An Unquiet Mind: A Memoir of Moods and Madness (19 page)

Time and again, because of both personal and clinical experiences, I found myself emphasizing the terrible lethality of manic-depressive illness, the dreadful agitation involved in mixed manic states, and the importance of dealing with patients’ reluctance to take lithium or other medications to control their moods. Having to stand back from my own feelings and past in order to write in a more cerebral, scholarly way was refreshing, and it forced me to structure and put into a more objective perspective the turmoil I had been through. Often, the science of the field was not only exciting, but it also held out the very realistic hope of new treatments. Although it was, on occasion, disturbing to see powerful and complicated emotions and behaviors distilled into deadeningly dull diagnostic phrases, it was hard not to be caught up in the new methods and findings of a very rapidly progressing field of clinical medicine.

I ended up strangely loving the discipline and obsessiveness that went into developing the countless tables of data. There was something lullingly reassuring about
entering number after number, percentage after percentage, into the summary charts; critiquing the methods used in the various studies; and then trying to make some overall sense out of the large number of articles and books that had been reviewed. Much as I had done when frightened or upset as a child, I found that asking questions, tracking down answers as best I could, and then asking yet more questions was the best way to provide a distance from anxiety and a framework for understanding.

L
owering my lithium level had allowed not only a clarity of thinking, but also a vividness and intensity of experience, back into my life; these elements had once formed the core of my normal temperament, and their absence had left gaping hollows in the way in which I could respond to the world. The too rigid structuring of my moods and temperament, which had resulted from a higher dose of lithium, made me less resilient to stress than a lower dose, which, like the building codes in California that are designed to prevent damage from earthquakes, allowed my mind and emotions to sway a bit. Therefore, and rather oddly, there was a new solidness to both my thinking and emotions. Gradually, as I began to look around me, I realized that this was the kind of evenness and predictability most people had, and probably took for granted, throughout their lives.

When I was an undergraduate I tutored a blind student in statistics; once a week he would make his way, with his guide dog, to my small office in the basement of the psychology building. I was very affected by
working with him, seeing how difficult it was for him to do the things I so much took for granted and by watching the extraordinarily close relationship he had with his collie, who, having accompanied him to the office, would immediately curl up and fall asleep at his feet. As the term went on I felt increasingly comfortable in asking him about what it was like to be blind; what it was like to be blind, young, and an undergraduate at the University of California; and what it was like to have to be so dependent upon others to learn and survive. After several months I had deluded myself that I had at least some notion, however small, of what life was like for him. Then one day he asked me if I would mind meeting him for his tutorial session in the blind reading room of the undergraduate library, rather than in my office.

I tracked down the reading room with some difficulty and started to go in. I stopped suddenly when I realized with horror that the room was almost totally dark. It was dead silent, no lights were on, and yet there were half a dozen students bending over their books or listening intently to the audiotapes of the professors’ lectures that they had recorded. A total chill went down my spine at the eeriness of the scene. My student heard me come in, got up, walked over to the light switch, and turned on the lights for me. It was one of those still, clear moments when you realize that you haven’t understood anything at all, that you have had no real comprehension of the other person’s world. As I gradually entered into the world of more stable moods and more predictable life, I began to realize that I knew very little about it and had no real idea of what it would be
like to live in such a place. In many ways, I was a stranger to the normal world.

It was a sobering thought, and one that cut both ways. My moods still shifted often and precipitously enough to afford me occasional intoxicating, mind-on-the-edge experiences; these white manias were infused with the intense, high-flying exuberance, absolute assuredness of purpose, and easy cascading of ideas that had made taking lithium so difficult for so long. But then when the black tiredness inevitably followed, I would be subdued back into the recognition that I had a bad disease, one that could destroy all pleasure and hope and competence. I began to covet the day-to-day steadiness that most of my colleagues seemed to enjoy. I also began to appreciate how draining and preoccupying it had become just to keep my mind bobbing above water. It was true that much got done during the days and weeks of flying high, but it was also true that one generated new projects and made new commitments, which then had to be completed during the grayer times. I was constantly chasing the tail of my own brain, recovering from, or delving into, new moods and new experiences. The new was beginning to lack both newness and luster, and the mere accumulation of experiences was beginning to seem far less meaningful than I imagined exploring the depths of such experiences ought to be.

The extremes in my moods were not nearly as pronounced as they had been, but it was clear that a low-grade, fitful instability had become an integral part of my life. I had now, after many years, finally convinced myself that a certain intellectual steadiness was not only
desirable, but essential; somewhere in my heart, however, I continued to believe that intense and lasting love was possible only in a climate of somewhat tumultuous passions. This, I felt, consigned me to being with a man whose temperament was largely similar to my own. I was late to understand that chaos and intensity are no substitute for lasting love, nor are they necessarily an improvement on real life. Normal people are not always boring. On the contrary. Volatility and passion, although often more romantic and enticing, are not intrinsically preferable to a steadiness of experience and feeling about another person (nor are they incompatible). These are beliefs, of course, that one has intuitively about friendships and family; they become less obvious when caught up in a romantic life that mirrors, magnifies, and perpetuates one’s own mercurial emotional life and temperament. It has been with pleasure, and not-inconsiderable pain, that I have learned about the possibilities of love—its steadiness and its growth—from my husband, the man with whom I have lived for almost a decade.

I first met Richard Wyatt at a Christmas party in Washington, and he certainly was not at all what I expected. I had heard of him—he is a well-known schizophrenia researcher, Chief of Neuropsychiatry at the National Institute of Mental Health, and the author of more than seven hundred scientific papers and books—but I was completely unprepared for the handsome, unassuming, quietly charming man I found myself talking with near a gigantic Christmas tree. He was not only attractive, he was very easy to talk to, and we got together often in the months that followed. Less than a year after we met, I returned to London for
another marvelous six months, again on sabbatical leave from UCLA, and then went back to Los Angeles long enough to fulfill my post-sabbatical obligations and make plans to move to Washington. The whole thing had been a short but very convincing courtship. I loved being with him and found him not just unbelievably smart, but imaginative, fiendishly curious, refreshingly open-minded, and wonderfully easygoing. Even then, very early in our relationship, I could not imagine my life without him. I resigned my tenured position at the medical school with genuine regret at leaving the University of California, which I loved, and considerable anxiety about the financial implications of giving up a secure income, and then went to a long round of farewell parties given by colleagues, friends, and students. Overall, however, I left Los Angeles with few regrets. It had never been the City of Angels to me, and I was more than happy to leave it, first, thousands of feet below me—and then, finally, thousands of miles behind—filled with near death, a completely shattered innocence, and a recurrently lost and broken mind. Life in California had been often good, even very wonderful, but it was hard for me to see any of that at the time I returned to Washington to live. The ever promising, always elusive, and infinitely complex Promised Land seemed to me to be exactly that: promised.

Richard and I moved into a house in Georgetown and quickly confirmed what our common sense should have told us: we could not have been more different. He was low-key, I was intense; things that cut me to the quick he was able to sail by with scarcely a notice; he was slow to anger, I quick; the world registered gently upon him, sometimes not at all, whereas I was fast to
feel both pleasure and pain. He was, indeed, in most ways and at most times, a man of moderation; I was quicker to slight, quicker to sense, and perhaps quicker to reach out and attempt to heal hurts we inevitably caused one another. Concerts and opera, mainstays of my existence, were torture to him, as were long, extended talks or vacations lasting more than three days. We were a complete mismatch. I was filled with a thousand enthusiasms or black despair; Richard, who for the most part maintained an even emotional course, found it difficult to handle—or, worse yet, take seriously—my intensely mercurial moods. He had no idea what to do with me. If I asked him what he was thinking, it was never about death, the human condition, relationships, or us; it was, instead, almost always about a scientific problem or, occasionally, about a patient. He pursued his science and the practice of medicine with the same romantic intensity that was integral to the way I pursued the rest of life.

He was not, it was clear, going to gaze meaningfully into my eyes over long dinners and fine wines, nor discuss literature and music over late-night coffee and port. He, in fact,
couldn’t
sit still very long, had a scarcely measurable attention span, didn’t drink much, never touched coffee, and wasn’t particularly interested in the complexities of relationships or the affirmations of art. He couldn’t abide poetry and was genuinely amazed that I seemed to spend so much of my day just wandering around, rather aimlessly, going to the zoo, visiting art galleries, walking my dog—a sweet, wholly independent, morbidly shy basset hound named Pumpkin—or meeting friends for lunch and breakfast. Yet not once in the years we have been together have I doubted
Richard’s love for me, nor mine for him. Love, like life, is much stranger and far more complicated than one is brought up to believe. Our common intellectual interests—medicine, science, and psychiatry—are very strong ones, and our differences in both substance and style have allowed each of us a great deal of independence, which has been essential and which, ultimately, has bound us very close to one another over the years. My life with Richard has become a safe harbor: an extremely interesting place, filled with love and warmth and always a bit open to the outer sea. But like all safe harbors that manage to retain fascination as well as safety, it was less than smooth sailing to reach.

When I first told Richard about my manic-depressive 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.