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Authors: Kay Redfield Jamison
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to a bob. The moods, the hair, the clothes all changed from week to week, month to month. My husband, on the other hand, was steady, and in most ways we ended up complementing one another’s temperaments.
Within months of our meeting we were living together in a small apartment near the ocean. It was a quiet, normal sort of existence, filled with movies, friends, and trips to Big Sur, San Francisco, and Yosemite. The safety of our marriage, the closeness of good friends, and the intellectual latitude provided by graduate school were very powerful in providing a reasonably quiet and harbored world.
I had started off studying experimental psychology, especially the more physiological and mathematical sides of the field, but after several months of clinical studies at the Maudsley Hospital in London—which I had completed just prior to meeting my husband—I decided to switch to clinical psychology. I had an increasing personal, as well as professional, interest in the field. My course work, which had focused on statistical methods, biology, and experimental psychology, now switched to psychopharmacology, psychopathology, clinical methods, and psychotherapy. Psychopathology—the scientific study of mental disorders—proved enormously interesting, and I found that seeing patients was not only fascinating but intellectually and personally demanding. Despite the fact that we were being taught how to make clinical diagnoses, I still did not make any connection in my own mind between the problems I had experienced and what was described as manic-depressive illness in the textbooks. In a strange reversal of medical-student syndrome, where students become convinced that theyhave whatever disease it is they are studying, I blithely went on with my clinical training and never put my mood swings into any medical context whatsoever. When I look back on it, my denial and ignorance seem virtually incomprehensible. I noticed, though, that I was more comfortable treating psychotic patients than were many of my colleagues.
At that time, in clinical psychology and psychiatric residency programs, psychosis was far more linked to schizophrenia than manic-depressive illness, and I learned very little about mood disorders in any formal sense. Psychoanalytic theories still predominated. So for the first two years of treating patients, I was supervised almost entirely by psychoanalysts; the emphasis in treatment was on understanding early experiences and conflicts; dreams and symbols, and their interpretation, formed the core of psychotherapeutic work. A more medical approach to psychopathology—one that centered on diagnosis, symptoms, illness, and medical treatments—came only after I started my internship at the UCLA Neuropsychiatric Institute. Although I have had many disagreements with psychoanalysts over the years—and particularly virulent ones with those analysts who oppose treating severe mood disorders with medications, long after the evidence clearly showed that lithium and the antidepressants are far more effective than psychotherapy alone—I have found invaluable the emphasis in my early psychotherapy training on many aspects of psychoanalytic thought. I shed much of the psychoanalytic language as time went by, but the education was an interesting one, and I’ve never been able to fathom the often unnecessarily arbitrary distinctions between “biological” psychiatry, which emphasizesmedical causes and treatments of mental illness, and the “dynamic” psychologies, which focus more on early developmental issues, personality structure, conflict and motivation, and unconscious thought.
Extremes, however, are always absurd, and I found myself amazed at the ridiculous level to which uncritical thought can sink. At one point in our training we were expected to learn how to administer various psychological tests, including intelligence tests such as the Wechsler Adult Intelligence Scale, or WAIS, and personality tests such as
Within months of our meeting we were living together in a small apartment near the ocean. It was a quiet, normal sort of existence, filled with movies, friends, and trips to Big Sur, San Francisco, and Yosemite. The safety of our marriage, the closeness of good friends, and the intellectual latitude provided by graduate school were very powerful in providing a reasonably quiet and harbored world.
I had started off studying experimental psychology, especially the more physiological and mathematical sides of the field, but after several months of clinical studies at the Maudsley Hospital in London—which I had completed just prior to meeting my husband—I decided to switch to clinical psychology. I had an increasing personal, as well as professional, interest in the field. My course work, which had focused on statistical methods, biology, and experimental psychology, now switched to psychopharmacology, psychopathology, clinical methods, and psychotherapy. Psychopathology—the scientific study of mental disorders—proved enormously interesting, and I found that seeing patients was not only fascinating but intellectually and personally demanding. Despite the fact that we were being taught how to make clinical diagnoses, I still did not make any connection in my own mind between the problems I had experienced and what was described as manic-depressive illness in the textbooks. In a strange reversal of medical-student syndrome, where students become convinced that theyhave whatever disease it is they are studying, I blithely went on with my clinical training and never put my mood swings into any medical context whatsoever. When I look back on it, my denial and ignorance seem virtually incomprehensible. I noticed, though, that I was more comfortable treating psychotic patients than were many of my colleagues.
At that time, in clinical psychology and psychiatric residency programs, psychosis was far more linked to schizophrenia than manic-depressive illness, and I learned very little about mood disorders in any formal sense. Psychoanalytic theories still predominated. So for the first two years of treating patients, I was supervised almost entirely by psychoanalysts; the emphasis in treatment was on understanding early experiences and conflicts; dreams and symbols, and their interpretation, formed the core of psychotherapeutic work. A more medical approach to psychopathology—one that centered on diagnosis, symptoms, illness, and medical treatments—came only after I started my internship at the UCLA Neuropsychiatric Institute. Although I have had many disagreements with psychoanalysts over the years—and particularly virulent ones with those analysts who oppose treating severe mood disorders with medications, long after the evidence clearly showed that lithium and the antidepressants are far more effective than psychotherapy alone—I have found invaluable the emphasis in my early psychotherapy training on many aspects of psychoanalytic thought. I shed much of the psychoanalytic language as time went by, but the education was an interesting one, and I’ve never been able to fathom the often unnecessarily arbitrary distinctions between “biological” psychiatry, which emphasizesmedical causes and treatments of mental illness, and the “dynamic” psychologies, which focus more on early developmental issues, personality structure, conflict and motivation, and unconscious thought.
Extremes, however, are always absurd, and I found myself amazed at the ridiculous level to which uncritical thought can sink. At one point in our training we were expected to learn how to administer various psychological tests, including intelligence tests such as the Wechsler Adult Intelligence Scale, or WAIS, and personality tests such as
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