The dark side of the self

The statistics are scary: manic depression affects one in every hundred people; women are almost twice as likely as men to suffer; one in seven of those untreated commits suicide. Each year in Britain some 400 people use anti-depressants to end their lives.

Kay Redfield Jamison was brought up in Washington in a military household. After a period of pathological mood disorder, she tried to kill herself by overdosing on lithium. Though not an anti-depressant, lithium is an anti-psychotic medication approved for use in mania and it can end a life just as effectively. Unknown to the young Jamison, the anti-depressant she was taking with lithium only encouraged her suicidal tendency.

Jamison is now a world expert on manic-depressive illness (what clinicians quaintly term "bipolar disorder"). She has lived with this demon for most of her adult years and, at 49, is currently Professor of Psychiatry at the John Hopkins University School of Medicine. "There will always be propelling, disturbing elements," Jamison writes of her own personality. But at least she has learned to control them, with the help of drugs. Tens of thousands of others have not been so lucky; the great clinical problem with manic depression (for which there is as yet no cure) is that patients often refuse to take the drugs which really do work. Usually, this is because they believe that to do so reveals a weakness.

Characterised by excessive mood swings, mania is va-va-vroom one moment (unrestrained shopping sprees; florid acts of generosity) and blank depression the next. Her confessional memoir, An Unquiet Mind, suggests that Jamison might have been good company when she was on the up. Glowing with the "light, lovely tincture of true mania", she could inspire a rare happiness in others. Then things slowed down as the psychosis took hold; very soon, life was just a cold, inward deadness.

Depression crept up on Jamison like a lengthening shadow. "For as long as I can remember I was frighteningly, although often wonderfully, beholden to moods," she writes. Her childhood manias (ping-pong, dissecting frogs, reading Gray's Anatomy at the age of 12) were warning signals; things began to go seriously wrong in her at the age of 28 when Jamison was hired as an assistant professor in the UCLA Department of Psychiatry. Fizzing over with energy ("antennae perked, eyes fast-forwarding and fly-faceted"), soon she was ravingly psychotic.

Convinced that Los Angeles was about to be invaded by rattlesnakes, Jamison cleared a chemist's of anti-venom kits. Irresistibly flirtatious (or so she thought) at a university garden party, she had unwittingly daubed her face with the gaudiest make-up. All this Jamison relates with a brave humour. The white-coated professors at UCLA are fondly recalled (the psychiatrist who was well-known for having "accidentally killed a rented circus elephant with LSD"); and Jamison describes her suicide attempt with a winning candour.

If she refused to take lithium again for so many years it was because her upbringing demanded a stoic approach to mood- swings: WASPs are not supposed to fall down. It's an astonishing moment when we learn that Jamison's own father, an Air Force officer, was himself probably a manic-depressive. Beneath his Brooks Brothers conservatism there lurked a man who knew the black chaos of life as well as its elations; did mania pass from father to daughter via a dangerous gene? Jamison is in no doubt that it did.

Superbly written, An Unquiet Mind recognises the poetic exhilaration of pure mania. Jamison says she does not resent her manic-depressive illness (now that lithium works so well for her) because it has made her test the limits of her mind. She also knows that the down side is awful beyond words. To witness a deep depression in someone is a frightening experience; as she says, one would put an animal to death for far less suffering. In so courageously putting her own life under the microscope, Jamison has written a compelling work of literature. She speaks both as the wounded healer and as one who has been touched by a most mysterious illness.