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illness, soon after we met, he looked genuinely stunned. We were sitting in the main dining room of the Del Coronado Hotel in San Diego at the time; he slowly put down the hamburger he was eating, stared straight into my eyes, and, without missing a beat, said rather dryly, “That explains a lot.” He was remarkably kind. Much as David Laurie had done, he asked me a great deal about what form my illness took and how it had affected my life. Perhaps because both were physicians, he, too, asked question after question of a more medical nature: what were my symptoms when I was manic, how depressed had I gotten, had I ever been suicidal, what medications had I taken in the past, what medications was I now taking, did I have any side effects. He was, as ever, low-key and reassuring; whatever deeper concerns he had, he was kind and smart enough to keep to himself.

But, as I well knew, an understanding at an abstract level does not necessarily translate into an understanding at a day-to-day level. I have become fundamentally and deeply skeptical that anyone who does not have this illness can truly understand it. And, ultimately, it is probably unreasonable to expect the kind of acceptance of it that one so desperately desires. It is not an illness that lends itself to easy empathy. Once a restless or frayed mood has turned to anger, or violence, or psychosis, Richard, like most, finds it very difficult to see it as illness, rather than as being willful, angry, irrational, or simply tiresome. What I experience as beyond my control can instead seem to him deliberate and frightening. It is, at these times, impossible for me to convey my desperation and pain; it is harder still, afterward, to recover from the damaging acts and dreadful words. These terrible black manias, with their agitated, ferocious, and savage sides, are understandably difficult for Richard to understand and almost as difficult for me to explain.

No amount of love can cure madness or unblacken one’s dark moods. Love can help, it can make the pain more tolerable, but, always, one is beholden to medication that may or may not always work and may or may not be bearable. Madness, on the other hand, most certainly can, and often does, kill love through its mistrustfulness, unrelenting pessimism, discontents, erratic behavior, and, especially, through its savage moods. The sadder, sleepier, slower, and less volatile depressions are more intuitively understood and more easily taken in stride. A quiet melancholy is neither threatening nor beyond ordinary comprehension; an angry, violent, vexatious despair is both. Experience and love have, over much time, taught both of us a great deal about dealing with manic-depressive illness; I occasionally laugh and tell him that his imperturbability is worth three hundred milligrams of lithium a day to me, and it is probably true.

Sometimes, in the midst of one of my dreadful, destructive upheavals of mood, I feel Richard’s quietness nearby and am reminded of Byron’s wonderful description of the rainbow that sits “Like Hope upon a death-bed” on the verge of a wild, rushing cataract; yet, “while all around is torn / By the distracted waters,” the rainbow stays serene:

Resembling, ’mid the torture of the scene,

Love watching Madness with unalterable mien.

But if love is not the cure, it certainly can act as a very strong medicine. As John Donne has written, it is not so pure and abstract as one might once have thought and wished, but it does endure, and it does grow.

Part Four

AN UNQUIET MIND

Speaking of Madness

Not long before I left Los Angeles for Washington, I received the most vituperative and unpleasant letter that anyone has ever written me. It came not from a colleague or a patient, but from a woman who, having seen an announcement of a lecture I was to give, was outraged that I had used the word “madness” in the title of my talk. I was, she wrote, insensitive and crass and very clearly had no idea at all what it was like to suffer from something as awful as manic-depressive illness. I was just one more