem to myself to be dull, boring, inadequate, thick-brained, unlit, unresponsive, chill-skinned, bloodless, and sparrow-drab.
What is the point in going on like this, I would ask. Over and over and over I would say to myself, if I can't feel, if I can't move, if I can't love, if I can't think, if I can't care, then what conceivable point is there in living? I reasoned they would kill an animal who was in far less pain. I could not bear the person I had become and could bear even less the burden I felt I had become to those who loved me. My psychiatrist repeatedly tried to persuade me to go into a psychiatric hospital, but I refused.
I was horrified at the thought of being locked up, being away from my friends. and having to put up with all the indignities and invasions of privacy that I knew went into being on a psychiatric ward. I was working on a locked ward at the time, and I didn't relish the idea of not having the key.
Mostly, however, I was concerned that if it became public knowledge that I had been hospitalized, my clinical work and my privileges at best would be suspended, and at worst, they would be revoked on a permanent basis. At the time, nothing was working. I simply wanted to die and be done with it, and I resolved to kill myself. I was cold-bloodedly determined not to give any indication of my plans or the state of my mind, and in this I was successful.
The only note made by my psychiatrist on the day before I attempted suicide was, severely depressed, very quiet. When I, you know, when I was writing An Unquiet Mind, I made the mistake of asking my psychiatrist in Los Angeles who I still... keep in touch with, if he would send me my medical records. And that was really a mistake, you know, because you think, first of all, your medical records are going to start. Thank you for referring this really interesting mom.
None. I mean, it was like, basically, I cannot believe she stopped her medication again. You know? So I said to him, when I read that, severely depressed, very quiet. And I have to say, I mean, he's...
He's as good a doctor as I've ever known. There's nothing I had it bad for him. There's nothing he could have done differently. He saved my life a thousand times. But I did say to him, I said, you know, when you write down very quiet and you're talking about me.
Glue one. Anyway, I took what I knew to be a greater than lethal dose of lithium. I was a lithium researcher. And I took an anti-emetic to keep from vomiting the pills. I was in and out of a coma for several days and nearly died.
As a result, I no longer fight taking lithium. Repeated psychosis and a nearly lethal suicide attempt have a way of convincing even the slowest of learners. And I am fortunate to have been able to take some of my own experiences into my teaching and writing. And I just want to end on saying, you know, you have an illness.
And... It's in a context of life, and I've had the great fortune of having great friends and colleagues and support when it was really important for me from people who were, quote, my bosses. So when I was a young assistant professor at UCLA and I'd been manic for the first time and I was concerned that anybody would find out about it and I'd be fired and my license would be taken away and all that kind of thing, the chairman of my department, who has to be said, said it was not without some strong moods of his own, came up to me and said, put his arm around me.
And he said, you know, kiddo, he said, I understand you have problems with your moods. And I said, well, that was one way of putting it, yes. And he said, you know, just, I have no idea how he heard this.
I mean, it's one of the many things about these things you don't know. But anyway, he said, just keep taking your lithium, keep seeing your doctor. Learn from it, teach from it, and write from it. He never once suggested that I stop seeing patients, I mean, though it was a legitimate concern, and he certainly attended to that in terms of making sure that people were aware and so forth.
But he never suggested, well, maybe you shouldn't go into academic medicine because it's a little too stressful, or anything like that. He never once, those words did not cross his lips. He just basically said he was in my corner.
And he said... Things every time he'd see me, practically, he would say, learn from it, teach from it, and write from it. When I went to the chairman, when I'd written the manuscript for An Unquiet Mind, I went to the chairman of my department at Johns Hopkins, and I said, you know, I have written this book, I love Hopkins, it's a great hospital, I don't want to do something that's going to put...
Hopkins in a legal situation, as you can imagine certain legal issues here, in a kind of clinical, we all know the jokes about who's in charge of the asylum. I don't want to do that, but I do think the problem is that professionals keep quiet about the illnesses they have and then people have no idea that there are a lot of professionals out there who have these illnesses. You know, I was going on and on about all the things I didn't want to happen to Hopkins, and he said, you know, just stop right there. He said, you've got it absolutely backwards.
He said when Professor Halstead was here, Professor Halstead was the first chairman of surgery at Hopkins and one of the great, if not arguably greatest, American surgeons. He said people knew, or some of the faculty knew, that he had a morphine addiction and that he had a cocaine addiction. He said, and the faculty took it upon themselves to make sure to protect Professor Halstead's patients from Professor Halstead when he was impaired. But they also took it upon themselves to look after Professor Halstead so that he could continue to teach and write and train young surgeons. He said, if Hopkins can't do that for you, Hopkins has no business being in business.
He said, you know, if you have any, anybody gives you any problems, I want to hear about it. I want you to know that we will do everything to back you. This is what Hopkins should be doing. He lined up a luncheon for me with the president of the Hopkins Hospital, who said exactly the same thing.
This is exactly what we should be doing. And I said, well, I sent my manuscript to a colleague of mine in California. And he says, yes, this is great, but what happens?
Say I'm in charge of the residency education program. And I know in advance that one of the residents has bipolar illness. And then something happens, and the doctor stops taking the medications, or he gets manic anyway, and he says, then what's the liability here? And so I ran that by the President of Hopkins Hospital.
And he says, you know, as soon as you start thinking that way, only legally, you have gone down the road to hell. You know, he said, you just have to do the best you can. And we won't.
you know, tobacco. So it was tremendous. And I'm not so naive as to think this is usual.
I know it isn't usual, but it is exemplary. And I speak this evening because of their compassion. Thank you. Okay, so I have five questions here.
I'm asking you on behalf of my 12-year-old daughter, what is one thing that anyone can do to destigmatize mental illness? I don't know that there's any one thing you can do. I think it's... hugely difficult problem.
Again, in talking to students earlier, I would say one thing, stigma is a terrible word. It's stigmatizing. It implies that there's something to be stigma. stigmatized in a way. I don't like it.
I mean, I use it just like everyone else uses it, just because it's the only word out there. But we've got to come up with better concepts without kind of stigmatizing ourselves before we even get out of the gate. I like the word discrimination because it has a nice legal ring to it. And I mean that quite seriously. I think that mental illness has not been seen.
It's seen in the legal light perhaps as much as it should be, and I'm not suggesting for a moment that our society get any more litigious than it already is, but I do think that these are serious civil rights issues for people who have mental illness. And I think destigmatizing this illness is, in many respects, like destigmatizing any other medical illness. You get treatment.
People find out it works. And people change their minds. So I think to the extent that we've made any progress, I would like to think it was because everyone goes out and advocates. I'm not sure that that's nearly as effective as coming up with good medications and understanding of what's going on in the brain.
Having said that, I think that people leaning on their... people, you know, depending on where you live and how gerrymandered your district is and whether it makes any difference to even write to somebody. But, you know, and saying earlier, again, I don't bring politics into this, not because because I don't have strong political feelings, because I do, but because mental illness, like cancer, like any other disease, hits across the aisle, Republicans, Democrats, and it's actually something where Republicans and Democrats have worked together reasonably well.
I would say the one thing that I do feel very, very strongly about, having advocated in this direction for quite a long time, is I think the Affordable Care Act in the field of psychiatry has done more to save more lives. than anything I can think of. Psychiatric illnesses are the least likely to get insured. They're pre-existing illnesses. They're illnesses of youth.
I mean, there are all these things. And I think that, you know, it's going to be pretty disastrous if anything happens to that insurance for a lot of people, not just people with mental illness, but disproportionately people. So, you know, you can... you can come up and destigmatize things but it doesn't do any good if the law doesn't back you up in terms of medicine I mean it's just that simple I mean I was giving the example earlier that you know I can get up and give a talk and say oh we'll get a second opinion most people in this country can't afford a first opinion so it's really a mockery to you know to talk from the position of of privilege when when we know that people with mental a little, I'll get care, most of them. Okay, so that's not really a difference in the issue of destigmatization, except I think a lot of stigmatization comes because people aren't treated and they're out on the streets.
What do you think about young children being diagnosed as having bipolar disorder? I have a healthy degree of skepticism about a lot of the diagnoses. I think that certainly bipolar disorder does occur in children. I think it's a little bit zip code related. It's a little bit...
It has become more of an all-inclusive diagnosis than it probably should. Why does it make a difference? You really don't want to be loading kids up on very serious, heavy-duty drugs if they don't need them. And you don't want to leave untreated and unmedicated kids that really do.
So this is a place where the head of the National Institute of Mental Health used to say, this is the perfect example of where you want science, good science. You want to be able to draw somebody's blood and say whether or not this kid at the age of seven has been able to do it. bipolar illness or something else because the treatments are going to be radically different and you want to have I think pretty strict diagnostic criteria so that there are some places in this country you can go where the diagnostic criteria pretty strict and they treat bipolar illness and kids and kids are doing great and there are other places where kids if they have temper tantrums and are out of control and so forth and they get diagnosed with bipolar illness are put on a slew of of anti-psychotic medications and not so great so I think it's over diagnosed I think in general mental illness is probably under diagnosed but this is a case where in some fields it's it's over diagnosed not to say that a lot of kids who could benefit from treatment that aren't getting treatment.
How have cultural taboos of mental illness affected your patients and how do you address this? I think It affects getting into treatment probably almost more than anything else, that people who come from cultures who think there's a lot of shame associated with mental illness tend not to come into treatment. And I think of two groups in particular. I think in Asian Americans and first generation very often.
huge stigma against seeking out mental illness treatment for mental illness and it's been problematic and a lot has been written about that. And I think also in African-American males, and I think that one of the things David Satcher, who was the Surgeon General under Bill Clinton and who was really the first person in the history of the Surgeon General's office to write a report on mental illness, and he actually wrote four reports. And one of the things that he felt very strongly about was that, you know, you have to get into the churches. You really have to get out there and advocate where people and teach people about these illnesses.
One of the things that was very striking to me when I went public was the hundreds and hundreds of vitriolic letters I got from the Christian right. Who just, I mean, the notions of mental illness were so primitive, I couldn't believe it. I mean.
The kind ones were basically, I wasn't praying enough and I would rot in hell forever. But it went pretty extremely from that to more dangerous and disturbing ones. So I think that there's a lot of misunderstanding across religions and ethnicities and so forth.
How do you feel? Magnesium is an important mineral. Well, sure. I mean, I do think magnesium is very important, probably in mental illness.
I think with all the kind of supplements and dietary and exercise things, we just don't know enough and we should know a lot more. I mean, I don't think anybody who seriously studies and treats mood disorders would say that Supplements are going to replace the standard treatments, standard medical treatments. I think people are much more aware now of what we don't know. The question is, what supplements do I personally take? I take actually only lithium, which is an element, a really nice element, a powerful element.
And... I'm trying to think if I take anything else that's vaguely healthy. I don't, but I really believe it. I mean, I really believe in, you know, basically the Kodiak-Bear theory of nutrition.
You eat lots of blueberries and salmon and you get exercise, a lot of exercise. What I think is a little complicated is that the first thing that goes when you get depressed is any desire to get anywhere near exercising. It's problematic, but I think there's a huge amount of evidence accumulating on the benefits of exercise to the well-being of the brain. So, I mean, I think that that's, you know, I think that's one of the contributions from neuroscience.
I think with other minerals, I think that would be controversial. Again, I think we don't know. It's not very well studied.
So, I'll just leave it at that. It's not my bailiwick. Do I feel... Do you feel the depression phase following psychosis is a healing shutdown for the brain to recover? I think it can act in that capacity.
The problem with depression is it doesn't tend to be very healing. I think what's healing is after depression and when people start to get well. Depression, even though it seems like an inert...
slowed down state, and it is in many of its manifestations, it's still a very active brain. And it's not a quiet, contemplative brain. It's a ruminating brain.
It's a brain that doesn't necessarily take you very many places. Having said that, I think if you look at writers, one of the things that you see is when people get mild depression, it's the depression, the severe depression that follows mania. it kind of tapers off into mild depression.
Many writers use that to begin writing and creating again. And I think that's an important part of recovery for people. Thank you.