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Contributed by Anonymous
“When you're high it's tremendous…. Shyness goes, the right words and gestures are suddenly there, the power to captivate others a felt certainty. There are interests found in uninteresting people….Feelings of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one's marrow. But, somewhere, this changes. The fast ideas are far too fast, and there are far too many; overwhelming confusion replaces clarity. Memory goes. 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.” (Jamison, 1995, p.67). A person determines their self by their personality. Are they laid-back? Are the serious? However, when one has manic-depressive, their manic and depressive moods rule their personality. They are high one minute, and in the depths of utter despair the next. Kay Jamison, a tenured professor at John Hopkins University, knows exactly how this feels. In her book, An Unquiet Mind, Jamison delves into her past to cohere how her past has affected her life currently. In the book, Kay initially refuses to get a psychiatrist. In fact, she says, “I decided early in graduate school that I needed to do something about my moods. It quickly came down to a choice between seeing a psychiatrist or buying a horse. Since almost everyone I knew was seeing a psychiatrist, and since I had an absolute belief that I should be able to handle my own problems, I naturally bought a horse.”(Jamison, 1995, p. 56). Kay initiates the story by telling tales of when she was a kid living on a military base. She emphasized the amount of structure yet independence necessary to live there. You do not rely on anything as a crutch. This was one reason that she had such reluctance to go see a therapist, and eventually, to take Lithium to calm her manic moods. However, when she reaches a therapist, he lets her talk out her problems and seems very concerned for her welfare, as well as her goals in life. He encouraged her to try and achieve tenure, even though it would have been discouraged if others knew of her illness. He was very positive, and seemed to employ a humanistic perspective. During the time Kay went to her psychiatrist, Lithium had just been approved to treat manic-depression. Kay refused to try lithium initially, and when she did, she only did until she initially felt better. This was detrimental, since this could lead to worse manic episodes (Monroe, 2005). This lead her to a suicidal meltdown where she severely overdosed on lithium. Lithium reduces the sensitivity of the postsynaptic norepinephrine receptor. If the receptor is less sensitive, then the receptor is less likely to receive norepinephrine and less norepinephrine transfers throughout the body. Lithium also increases uptake of norpinephrine into synaptosomes (Synaptosomes are pinched off nerve endings that cannot release hormones such as norepinephrine) . In smaller amounts, this would help her manic episodes. However, when she overdosed, her arousal became too low. These attempts to help Kay become well again are slightly controversial in my mind. Since the lithium had just been approved, larger doses than what was healthy were being prescribed. In fact, when Kay finally reduced the amount, she said ““Lowering my lithium level had allowed not only a clarity of thinking, but also a vividness and intensity of experience…. The too rigid structuring of my moods and temperament, which had resulted from a higher dose of lithium, made me less resilient to stress than a lower dose, which, like the building codes in California that are designed to prevent damage from earthquakes, allowed my mind and emotions to sway a bit. Therefore, and rather oddly, there was a new solidness to both my thinking and emotions.” (Jamison, 1995, p. 128). It would have been better if the psychiatrist prescribed smaller amounts then increased if that didn’t work. I commend the psyciatrist’s use of the humanistic approach for Kay, however. Kay was a scientist and a logical thinker- she knew that she had to beat the disease to get what she wanted, and the psychiatrist just reiterated that. However, he may have been too lax with his patient. When she was off lithium, she became very depressed, and told her therapist that she was going to commit suicide. He did not try to get her help- in fact, she left after the appointment was over and tried to. If I had Kay as a patient, I would probably of done more of a biological approach, especially explaining the heredity elements of the disease. Since Kay is at ease with the scientific community, this would help her identify her illness with others she had researched as well as her family. In the book, Kay sat down and did one of these family tree charts later in her life, and it helped her immensely. Overall, I think Kay’s therapist did help her, but due to the time period as well as significant oversight in the role a therapist plays, he lacked in his job.
Contributed by Jessica Kalmazu Stimely