Nothing Was the Same

ALSO BY KAY REDFIELD JAMISON

Touched with Fire:
Manic-Depressive Illness and the Artistic Temperament

An Unquiet Mind: A Memoir of Moods and Madness

Night Falls Fast: Understanding Suicide

Exuberance: The Passion for Life

TEXTBOOKS

Abnormal Psychology
(with Michael Goldstein and Bruce Baker)

Manic-Depressive Illness:
Bipolar Disorders and Recurrent Depression
(with Frederick Goodwin)

In memory of my mother
,
Mary Dell Temple Jamison

and for

Julian, Eliot, and Leslie Jamison
,
Daniel Auerbach
,
Thomas Traill
,
and
The Snowflake Club

RICHARD WYATT, M.D., 1939-2002

C
ONTENTS

P
ROLOGUE

PART ONE
A
SSURED BY
L
OVE

The Pleasure of His Company

Lilacs and a Roman Ring

PART TWO
L
AST
C
HAMPAGNE

Broken Portions

Raining Stars

Joy Be the Starlight

PART THREE
O
F
S
OMETHING
L
OST

Wildflowers and Granite

Mourning and Melancholia

Fugitive Dyes

A
CKNOWLEDGMENTS

Prologue

When I was young, I thought that fearlessness and an easy way with love would see me to the other side of anything. Madness taught me otherwise. In the wake of my first insanity I assumed less and doubted more. My mind was suspect; there was no arguing with the new reality. I had to learn to live with a brain that demanded more coddling than I would have liked and, because of this, I avoided perturbance as best I could. Needwise, I avoided love.

I kept my mind on a short lead and my heart yet closer in; had I cared enough to look I doubt I would have recognized either of them. Before mania whipped through my brain I had been curious always to go to the far field, beyond what lay nearest by. After, I drew back from life and watered down my dreams. I retaught myself to think and to negotiate the world, and as the world measures things, I did well enough.

I was content in my life and found purpose in academic and clinical work. I wrote and taught, saw patients, and kept my struggles with manic-depressive illness to myself. I worked hard, driven to understand the illness from which I suffered. I settled in, I settled down, I settled. In a slow and fitful way, predictability insinuated itself into my life, and with it came a certain peace I was not aware had been missing. Grateful for this, and because I had no reason to know otherwise, I assumed that peace was provisional upon an absence of passion or anything that could forcibly disturb my senses. I avoided love.

This lasted for a while, although not perhaps as long as it seemed. Then I met a man who upended my cautious stance toward life. He did not believe, as I had for so long, that to control my mind I must first control my heart. He loved the woman he imagined I must have been before bowing to fear. He prodded my resistance with grace and undermined my wariness with laughter. He could say the unthinkable because he instinctively knew that his dry wit and gentle ways would win me over. They did. He was deft with my shifting moods and did not abuse our passion. He liked my fearlessness, and he brought it back as a gift to me. Far from finding the intensity of my nature disturbing, he gravitated toward it. He induced me to risk much by assuming a portion of the risk himself, and he persuaded me to write from my heart. He loved in me what I had forgotten was there.

We had nearly twenty years together. He was my husband, colleague, and friend; when he became ill and we knew he would die, he became my mentor in how to die with the grace by which he lived. What he could not teach me—no one could—was how to contend with the grief of losing him.

It has been said that grief is a kind of madness. I disagree. There is a sanity to grief, in its just proportion of emotion to cause, that madness does not have. Grief, given to all, is a generative and human thing. It provides a path, albeit a broken one, by which those who grieve can find their way. Still, it is grief’s fugitive nature that one does not know at the start that such a path exists. I knew madness well, but I understood little of grief, and I was not always certain which was grief and which was madness. Grief, as it transpires, has its own territory.

PART ONE

A
SSURED BY
L
OVE

How like you to be kind
,
Seeking to reassure
.
And, yes, how like my mind
To make itself secure
.

—THOM GUNN

T
HE
P
LEASURE OF
H
IS
C
OMPANY

Death forces cold decisions. Five years ago, as I waited in my husband’s hospital room the night before he died, I was numb with fear. The doctor in the intensive care unit had been blunt. “Mrs. Wyatt,” he said, “we need to talk about what your husband would have wanted done.” I reached out instinctively to my husband, the person who had made bearable so many painful things over the years, and for a short while was reassured by the warmth of his hand. The reassurance was illusory, however, as any reassurance must be when it comes from the dying. The doctor and I talked about what had to be done.

My husband, nothing if not a practical man, had detailed years earlier the final medical decisions he wished to be made on his behalf, sparing me now some measure of pain and uncertainty. Indeed, he had laid out with such precision the circumstances under which he wished to have life support measures removed that the attending physician cited his directives to the medical students and residents as a model of how such things should be drawn up. Dr. Wyatt, he told them, was a scientist as well as a doctor, and it showed in the precision of his orders.

Richard, I told myself, was also a teacher, and he would have been pleased to be teaching in death as he had in life. He would have laughed and said that, all things considered, he would have preferred to be alive and to have left this particular kind of teaching to someone else. The warmth of his hand may have been illusory, but the recollection of his wit was not. For a moment I felt the solace and pleasure of his company.

The decision to sign the papers to end Richard’s life was difficult but peculiarly straightforward. His medical condition and the specifics of his advance directives made signing, however haunting, inevitable. It was a final and necessary act. More wrenching was the decision of where to spend the last night we would have together. There should have been no question at all. Every human instinct, every impulse of love and friendship, told me I should be with him at the end. It did not matter that he was unconscious and would not be conscious again. The desire to hold and console, to accompany, is ancient for cause: it is human; it is who we are. Left to my own ways, before Richard became a part of how I faced the world and my disquietude, I would have been by him all night, not willing or able to sleep. I could not have imagined otherwise. To spend our final night apart seemed monstrous.

Yet it was Richard’s gift to me that I thought that night as Richard would have thought, not as others would think or as I would once have thought. I thought of sleep, of practical things. You cannot afford to lose sleep, he had said to me so often, in so many places: You are staying up too late; you are pushing it. You will get manic. Take something. Get some sleep.

Medication, love, sleep: these were the things Richard had shown would keep my mind in check. His love would soon be gone, at least that form of his love that was physical and more obviously comprehensible. It was left to me to take care of myself, to attend to the practicalities that up to that point he had taken onto himself.

If I stayed with him in the hospital, a sleepless night would be followed by others in the difficult days to come; inevitably, the loss of sleep would push my brain over its edge. I might rail against such weakness, but it would do no good. I had been down that particular defiant and destructive path too many times to delude myself now. By all odds and within short order, I would become manic again. Having lost my heart, I would then lose my mind. Richard would be dead, I would be ill, a funeral still would need to be planned, and I still would have to live with the fact that he would be in the ground, cold and inaccessible. Everything—Richard, my sanity, my long-sought peace—would be gone. To realize a tolerable future, I had to turn away from the man who had made my future possible. It was expedient and an act of betrayal; it was rational in a way that Richard was; it was preserving.

I kissed Richard on his forehead, left him alone in a room filled with monitors that blinked numbers going in the wrong direction, and told the nurses how to reach me. Richard and I spent our last night as husband and wife apart, in cold and separate beds, an unthinkable distance from what we had known together for nearly twenty years. Richard was going to die the next day, and his quick mind and sheltering ways were going to die with him.

Richard was first and last a doctor and a scientist. Nothing else in his life carried matching weight. He loved science unreservedly from the time he was a young child until he died; no one could compete with the pleasure he found in grappling with questions provoked by nature or the human brain. I loved this about him. The same mind that served Richard well in science, along with a droll wit and a remarkable tolerance for diverse ways of going through life, made living with him a delight. Or, if not always a delight, certainly never dull. I cannot remember a time in the years we had together that I was bored. Nearly out the door on more than one occasion, certainly. But bored, never.

Early on, Richard wrote to me that he was new to love. He said this on many occasions and felt it to be an important part of who we were, a source of pleasure as well as vulnerability. At first I found this difficult to believe. He was forty-five and I was thirty-eight when we met; neither of us was new to life or to romantic entanglements. He was quietly but unquestionably charming, easy on the eyes, and confident in who he was. His reserve was seductive, as was his intelligence, and he was the kind of interested listener one waits for but seldom finds. He was catnip to women yet, savingly, largely oblivious to that fact.

We hit it off straightaway. We had many things in common—curiosity about the natural world, interest in the customs and love lives of our colleagues, and fascination with the ways the brain can veer off its tracks—and we made each other laugh. We were both optimists who bounded into our days with the belief that something interesting was certain to happen. We were inclined to find pleasure in whatever it was we were doing.

In time we came to realize that each of us also felt that we had been given a second chance at life: he by surviving Hodgkin’s disease some ten years earlier, and me by having lived through mania, paralyzing depressions, and what should have been a lethal suicide attempt. We knew we had been saved by the grace of science and good doctors and we felt that we owed back because of this. We didn’t assume that we had an endless shot at life, nor that life should be easy. Both of us had worked hard to get where we were, but we also had been lucky in opportunity and circumstance.

Richard, severely impaired by dyslexia, knew early on that he would have to work around difficulty. This first came home to him when he was in the second grade and he discovered that his class was divided into reading groups designated as “Eagles,” “Hawks,” “Owls,” and “Robins.” The Robins, it was clear, could scarcely put their books the right way up, and he was, most decidedly, a Robin. Not only a Robin, but at the bottom of the bottom of the Robins. He could read only with great difficulty and meager retention; his spelling was dreadful and his handwriting worse. He had, as he put it, the fine motor coordination of a clam.

Richard’s attitude toward this was typical of how he approached problems throughout the rest of his life: he was philosophical and he worked harder. His stepfather, an antitrust lawyer in Chicago who had a passion for astronomy, encouraged him to learn about science and to visit the city’s great science museums. These museums, perfectly suited to a mind more comfortable with ideas and images than words, became a second home to him. Neither he nor his stepfather equated his inability to read with a lack of intelligence, and Richard slowly worked his way through the science books in the local library.

Throughout college, medical school, internship, residency, and his scientific career, he had to add four or five extra hours of work to each day. He accepted this as a fact of life, grateful to be able to pursue his ambitions. I never heard him complain about the inordinate amount of time it took him to read or write scientific articles; nor did he ever beg off reviewing the many manuscripts of the young scientists who trained in his laboratory. He felt he had had the advantage of inheriting a good mind and receiving an excellent education; he thought himself greatly fortunate in life. For the most part, he laughed about his frequent misspellings and misreadings and, once successful in his career, spent a considerable amount of time encouraging young people with similar difficulties to persevere.

Richard’s combination of intellect and discipline paid off: he received his medical degree from Johns Hopkins, did his psychiatric residency at Harvard, and became Chief of Neuropsychiatry at the National Institute of Mental Health. Along the way he wrote or coauthored eight hundred scientific papers and six books. He was often asked, How dyslexic can you really be and write so much? He would laugh and say, Trust me, very. And he was. He struggled to write each sentence of each paper and had to reread, and then read again, medical and scientific articles. Each prescription he wrote he had to have read back to him by his patients in order to catch possible errors in dosage. Nothing, except ideas and enthusiasm, came easily to him.

Life to Richard was an adventure made up of worlds to be discovered and problems to be solved. The more intractable the problem, the more he dug in, mulled, tussled, and persevered, rotating the problem within his mind until a new way of looking at it emerged. He tackled with discipline and originality what my mind, given to restlessness and quick frustration, too easily skittered away from. His brain was constantly in motion, and little within its hailing distance was left unexamined. This curiosity and persistence paid off most clearly in medicine and science, where he made fundamental contributions to the understanding and treatment of schizophrenia and other diseases of the brain. He also found fulfillment in being a doctor to patients severely ill with schizophrenia. Although most of his practice was as a consultant, which meant he generally did not see his patients more than once or twice, he loved his clinical work and was painstakingly thorough in his diagnostic workups and recommendations for treatment. He and I saw many patients together, and I was struck by his gentleness and patience, as well as by how he encouraged them to ask him about things they did not understand or share with him fears that they might have.

When Richard received the first Margaret Byrd Rawson Award for dyslexic adults of exceptional professional achievement, he emphasized that he saw his learning problems as a disguised blessing. “I learned to fail and pick myself up at an early age, which is enormously practical,” he said. “I know I am not like most of my competent colleagues, who can think linearly. I learn spirally, coming back to a topic from many directions over a long period of time. Because I must continuously relearn a subject, there is more opportunity to make associations that others might miss. Most important for me, learning is a long-term investment and requires a philosophy of life.” Richard’s victories in life were not at the quarter mile but at the mile and a half. He was in the race for however long it took. Once Richard decided a problem was worth his time and effort, he never gave up. Fortunately for me, I appear to have been that kind of problem.

Richard’s curiosity and imperturbability made the task of loving me easier than it otherwise would have been. From the beginning, he kept close to him those things in me that he loved; toward my more disturbing qualities he kept, as best he could, an attitude of detached bemusement. He was able to do this well enough to keep us together, even when circumstances made it hard. A constitutional tendency to see the positive in people played an essential part as well. After our first Christmas, when I was living in London, he wrote to me about the challenges in our relationship, but presented them in an altogether wonderful context: “There are two Christmas presents that I will always remember,” he said. “My electric train, circa 1946, and my trip to Kay via London—shall I compare Kay to an electric train? I shall. How fast could I run the train without its falling off the track? When it did fall off, it was picked up, placed back on the track, and ultimately the banking steepened. So I am with you.” It took patience and skill to bank the slope, and Richard did it particularly well.

We were temperamentally different in critical respects—his passion for work over people; my intensity and less settled ways—but at the start of our life together it was my manic-depressive (bipolar) illness that created the greatest misunderstanding and discord. The disease took a serious toll on us before it eventually stabilized and, had it not been for Richard’s light touch and formidable intellect, his adept way of dealing with the illness and with me, we would not have made it. Mental illness sabotages the best of relationships and, even in the most steadfast, generates an unrelenting bone-weariness. Early on, we found it hard.