An Unquiet Mind - Kay Redfield Jamison [61]
Inevitably, the year passed: the snows and warming brandies of the English winter gave way to the soft rains and white wines of early summer. Roses and horses appeared in Hyde Park; gorgeous, diaphanous apple blossoms spread out over the black branches of the trees in St. James’s Park; and the long, still hours of summer light cast an Edwardian hue over the days just up to my parting. It had become difficult to remember my life in Los Angeles, much less to think about returning to the chaotic days of running a large university clinic filled with very sick patients, teaching, and seeing a full caseload of patients again. I was beginning to have doubts that I could remember the details of conducting a psychiatric history and examination, much less teaching others how to do it. I was reluctant to leave England, and even more reluctant to return to a city I had come to associate not only with a grueling academic career, but also with breakdowns, the worn, cold, bloodlessness following in their wake, and the draining charade of pretending to be well when I wasn’t and going through the motions of being pleasant when I felt dreadful.
I was, however, very wrong in my forebodings. The year had served as far more than just a restful interlude; it had been, in fact, truly restorative. Teaching was once again fun; supervising the clinical work of the residents and interns was, as it had been in earlier times, a pleasure; and seeing patients gave me the opportunity to try to put into practice some of what I had learned from my own experiences. Mental exhaustion had taken a long, terrible toll, but, strangely, it was only in feeling well, energetic, and high-spirited again that I had any true sense of the toll taken.
So work went well and relatively smoothly. Much of my time was spent working on a textbook that I was coauthoring about manic-depressive illness, delighted with how much easier it was to read, analyze, and retain the medical literature, which, until only recently, had been a terrible struggle to comprehend. I found writing my sections of the textbook a satisfying mix of science, clinical medicine, and personal experience. I was concerned that these experiences might unduly influence—by content or emphasis—portions of what I wrote, but my coauthor was fully aware of my illness, and many other clinicians and scientists also reviewed what we wrote. Often, though, I found myself drawing upon certain aspects of what I had been through in order to emphasize a particular point of phenomenology or clinical practice. Many of the chapters I wrote—those about suicide, medication compliance, childhood and adolescence, psychotherapy, clinical description, creativity, personality and interpersonal behavior, thought disorder, perception, and cognition—were influenced by my strong belief that these were areas that had been relatively overlooked in the field. Others—such as epidemiology, alcohol and drug abuse, and assessment of manic and depressive states—were more straightforwardly a review of the existing psychiatric literature.
For the clinical description chapter—the basic characterization of hypomanic and manic states, depressive and mixed states, as well as the cyclothymic features underlying these clinical conditions—I relied not only upon the work of classic clinicians such as Professor Emil Kraepelin, and the many clinical researchers who had conducted extensive data-based studies, but upon the writings of manic-depressive patients themselves. Many of the descriptions were from writers and artists who had given highly articulate and vivid descriptions of their manias, depressions, and mixed states. Most of the rest of the accounts were from my patients or passages taken from the psychiatric literature. In a few instances, however, I used my own descriptions of my experiences that I had written for teaching purposes