For most of her adult life, clinical psychologist and writer Kay Redfield Jamison, PhD, has struggled with bipolar disorder. In 1996 she published An Unquiet Mind: A Memoir of Moods and Madness, in which she described the extreme “highs” and “lows” she experienced at the beginning of her academic medicine career. Jamison eventually learned to manage the illness through medication and psychotherapy. Now The Dalio Family Professor in Mood Disorders at John Hopkins Medicine, Jamison has become an advocate for others suffering from mental illness, writing extensively about bipolar disorder and the intersection between madness and brilliance. Her upcoming book, Robert Lowell: Setting the River on Fire, explores the life of the famous American poet whose career was interrupted by frequent episodes of mania. In Jamison’s words, “[Mood disorders] are terrible illnesses, but people do extraordinary things with them.”
Jamison spoke at Learn Serve Lead 2016: The AAMC Annual Meeting in Seattle on Tuesday, Nov. 15. Her plenary speech is titled “Mental Illness, Physician and Student Well-Being, and Support for Our Own.”
AAMCNews: What compelled you to write a book about your own struggles with mental illness?
Jamison: I was teaching and treating patients with this illness and felt like it was important for people to know how common it is—especially in the medical community. I think it’s very hard for people who’ve never been manic or suicidal to really know what it feels like, and I was hoping that I might make it a bit clearer.
An Unquiet Mind is very detailed and highly personal. How did your colleagues respond?
Overwhelmingly, their response was extremely positive. Clearly, there were some people who were less than supportive, but Johns Hopkins could not have been more wonderful or more intelligently supportive. I can’t think of a single thing they could have done to make things easier for me.
As a young medical professional, did you feel like you could reach out for help?
I didn’t reach out, mainly because of my background. I came from a military family where asking for help wasn’t done. One of the reasons why I wrote the book was that a lot of people are not brought up to reach out for psychiatric care. That’s changed a lot, but it’s still hard. I think it’s not in human nature to ask for help.
How have you seen attitudes toward seeking help change within the medical education community?
It’s getting better, but there’s a very long way to go. People still are reluctant to seek help because of professional reprisal. I think people are trying to change that, and professional organizations are making more of an effort to reach out, to educate medical students and house staff and graduate students about the symptoms of depression and bipolar illness. There is much more of a concerted effort, but it’s not nearly as fast as probably a lot of people would like it to be.
What do you think is behind the shift toward more openness about mental health?
People are much more aware that [mood disorders] are treatable illnesses, and as a result, some of the stigma has lifted. Just like with AIDS or epilepsy or cancer. When people had treatments that worked, the stigma started to drop off. And I think that’s true of the major psychiatric illnesses.
With treatment, it’s lot easier for people to see these illnesses as something you can do something about—not as something caused by lack of character, lack of will, or whatever. But there is still a lot of misunderstanding out there. A lot of people just haven’t a clue about depression and mania. It can be very threatening, very alienating. So yes, I think there is a lot of progress, but not enough.
What do you see as the biggest misunderstanding about mental illness?
In medical circles, there is a lack of awareness of how common [mood disorders] are and how many young doctors they affect. We tell the medical students at Hopkins, “Look, a lot of you are going to get depressed; it’s a common illness and you are at the [typical] age of onset. We are going to do everything possible to get you well, but we can’t have impaired doctors, so it’s your responsibility to get treatment, and we will be there to help you.”
So, I think the gradient has to be toward treatment, to make it clear that people are encouraged to seek help, that there won’t be reprisals, and that we’re in this together.
So it’s a matter of normalizing?
There needs to be both more compassion and a sense that this is up to all of us. It’s not going to go away. You have to deal with it and be straightforward instead of getting caught up in all this waffling mental illness babble. We need to say, it’s a common illness, we’ve got to do something about it, and we are all in this together.
As a psychologist who has openly sought help for mental illness, what would you say to people who are struggling—or feel hopeless about treatment? Perhaps they think they are too busy and should just push through it.
I would say it is completely understandable what you are feeling. My saying that you ought not to feel hopeless isn’t likely to be helpful because the first thing that goes when you get depressed is hope. But you should know that this is a really treatable illness. You can read about it, learn about it, and decide if you want to reach out for treatment. But don’t keep it to yourself because if people keep it to themselves they risk alcohol and drug use; they risk suicide; they risk impairing the health of their patients. It is very important for them to know that the treatment is out there.
An awful lot of doctors commit suicide, and I think for the community, it’s intolerable. The amount of suffering that goes on with these illnesses is unnecessary. The only thing that is going to make a difference is talking about it and acting on it.
Friday, December 02, 2016