Manic-depression, also currently known as bipolar disorder, has baffled medical
practitioners for thousands of years. Observers as far back as Plato have written of its
strange behaviors and its apparent link to creative genius. Only in the last 40 years have
doctors been able to treat manic-depression effectively, using lithium and other drugs.
Yet, of the estimated 2.2 million Americans suffering from the disorder, more than two
thirds are not receiving medical attention today: a fifth of these untreated
manic-depressives will end their lives in suicide.
*Bipolar I: Because manic-depressive patients suffer from different degrees of
mania, psychiatrists classify the severe and heightened mania with swings to depression as
bipolar I. The cyclical, recurrent episodes of mania can range from moderate euphoria to
inappropriate excitement, exaggerated feelings of grandiosity, and dangerously poor
*Bipolar II: With less exaggerated forms of mania (hypomania) before swings to
depression, patients are classified as bipolar II.
*Unipolar: The name is given to patients with the hereditary form of mood disorder
in which the illness is characterized by recurrent episodes of depression without mania.
All the above categories of patients differ in the length of time between episodes, a
phenomenon referred to as cycling.
It is important to recognize and diagnose these forms of hereditary mood disorders.
Once diagnosed properly, patients can be treated with lithium and other drugs that have
been shown to be effective for bipolar and unipolar illnesses.
In this issue, the Post calls attention to this very different kind of mental illness
because it has its own special medical treatment. Manic-depression is a lethal disease
that is very treatable. It is found in a family's genes. We are inviting readers who
recognize some manic-depressive symptoms in family histories to help further research by
sending in the questionnaire on page 51.
Dr. Kay Redfield Jamison, professor of psychiatry at the Johns Hopkins University
School of Medicine, is herself a manic-depressive patient. In her new book, An Unquiet
Mind, she tells in beautiful prose what manic-depression does to the mind. Only
patient could so exquisitely describe the roller-coaster life and the helplessness to
control emotions that manic-depressive patients endure. Her interview with the Post follows:
Dr. SerVaas: You mention in your book that it is hard for someone, even
for a physician who isn't a manic-depressive, to understand the problem as well as one who
is. How old were you when you first realized that you were different from your friends?
Did you start as a preteen or as a child having episodes of euphoria or depression?
Dr. Jamison: No, I don't think so. I think it was more that I was always a very
intense child. I was really pretty normal until I was about 17, which is not
uncharacteristic for a manic-depressive. A lot of people have problems earlier, but a lot
also don't really get sick until their late teens or early 20s. When I first got really
sick, like a lot of people, I didn't put it in terms of having an illness; I just knew
something was very wrong with me.
Dr. SerVaas: A lot of children are given drugs such as Ritalin for
attention deficit disorder. Do you think that quite often it may be the beginning of
Dr. Jamison: Certainly, children can get manic-depressive illness,
and sometimes some of the symptoms of hyperactivity can look like mania and the other way
around. That's one of the reasons why you should really be evaluated by somebody who knows
what he or she is doing. The medication and treatments are very different, depending on
whether you have a mood disorder or attention deficit.
Dr. SerVaas: Lithium is the best known treatment for manic-depression. Is it
true that lithium is more likely to be effective in cases where there is a family history
Dr. Jamison: Yes. That's certainly true, and there are certain
kinds of manic-depressive illness where you have generally more euphoria in your manias
and certain other patterns within the illness itself in which you're more likely to
respond to lithium. What's great now is that there are several treatments available,
whereas before there was only lithium. Two other major drugs that are used in
manic-depressive illness are Depakote, manufactured by Abbott Laboratories, which was
developed for epilepsy but turns out to work well on manic-depressive illness, and
Tegretol [Basel Pharmaceuticals], another drug that has also been used for seizure
Dr. SerVaas: Are there countries where there is less manic-depression because
of a higher lithium content in the soil?
Dr. Jamison: No. People used to talk about that being true in parts of
Texas-more lithium in the drinking water and so forth. But the concentrations are so low
there, there wouldn't be any clinical impact.
Dr. SerVaas: How about areas where the suicide rate is high, such as in
Scandinavian countries? Might lithium be playing a role?
Dr. Jamison: No. Just the rate of manic-depressive illness is probably higher
Dr. SerVaas: Are there any environmental factors that may be detrimental to
manic-depressives? There's a doctor in West Palm Beach, for example, who is convinced that
NutraSweet [aspartame] is bad for his epilepsy patients.
Dr. Jamison: There is nothing like that demonstrated for manic-depressive
illness. It really seems to be genetic and sometimes, certainly the initial episode, can
be triggered by drug abuse, but it doesn't seem to be the case that there is anything
causative in the environment per se.
Dr. SerVaas: Is it true that manic-depression is very often apt to get worse as
the patient gets older?
Dr. Jamison: Yes, if it is left untreated.
Dr. SerVaas: You have gone public about your disease. If you had a
manic-depressive patient who wanted to go public and really help the cause, how would you
counsel that patient?
Dr. Jamison: In this age, I would counsel caution, because there is still a
tremendous amount of stigma and discrimination. I think there is no question that is true.
It is one thing to face your family and another to face the world and employers and so
forth. Actually, one of the things that has been very nice for me is discussing this in
more depth with my own family, nephews, and nieces. Not that we haven't talked about it
before, but the book causes us to talk about it a lot more, and it has been wonderful. I
think the younger people in the family have ended up feeling a lot more optimistic as a
result of knowing that things can work out well.
Since manic-depression is genetic, you really want kids to know that there is a certain
risk. If they start getting depressed, they know that they've got an illness that can be
treated; they can go to a doctor and get good care. What was so frightening for me when I
got sick and for so many other people whom I have treated is that they didn't have any
idea what was going on. It just came out of the blue and was so awful, so devastating that
there was no context in which to put it. To the extent that family members can be honest
with one another, that can be enormously helpful to the younger generation.
There is no reason to have stigma attached to this disorder, but that doesn't mean that
there isn't. One of my hopes in writing the book was that it would make it easier for
people to talk about manic-depression. And one Of the things that has been very nice is
thatat least in some situationsfeel that there has been more public discussion
about manic-depressive illness, than there was before. That is the whole point of doing
it, because it is a very lethal disease if it is left untreated, and it is very treatable.
Dr. SerVaas: Patty Duke wrote about her manic-depression in Call Me Anna. Did
she accurately describe the illness?
Dr. Jamison: Yes. I think overall her book was very helpful, because it made
people aware of an illness that they ordinarily didn't talk about. A lot of people paid
attention to Patty Duke who wouldn't pay attention to someone else. Her reaction to
lithium was that she took it, thought it was wonderful, and everything was great. My sense
is that's true for some people. In fact, for myself that's true, but it's generally a lot
more difficult than that. It's a very complicated illness. I think what she perhaps didn't
address was some of the complexities and how the disease overlaps with personality and
temperament. People need to hear from a whole lot of different types of people. My hope is
that by having a professional reach out, it will take away some of the stigma by saying,
"This is a doctor who has it."
Dr. SerVaas: You've written about the ongoing search for a manic-depressive
gene. Could you tell us about the Dana Foundation and the Genome Project?
Dr. Jamison: It's the Charles A. Dana Foundation in New York. The chairman is
David Mahoney, a very, big-time businessman who used to be chairman of the board of Norton
Simon. He became interested many years ago in neuroscience and the study of the brain, and
has given huge amounts of money to brain research, Both the center at Harvard and the one
at the University of Pennsylvania are named after him. Presently, the Dana Foundation is
funding a study of genetics of manic-depressive illness that is a collaborative research
program between Johns Hopkins, Stanford University, and Cold Spring Harbor Laboratory in
Dr. SerVaas: You are on an advisory group there. Is that a very active group
Dr. Jamison: Yes it is, and the Genome Project is an extremely active, ongoing
scientific program in Washington, D.C.
Dr. SerVaas: What benefits do you see coming from the present gene research?
Dr. Jamison: From the point of view of somebody who is both a scientist and a
patient, I think the answers to what causes so many illnesses are going to flow from the
genetic studies. You can see almost every week that they are coming up with a new gene. It
is a very exciting time in research.
Dr. SerVaas: Do you see gene treatment many decades away or maybe within our
Dr. Jamison: Absolutely within our lifetime.
Dr. SerVaas: Will treatment be available in which we would manipulate the gene
that causes manic-depression?
Dr. Jamison: Yes, or certainly there will be drug treatments based on what we
find out about the causes of manicdepressive illnesses and other psychiatric illnesses.
Dr. SerVaas: In your book you mention MRI and CAT scans. Are these tools useful
in diagnosing manic-depressive states?
Dr. Jamison: They are not so useful in diagnosing as in studying. The major way
of diagnosing manic-depressive illness now is through a very extensive clinical interview.
I think in the future, MRI and CAT scans may be used in diagnosis, but they are expensive,
and we don't know enough at the moment. I think what is really interesting is to see what
goes on with the brain when the brain is manic.
Dr. SerVaas: In diagnosing mental diseases, is it sometimes difficult to
differentiate a schizophrenic action from a first manic episode?
Dr. Jamison: Yes, it can be. And certainly a lot of people get diagnosed as
having schizophrenia who have manic-depressive illness. It's less common now to make that
mistake than it used to be. It used to be thought that if you were at all psychotic and
hallucinated and were delusional, that meant you had schizophrenia. People are much more
aware now that you can be very psychotic and violent with manic-depressive illness. To a
certain extent, it depends on what part of the country you are in and the level of
expertise of the doctor who sees the person. That's where things like family history can
be very important.
Dr. SerVaas: Does manic-depressive illness come more frequently from the
maternal or paternal side of a family?
Dr. Jamison: I don't think anybody really knows the patterns yet. There are
certainly suspected patterns. Dr. Raymond De Paulo and the Johns Hopkins group are
studying quite carefully the kind of transmission patterns, the maternal and paternal and
Dr. SerVaas: This may be somewhat personal, but have you and your husband
considered having children?
Dr. Jamison: My husband has three children, and I think that we sort of decided
to leave it at that, but I certainly would not have refrained from having children because
of manic-depressive illness. First of all, I'm glad my parents had me. It is a very
treatable illness, and I hope that comes across. Of all the mental illnesses that exist,
it is one of the most treatable. The real problem is getting people into treatment and
getting them to stay on treatment, but certainly I wouldn't hesitate to have children.
Fifteen years from now, we are going to know a lot more about the illness than we do now.
Any child born now wouldn't really be at risk for 15 or 16 years, and that is an awful lot
of time to develop good, new medication.
Dr. SerVaas: I was fascinated by what you said in your book about men and women
and how women who are frequently thought of as being more passive are more frequently
diagnosed with depression.
Dr. Jamison: I've always been struck by the fact that the notion of depression
is more congruent with what people think about women, and the impression that men are more
tempestuous and impatient. I also think a lot of women get misdiagnosed. That is a real
concern of mine.
Dr. SerVaas: Misdiagnosed as depression when it's really manic-depression?
Dr. Jamison: Yes, or when they have very mild cases. When somebody gets as
off-the-wall as I was, it's not hard to diagnose. It's the mild cases of mania where
people get misdiagnosed.
Dr. SerVaas: Are you working on any other books at present?
Dr. Jamison: At the moment I have decided not to write. I am just trying to
catch up on my correspondence and get my life in order a bit. I am sure I will write
again, just because I like to write.
Dr. SerVaas: In your own case, you're so candid about your disease. I believe
your books are going to be extremely helpful to patients. What do you see for your
personal future? Do you think with the treatments now available that you pretty well have
the demon licked?
Dr. Jamison: I am optimistic about my future. I think anybody who has
manic-depressive illness has to have a certain concern that it may recur. I am lucky that
I respond well to medication and that I have good cause to think I will do OK by it, but I
think it is like any recurrent illness. There is always in the back of your mind the
possibility that you can get sick again.