FROM: McMan's Depression and Bipolar Web
http://www.mcmanweb.com/article-247.htm
Kay Jamison
Interview
At the Depression and Bipolar Support Alliance conference in Aug
2003, this writer had a chance to sit down with Kay Jamison PhD. For the
benefit of the uninitiated, Dr Jamison is a professor of psychiatry at Johns
Hopkins and honorary professor of English at the
Following is our conversation on topics
ranging from the state of bipolar treatments to how to handle a bad day to her
current projects:
McMan: Stanley Bipolar Network figures - 85 percent hospitalized,
on average three times, 50 percent attempt suicide, only one-third are married,
65 percent unemployed, 40 percent on welfare or disability . Bipolar is the
number 6 disability on the World Health Organization list. It’s almost an
admission that we’re very hard to treat and the treatments we have are abysmal.
Dr Jamison: I would be a little more optimistic than
that. I would say that things are very different now than they were 10 years
ago, that people are diagnosed more accurately and more quickly than they used
to be. For example, when the NDMDA was still the NDMDA, they published a survey
showing it took 10 years on average from the time you were first ill to the
time you got the correct diagnosis. I would bet that’s cut down now. I think
more doctors are aware of what the symptoms are than they used to be. There’s
been more publicity.
That doesn’t mean there isn’t a tremendous
amount of bad practice going on. Much more importantly, people can’t afford to
get good care. I think that most people don’t know that they’ve got an illness.
They think that it’s their personality, and even if they know they have an
illness, they don’t think it can be treated and they don’t get treatment until
it’s too late. Even if they know they’re sick and need treatment, they can’t
afford it because of the outrageous discrepancy in terms of insurance. I think
that the political system is to a considerable extent responsible. We just have
terrible care for people who have mental illness.
I think the treatments are pretty good. I
don’t think they’re as good as they could be by any stretch, but they work in
most people quite well.
McMan: Would you care to give a percentage?
Dr Jamison: Roughly 70 percent of people who have
bipolar illness have a strong response to treatment, higher than that for
depression. When you consider the other major illnesses, those are pretty good
statistics.
McMan: My readers complain of side effects ranging from cognitive
slowing to weight gain. Sometimes I get the impression that psychiatrists are
willing to trade side effects for mood stabilization, perhaps too much so.
Dr Jamison: I think that’s sometimes true, often
true, maybe, but I think that’s where people really need to go in and badger,
really go in and say, look, is there any possibility of a different medication
that might work or if I can take it in a lower amount? Are there any things
that I can do that might mean I don’t have to take as much medication? And that
these are debilitating side effects. I think sometimes doctors have to hear it
a lot, and sometimes even put it in writing.
McMan: Thomas Insel, the new head of
the NIMH, this summer said we have no evidence-based medicine to speak of, and
Edward Scolnick, president emeritus of Merck research,
said that mental illness is 180 degrees out of phase with the rest of medicine.
Dr Jamison: I wouldn’t put it that strongly, but I
think there’s a lot of truth, in fact. I think that what probably both of them
would say is that given the severity of the problem and given the fact that
it’s a common illness that the amount of resources in science has not been
nearly enough, and given the death rate from suicide and the pain of the
illness, the suffering through drugs and alcohol, all those things, we should
be doing a lot more than we are doing.
McMan: Dr Scolnick also said we have no
equivalent of a
Dr Jamison: It’s true. We do have lots of really good
science about the illness, but I don’t think we begin to have enough good
science, particularly in terms of treatment. There’s been a lot more emphasis
on other illnesses and what’s the best way to treat them.
McMan: Another thing Dr Scolnick
mentioned - a Zocor study that went on for four or
five years. I can’t think of a single psychiatric drug study that has gone on
for that long.
Dr Jamison: They got in and got out. Lithium has been
around for 50 years, so we have a tremendous amount of evidence about lithium.
We don’t about most of the antidepressants. We don’t about the anticonvulsants,
really. We don’t begin to have that kind of information.
McMan: How do you handle your bad days?
Dr Jamison: I think I’m much more likely to talk to
friends now than I used to be. For a long period of time, when I was really
ill, I isolated myself and went off like a wounded animal. I’m more willing to
pick up the phone. It’s still very hard, you know. Being depressed, the last
thing you want to do is talk to someone else; you don’t want to feel you’re a
burden and all.
I think I probably tend to be a little bit
more concerned about getting high and I’m more inclined to keep my ideas to
myself. I think those are things you learn over time. I’ve had the illness so
long that I sort of learned if I think that something is really vital that
perhaps it isn’t as vital as I think, that if I think something has to go out
immediately I tend to sit on it a few days and get more sleep.
McMan: Have you ever joined a support group?
Dr Jamison: No, I haven’t. I helped start quite a
few. I think you end up making informal support groups. I have a lot of friends
who have depression or bipolar illness, and we’ve had sort of an informal
support line, the manic mafia. People keep informal tabs on how everyone else
is doing.
People are just very different who have
this illness. There’s a tendency I find aggravating when people just sort of
lump everybody in together as if there’s not a lot of differences, and I think
it’s really important to tend to the differences. Some people who don’t have a
lot of friends to draw upon may have other resources. Some people may have a
lot of friends, but they don’t have the same resources.
McMan: Is individualizing treatment to temperament feasible, say Depakote for introverts and Tegretol
for extroverts?
Dr Jamison: Many of these temperaments go with a
particular kind of biology to the illness. Hopefully, at some point, we’ll be
able to draw blood and you find out this person has a form of bipolar illness
that is super-responsive to an anticonvulsant. So you can save people having to
go through all those drug trials that are so demoralizing and frustrating.
People get so discouraged, and when they’re feeling a lot of pain it’s really
hard to be patient.
McMan: Can we begin to see something happening in five or 10
years?
Dr Jamison: I think we’re going to know a lot more.
Let’s take it out of the realm of bipolar illness to the science of the brain.
It’s moving so much faster than anybody would have imagined in terms of imaging
and genetics and biological studies. And I think that’s all to the good,
because that’s where some of the answers for bipolar illness are going to come
from.
And don’t forget the importance of
psychotherapy, which I think is very underemphasized.
There’s a tendency to think that if you just get the right drug cocktail that
that’s necessarily enough. For some people it is, for a lot of people it isn’t.
What’s also important is having somebody there for you who knows
what he or she is doing, who knows the illness, knows the person.
McMan: My readers are always asking me about vitamin therapy.
Dr Jamison: It doesn’t mean that they don’t work, and
it doesn’t mean that they’re not important. It just means that the evidence is
not so strong. The evidence on fish oil is pretty strong. We know it is very
important to the nutrition of the brain.
McMan: Exercise?
Dr Jamison: It’s very hard if you’re depressed to
exercise. When I have been depressed I couldn’t get out of bed. Exercising
would have been incomprehensible, just no way. But when you’re well, it’s
certainly a good idea to exercise.
McMan: You have a book on exuberance coming out in the fall of
2004. Two of the people you write about are the naturalist John Muir and
Theodore Roosevelt. Who are some of the others?
Dr Jamison: Snowflake Bentley, who was the first to
photograph snowflakes, Richard Feynman the physicist, Michael Faraday the
physicist, Tigger, Toad, and Robert Louis Stevenson. Quite a lot of living scientists.
McMan: You must have related to the subject matter.
Dr Jamison: Yeah, and I think it’s an important
subject and I think there’s definitely a relationship to bipolar illness. It’s
not the same. Things kind of overlap in people, intense enthusiasm and passions
and so on.
McMan: Are you exuberant in temperament?
Dr Jamison: Yes. Absolutely.
McMan: Does exuberance apply to your writing, or would you say
disciplined exuberance?
Dr Jamison: Disciplined exuberance in the case of
this book.
McMan: There is a film project in the works based on An
Unquiet Mind. Who is going to be playing you, Julia Roberts?
Dr Jamison: I have no idea. They’re just writing a
screenplay at the moment.
McMan: Do you have any artistic control over that?
Dr Jamison: I’m working with a screenwriter.
McMan: Thank you very much, Dr Jamison.
Dr Jamison: Sure, sure. Tell your readers hi for me.