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Authors: Kay Redfield Jamison

Tags: #Mood Disorders, #Self-Help, #Psychology, #General

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It took my year in England to make me realize how much I had been simply treading water, settling on surviving and avoiding pain rather than being actively involved in and seeking out life. The chance to escape from the reminders of illness and death, from a hectic life, and from clinical and teaching responsibilities was not unlike my earlier year as an undergraduate in St. Andrews: it gave me a semblance of peace that had
eluded me, and a place of my own to heal and mull, but most important to heal. England did not have the Celtic, magical quality of St. Andrews—nothing, I suppose, ever could for me—but it gave me back myself again, gave me back my high hopes of life. And it gave me back my belief in love.

I
had come at last to some sort of terms with David’s death. Visiting his grave in Dorset one cold, sunny day, I was taken aback by the loveliness of the churchyard in which he was buried. I had not remembered very much of it from the funeral, and certainly not its tranquillity and beauty. The deathly quietness was a certain kind of consolation, I suppose, but not necessarily the kind one would seek. I put a bouquet of long-stemmed violets on his grave and sat, tracing the letters of his name in the granite, remembering our times together in England and Washington and Los Angeles. It seemed a very long time ago, but I could see him still, tall and handsome, standing, arms crossed and laughing, at the top of a hill, during one of our walks in the English countryside; I still could feel his presence next to mine, kneeling together in a strange intimacy, at the communion rail in St. Paul’s; and I still could feel, with absolute clarity, his arms tight around me, holding the world at bay, giving me comfort and safety in the midst of total desolation. I wished more than anything that he could see that I was well, and that I somehow could repay him for his kindness and his belief in me. But mostly, as I was sitting there in the graveyard, I thought of all of the things that David had missed by dying young. And then, after an hour or more of being lost in my thoughts, I was
caught up short by the realization that I had been thinking, for the first time, about how much David had missed, rather than what we together would miss.

David had loved and accepted me in an extraordinary way; his steadiness and kindness had sustained and saved me, but he was gone. Life—because of him, and despite his death—went on. And now, four years after his death, I found a very different kind of love and a renewed belief in life. These came by way of an elegant, moody, and totally charming Englishman whom I had met early in the year. We both knew that, due to personal and professional circumstances, our affair would have to end once the year did, but it was—despite or because of this—a relationship that succeeded, finally, in restoring love and laughter and desire to a walled-in life and a thoroughly iced heart.

We had first met at a London dinner party during one of my earlier visits to England; it was, wonderfully, and without question, love at first sight. Neither of us had any awareness of anyone else at the dinner table that night, and neither of us—we agreed much later—had ever been so completely and irrationally swept away by the power of our feelings. Several months later, when I returned to London for my year’s sabbatical leave, he called and asked me to go out to dinner. I was renting a mews house in South Kensington, so we went to a restaurant nearby. It was, for both of us, a continuation of what we had felt when we first met. I was spellbound by the ease with which he understood me, and physically overwhelmed by his intensity. We both knew, long before the wine was through, that we were beyond any way of turning back.

It was raining when we left the restaurant, and he put
his arm around me as we ran madcap to my place. Once there, he held me very close to him for a long, long time. I felt and smelled the rain against his coat, felt his arms around me, and remembered, with relief, how extraordinary scents and rain and love and life can be. I had not been with a man in a very long time, and, understanding this, he was kind and gentle and utterly loving. We saw each other as often as we could. Because we both were inclined to intense feelings and moods, we could console one another easily and, likewise, give one another a wide berth whenever necessary. We talked about everything. He was almost frighteningly intuitive, smart, passionate, and, occasionally, deeply melancholic; and he came to know me better than anyone had ever known me. He had no difficulty seeing the complexity in emotional situations or moods—his own made him well able to understand and respect irrationality, wild enthusiasms, paradox, change, and contradiction. We shared a love for poetry, music, tradition, and irreverence, as well as an unflagging awareness of the darker side of almost everything that was light, and the lighter side of almost everything that was bleak or morbid.

We created our own world of discussion, desire, and love, living on champagne, roses, snow, rain, and borrowed time, an intense and private island of restored life for both of us. I had no hesitancy in telling him everything about myself, and he, like David, was extremely understanding about my manic-depressive illness. His immediate response, after I told him, was to take my face in his hands, kiss me gently on either cheek, and say, “I thought it was impossible for me to love you any more than I do.” He was silent for a while and then added, “It doesn’t really surprise me, but it does explain
a certain vulnerability that goes along with your boldness. I am very glad you told me.” He meant it. They were not just easy words to cover awkward feelings. Everything he did and said after our discussion only underscored the meaning of his words. He understood, took into account, and put into perspective my vulnerabilities; but he also knew and loved my strengths as he saw them. He kept both in mind, protecting me from the hurt and pain of my illness and loving those aspects of me that he felt carried over with passion into life and love and work and people.

I told him about my problems with the idea of taking lithium, but also that my life was dependent upon it. I told him that I had discussed with my psychiatrist the possibility of taking a lower dose in hopes of alleviating some of the more problematic side effects; I was eager to do this, but very frightened that I would have a recurrence of my mania. He argued that there would never be a safer or more protected period of time in my life in which to do it and that he would see me through. After discussing it with my psychiatrist in Los Angeles and my doctor in London, I did, very slowly, cut back on the amount of lithium I was taking. The effect was dramatic. It was as though I had taken bandages off my eyes after many years of partial blindness. A few days after lowering my dose, I was walking in Hyde Park, along the side of the Serpentine, when I realized that my steps were literally bouncier than they had been and that I was taking in sights and sounds that previously had been filtered through thick layers of gauze. The quacking of the ducks was more insistent, clearer, and more intense; the bumps on the sidewalk were far more noticeable; I felt more energetic and
alive. Most significant, I could once again read without effort. It was, in short, remarkable.

That night, waiting for my moody, intense Englishman to appear—needlepointing, watching the snow fall, listening to Chopin and Elgar—I suddenly was aware of how clear and poignant the music seemed, how intensely, beautifully melancholic it was to watch the snow and wait for him. I was feeling more beauty, but more real sadness as well. When he arrived—elegant, just in from a formal dinner party, black tie, white silk evening scarf draped, askew, around his neck, a bottle of champagne in his hand—I put on Schubert’s posthumous Piano Sonata in B-flat, D. 960. Its haunting, beautiful eroticism absolutely filled me with emotion and made me weep. I wept for the poignancy of all the intensity I had lost without knowing it, and I wept for the pleasure of experiencing it again. To this day, I cannot hear that piece of music without feeling surrounded by the beautiful sadness of that evening, the love I was privileged to know, and the recollection of the precarious balance that exists between sanity and a subtle, dreadful muffling of the senses.

O
nce, after several days completely to ourselves and with no contact at all with the outside world, he brought me an anthology of writings about love. He had tagged one short entry that captured the essence not only of those intense, glorious days but of the entire year as well:

Thank you for a lovely weekend
.
They tell me it rained
.

Love Watching Madness

I
dreaded leaving England. My moods had held at a more even keel for longer than I could remember; my heart was newly alive; and my mind was in a glorious state, having loped, grazed, and mulled its less medicated self through Oxford and St. George’s. It was increasingly hard to imagine giving up the gentle pace of days I had set for myself in London, and harder still to think of losing the passion and close understanding that had filled my nights. England had laid to rest most of my incessant wondering about the what-ifs and whys and what-might-have-beens; it also had laid to rest, in a very different way, my relentless warrings with lithium, most of which had been nothing but a futile battle against the givens of my own mind. These warrings had cost me dearly in time lost, and, feeling myself again, I was unwilling to risk losing any more time than I already had. Life had become worth not losing.

Inevitably, the year passed: the snows and warming brandies of the English winter gave way to the soft rains
and white wines of early summer. Roses and horses appeared in Hyde Park; gorgeous, diaphanous apple blossoms spread out over the black branches of the trees in St. James’s Park; and the long, still hours of summer light cast an Edwardian hue over the days just up to my parting. It had become difficult to remember my life in Los Angeles, much less to think about returning to the chaotic days of running a large university clinic filled with very sick patients, teaching, and seeing a full caseload of patients again. I was beginning to have doubts that I could remember the details of conducting a psychiatric history and examination, much less teaching others how to do it. I was reluctant to leave England, and even more reluctant to return to a city I had come to associate not only with a grueling academic career, but also with breakdowns, the worn, cold, bloodlessness following in their wake, and the draining charade of pretending to be well when I wasn’t and going through the motions of being pleasant when I felt dreadful.

I was, however, very wrong in my forebodings. The year had served as far more than just a restful interlude; it had been, in fact, truly restorative. Teaching was once again fun; supervising the clinical work of the residents and interns was, as it had been in earlier times, a pleasure; and seeing patients gave me the opportunity to try to put into practice some of what I had learned from my own experiences. Mental exhaustion had taken a long, terrible toll, but, strangely, it was only in feeling well, energetic, and high-spirited again that I had any true sense of the toll taken.

So work went well and relatively smoothly. Much of my time was spent working on a textbook that I was
coauthoring about manic-depressive illness, delighted with how much easier it was to read, analyze, and retain the medical literature, which, until only recently, had been a terrible struggle to comprehend. I found writing my sections of the textbook a satisfying mix of science, clinical medicine, and personal experience. I was concerned that these experiences might unduly influence—by content or emphasis—portions of what I wrote, but my coauthor was fully aware of my illness, and many other clinicians and scientists also reviewed what we wrote. Often, though, I found myself drawing upon certain aspects of what I had been through in order to emphasize a particular point of phenomenology or clinical practice. Many of the chapters I wrote—those about suicide, medication compliance, childhood and adolescence, psychotherapy, clinical description, creativity, personality and interpersonal behavior, thought disorder, perception, and cognition—were influenced by my strong belief that these were areas that had been relatively overlooked in the field. Others—such as epidemiology, alcohol and drug abuse, and assessment of manic and depressive states—were more straightforwardly a review of the existing psychiatric literature.

For the clinical description chapter—the basic characterization of hypomanic and manic states, depressive and mixed states, as well as the cyclothymic features underlying these clinical conditions—I relied not only upon the work of classic clinicians such as Professor Emil Kraepelin, and the many clinical researchers who had conducted extensive data-based studies, but upon the writings of manic-depressive patients themselves. Many of the descriptions were from writers and artists
who had given highly articulate and vivid descriptions of their manias, depressions, and mixed states. Most of the rest of the accounts were from my patients or passages taken from the psychiatric literature. In a few instances, however, I used my own descriptions of my experiences that I had written for teaching purposes over the years. So interspersed throughout clinical studies, symptom frequencies, and classic clinical descriptions from the European and British medical literature were excerpts from poems, novels, and autobiographical accounts written by individuals who had suffered from manic-depressive illness.

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