Diagnostic Analysis
Kay Redfield Jamison
Bipolar 1, Mixed Features
Identifying Information and Brief History
Kay Redfield Jamison was born on June 22, 1946 to Dr. Marshall Jamison and Mary Temple Jamison. Jamison’s father was an officer in the US Air Force, leading to a military lifestyle and upbringing for most of her childhood. This military lifestyle afforded Jamison several unique privileges and experiences such as a comprehensive and rigorous education, exposure to other cultures, and life abroad in several different countries. The family moved around quite often before finally settling down in California, where Jamison would graduate from high school and transition into a career in clinical psychology. Despite moving from one place to another, Jamison grew up in a relatively normal family environment. Jamison’s father lived with what would appear to be manic depression, as he was described as possessing a “contagious expansiveness” (Jamison, 1997, p. 33), and dark, melancholic periods of intense depression. Jamison’s mother took a more involved and steady-hand approach to childrearing and spousal role.
After finishing her undergraduate studies, Jamison began a degree in clinical psychology at UCLA. During this time, Jamison had experienced intense “high flying times” (Jamison, 1997, p. 86), phrenetic periods wherein she was filled by a sense of urgency and intense expansiveness. These periods were punctuated by intervals of black and grim despair. After graduating with a doctorate in clinical psychology, Jamison moved into a teaching and supervisoriorial position at UCLA, where the intensity of her moods increased dramatically. She
had experienced a period of remission during graduate school but was then beset by hallucinations and full on manic psychosis after a few years into her career. After this episode, Jamison entered treatment for her diagnosed manic depression, a treatment approach that included both lithium prescription and psychotherapy.
Jamison would continue psychotherapy with her trusted psychiatrist to the present day of her writing and would go on and off her lithium medication until finally choosing to stay on it permanently. Her struggle with depression led to one serious suicide attempt through overdosage, for which she would recover and flourish. Jamison received substantial and profound support outside of therapy through her family, close friends and romantic partners. Jamison has been married twice, and survived the death of one significant romantic partner, bearing the grief of these relationships alongside her mercurial and grim moods. She now lives her life teaching, authoring books and studies and lives with her partner and the love of those closest to her. She remains on lithium to avoid the tragical and intense nature of her manic episodes, and to lessen the sting of her seasons of despair. She still experiences manic and depressive symptoms, but to a more moderate and manageable extent. Though her mood is more flattened, and the world is not as vibrant as it is during her high times, she lives a life that is anything other than flat.
Diagnostic Analysis
Jamison is upfront and knowledgeable about her diagnosis from the outset of her memoir. Details of her symptoms and behaviors throughout align with the stereotypical textbook definition of Bipolar 1 as an outlined by the DSM-5. First and foremost, Jamison experiences periods of intense mania for several weeks at a time and has had many throughout her life. During these periods that she calls the “black manias” (Jamison, 1997), Jamison expresses an influx of a boundless and restless energy, and a decreased need for sleep. She has been observed by others as being more talkative during these periods, as evidenced by her fellow guests and psychiatrist at a dinner party (Jamison, 1997, p. 107). This phenomenon was not only expressed through spoken word, but through racing thoughts as well (p. 124). Jamison also experiences a surge in goal-driven behavior, as demonstrated by her ability to write research articles and accomplish myriads of paperwork necessary to uphold her job as a clinical director. The frenzied pace at which Jamison drafts an article a day, and her excessive involvement in extracurricular activities showcases the expansiveness of her mania. Yet, these expansive moods shift to moods of a more irritable nature as Jamison matures and ages. None of these episodes were triggered or induced via substances or medical condition.
Jamison’s “black manias” also take a toll on her and her social life. Jamison extends herself to social and progressive causes during her “high flying times”. Jamison would attempt to appease her manic periods through lavish spending sprees, resulting in financial burdens to be dealt with later. A prime example of this behavior was Jamison’s purchase of a horse in her early twenties, while in the grips of an expansive mania (p. 87). Jamison also experienced a psychotic break with an accompanying hallucination of herself changing out the machinery or a centrifuge (pp. 119-120). This hallucinatory episode was the episode that brought Jamison to therapy in the first place. Before this, Jamison believed that she could handle her episodes on
her own without the help of others. Her mania and lack of attention towards it caused serious damage to both her and her relationships. Most notably, her first husband and steady hand to her manic episodes, felt the strain of the intensity of said mania and the marriage ended in divorce. Jamison expressed moving between different friend groups and breaking relationships off in harsh manners in her early twenties before she began seeking help. Her manic episodes take an intense toll on her mind and her body, as the periods following can attest to.
Though mania is the main characteristic of Bipolar I, Jamison does experience severe bouts of depression that impact her social and occupational functioning. These black depressions and mercurial moods took a toll on her health and her academic grades throughout school (p. 77). In the throws of these moods, Jamison would experience a loss of energy, low motivation, and decreased interest and pleasure in formerly pleasurable activities like sex, reading and horse-back riding. Recurrent feelings of worthlessness, death and suicidal ideation accompanied the fatigue and diminished nature of these dysphoric and depressive episodes. The “black depressions” last for several weeks or months at a time, with the longest depression lasting for over a year. These depressions do not appear to be brought on by external stimuli or forces, though they are impacted and influenced by significant life events as evidenced by the profound and abrupt death of her significant other. The grim and black depressions seep into the manias through Jamison’s irritability and suicidal ideation. Jamison is most at danger when off her medication or when lowering her dosages of lithium, a state where she has come close to committing suicide, highlighting that her manic episodes contain features of depressive symptoms. That said, Jamison’s only major suicide attempt by overdose was during one of the darkest seasons of her life (p. 168). Both the manias and depressions negatively impact Jamison’s social and personal life, and these seasons bleed into one another. As Bipolar I is
characterized by the manic symptoms, a provisional specifier of mixed features helps to capture the sheer intensity of Jamison’s “black and grim depressions”.
Context and Lifeworld
When assessing for diagnosis, it is important to bear in mind the cultural context and lifeworld for the individual patient. Jamison grew up in a unique cultural context, as she was the daughter of a military officer and was thrown into a world of the military lifestyle. As mentioned in the history section, Jamison was privileged to be highly educated and well-travelled and cultured before entering high school. Despite this upbringing and privilege, Jamison was born shortly after World War II. This meant that Jamison was to grow up in a more racially segregated and gender binary society. As a result, Jamison had to manage the expectations of a highly patriarchal society, and later a male dominated profession in clinical psychology. These aspects to which Jamison also noted, played into how she was perceived by others and how her behavior was even more unacceptable and outrageous. A typical manic episode as a woman was inappropriate, whereas depression was more commonly associated with femininity, leading to stereotyping and potential misdiagnosis. Luckily, Jamison was able to find a psychiatrist who did not diagnosis her incorrectly with histrionic personality disorder.
Jamison also grew up in a more conservative family and a nuclear family dynamic. Her family went to church every Sunday, and she was expected to speak with respect towards whomever she was addressing (p. 178). Jamison’s family life was normal and pleasant. The only abnormal aspect of her family life was her father’s temperament that matched her own later in life. Jamison’s father experienced accele