An Unquiet Mind: Chapter 4 Summary & Analysis

Kay Redfield Jamison offers up a lyrical description of her descent into madness. A meteorologist’s daughter, she had always been fascinated by the heavens—her early days of madness provided the “illusion of high summer days […] lurching through cloud banks and ethers, past stars”. She felt, at the heights of her mania, as if she could soar past Saturn itself. After the mania cleared and her medications began to level her out, Jamison found herself overcome by longing and nostalgia—even now, looking at pictures of Saturn’s rings fills her with melancholy.

For many years, Jamison writes, she failed to take her medications as prescribed—even though as a clinician she knew the devastating effects of resisting psychiatric treatment. Still, it would take many more journeys through manias and depression for Kay to admit that she needed medication. Giving up her “high flights of mind and mood” was, for a time, a threat to her very sense of self.

After Kay began taking lithium, her friends and family, she writes, assumed she’d be happy to finally be “normal”—but Kay could not stop comparing herself with her “former self,” believing that she’d been the best version of herself when mildly manic. She could not stop missing Saturn.

Kay was prescribed lithium in the fall of 1974, but by the spring of 1975, she’d gone against her psychiatrist’s advice and stopped taking it. Her reasons for rejecting the medication were psychological as well as biological—lithium is a powerful drug with strong physiological side effects, and, if one takes too much, one can experience lithium toxicity. Kay often found herself nauseous or even “violently ill” in public. As she approached toxic levels due to her high dosage, she trembled, slurred her words, and appeared to the untrained eye to be drunk or high, a fact which embarrassed her.

All of the physical side effects, however, paled in comparison to the havoc lithium wreaked upon Kay’s ability to read, comprehend, and remember the things she read—her attention span and memory were profoundly compromised. An avid reader who read several books a week, Kay could, in late 1974 and early 1975, barely focus long enough to get through a single paragraph. Kay attempted to keep her reading life alive by turning to poems and children’s books, but she found herself left full of longing for her past and discontented with her “broken” present.

Kay felt embarrassed by her diagnosis and the lithium prescription it required. She attempted to hide it from guests, friends, and lovers by clearing out the medicine cabinet before having everyone over, laughing off  her newly-acquired tremor, and attempting to sublimate her frustrations into patience by reading the Book of Job and learning to “be philosophical” about her situation. Kay eventually resisted taking her lithium because she “simply did not want to believe that [she] needed” it. “Addicted” to the highs of mania, Kay stopped taking the drug and sacrificed everything to experience the ecstasy of mania once again.

Other people in Kay’s life, too, felt she should be able to power through without the help of drugs—her sister, in particular, ridiculed Kay for relying on prescription medication, a stance which both humiliated Kay and validated her own desire to move away from lithium. When Kay’s sister declared that Kay was a “shell of [her] former self,” Kay felt her own worst fears were true. Even though she knew that not just her sanity but her very life, too, was at stake, in March of 1975, Kay stopped taking lithium.

Over the course of the rest of the year, Kay continued to see her psychiatrist—but she went on and off of lithium, cycling through manias and severe depressions as she did. Every time the medication made her feel better, she felt she no longer needed it—the voice of her sister, her own staunch belief that she should be able to weather her moods alone, and simple resistance to taking a daily medication all contributed to making 1975 a difficult year. Kay knew, from a scientific standpoint, that lithium was effective; she also knew that her illness necessitated medical treatment. In spite of all this, however, her stubbornness prevailed. Underneath it all, Jamison writes, she resisted adhering to the regimen her psychiatrist prescribed because deep down she feared that lithium might not work even if she took it consistently.

Years later, speaking before a packed conference hall at an annual meeting of the American Psychiatric Association, Jamison was giving a talk about the psychological and medical aspects of lithium treatment. She quoted a “patient” of hers suffering from manic-depressive illness—too afraid to share with the crowd gathered before her that she was, in fact, drawing on her own experiences with manic depression and lithium. As the audience reacted to both the humor and gravity of Jamison’s “patient’s” anecdote, she felt saddened not just for herself, but for the many patients each year who fail to take their lithium and suffer the “high costs” of doing so.

Jamison recalls one afternoon in the UCLA emergency room. One of her patients, strapped down to a gurney by his limbs, issued a blood-curdling scream that summoned Kay to his room. A year ago, this patient had held a knife to Kay’s throat in the midst of a psychotherapy session, yet Kay continued overseeing his treatment, desperate for him to get better through a combination of institutionalization, medication, and talk therapy. As Kay stood over the man’s bed that afternoon, she empathized with the “delusional mania” he was experiencing and tried to assure him that everything would be all right. She wasn’t lying—she was sure he’d be well, but the question of how long his remission would last, she knew, would depend entirely on his willingness to comply with the regimen of lithium she’d prescribed.

Kay reveals that eventually, this patient died—no amount of psychotherapy, medication, persuasion, nor coercion worked for him. Nothing psychology could do, Jamison writes now, could make this man stay on his medication. Tens of thousands of patients, she writes, lose their lives to manic-depressive illness each year—there are limits on what doctors can do for their patients. “We all,” she admits, “move uneasily within our restraints.”