- [Dr. Jeff] Welcome to "Healthy Minds".

I'm Dr. Jeff Borenstein.

Everyone is touched by psychiatric conditions, either themselves or a loved one.

Do not suffer in silence.

With help there is hope.

Today on "Healthy Minds".

- [Kay] Since I'd never really talked about my illness to anybody, all of a sudden, you know at book signings and around the country and with colleagues, I could say what I'd gone through.

And I think that's true for a lot of people, just the experience of being able to be honest with other people.

People want to talk about it.

People wanna know that they, that there's hope.

- I'd like to shift gears and ask you a little bit about the issue of creativity and bipolar disorder.

- It's common sense, but people tend to feel like you don't want to romanticize this disease.

Well, absolutely true.

You really don't want to romanticize bipolar disorder.

It kills people and makes lives unbelievably miserable.

- [Dr. Jeff] That's today on "Healthy Minds".

This program is brought to you in part by: the American Psychiatric Association Foundation and the John and Polly Sparks Foundation.

Welcome to "Healthy Minds".

I'm Dr. Jeff Borenstein.

Today, I continue my conversation with leading expert, Dr. Kay Redfield Jamison about depression and bipolar disorder.

But you pointed out an important issue for many people with bipolar disorder and other psychiatric and medical conditions.

Continuing with medicine, wanting to try to get off the medicine.

Could you speak a little bit about that aspect of your treatment and sort of the broader aspect for other people?

- Sure, I think it's, I think it's the major issue.

A major issue is getting people into treatment and aware that there's treatment and so forth.

And then the other is figuring out the correct treatment.

And then the chronic problem is keeping people on treatment.

I have this discussion with my husband, who's a cardiologist at Johns Hopkins, he says people in psychiatry and psychology blather on about how difficult it is to keep patients on medications and so forth.

He says, try being a cardiologist.

You know, try keeping, getting people to exercise, to lose weight, to not smoke, to not drink, to take their medicines.

You know, this is a problem, as you said, in all of medicine, it's not unique to psychiatry.

I think one of the things that feeds into it is that you're talking about a relatively young age group that's being asked to adhere to, to take medications and to do it over the rest of their lives.

I mean, this is, it's very hard to do that.

And it's counterintuitive, it's counterintuitive to people who are young or anybody that they have an illness that's gonna come back.

You know, you just don't think that way.

And certainly when you're 25 years old, you're not sitting around thinking, oh, I could get sick again.

I mean, it's not, I mean, that may be how a doctor thinks.

It's certainly not how a patient thinks.

- What component of the, part of, in bipolar disorder where people may feel actually good and better during the more hypomanic, less severe manic stages, how does that play into the issue of medication and sort of not wanting to take the medicine?

- I think again, you have to be direct.

I, one of the things we had a consensus meeting at Johns Hopkins a few years ago about this very issue.

You have people, most people who have bipolar disorder may not have that feeling but certainly a lot do, that they miss their highs, that they feel more creative off medications and so forth.

And whether that's true or not is a separate issue.

It's people's perceptions that you have to live with because that's how they act on, their perceptions.

And so, one of the things we're trying to figure out is how do you address this with patients?

Instead of saying, "You've got this ghastly life-threatening disease and you're gonna be put on medications and take them and be grateful", which is, doesn't work too well, is you can say, "Look, this is a really interesting illness that you have."

We all understand that it's an interesting illness and in some people, it has some really positive aspects.

So I wanna, what I want to do is hear about what you like about those things.

What it is that you think you're going to be missing?

And then we're gonna work around that.

We're going to figure out, not in any way, not take medication, but deal with these issues, either in psychotherapy, but have a kind of relationship where you're not just dismissing people's views of what they've got.

It's, I think it's common sense but people tend to feel like you don't want to romanticize this disease.

Well, absolutely true.

You really don't want to romanticize bipolar disorder.

It kills people and makes lives unbelievably miserable.

But what you do wanna do is recognize the reality of the illness, which is that for some people at some periods in their illness, there's a very attractive component to it.

And that you want to say we're gonna do everything possible to minimize making you, bringing you down to the point that you aren't, you feel depressed or are missing things.

But we're not going to cave in and say just stop taking your medication.

You want to establish an intelligent relationship between clinician and patient that allows for questioning, allows for judgment calls, you know, allows for reading.

And I mean, it allows for all sorts of interactions that are more than just coming in for a 15 minute med check, which is what everybody knows is the current practice in this country because we have sort of a very injured healthcare system.

- A good therapeutic relationship really is the collaboration between - [Kay] Right.

- the clinical person and the person getting treatment.

That they're together, in it together.

- Yeah, and you've gotta, the respects gotta go both ways.

- In the course of your life, what ultimately got you to say okay, I need this medicine and I'm gonna keep taking the medicine?

- Well, I stopped taking lithium a few times and each time I got kind of manic and then I got severely depressed.

And the last time I stopped, I was suicidally depressed for 18 months and I tried to kill myself and nearly did.

After that, you know, I sort of figured I'm going to either live or not live, but I clearly can't keep doing this 'cause I'm gonna ruin my life and every aspect of my life that I value.

And I haven't stopped taking lithium since.

That was a long time ago.

And I've been lucky.

I respond very well to it.

I don't have, at this point, side effects.

So, you know, but it's, it is a trial for people and it's a trial for a lot of people.

And I think that you can't, it's a thin line between recognizing that there are side effects and complications to taking medications, and being aware of the clinical literature and the human literature that people die from these illnesses.

- In addition to the medicine and therapy, talk therapy, are there other tricks of the trade, so to speak, that are helpful to you?

Whether it be exercise or having a routine?

What else helps you maintain your health?

- I wish I could say exercise.

(chuckles) That's not true.

I think a routine is very important.

I think the one thing that we, well we know a lot of things about bipolar disorder, but we know that sleep is incredibly important.

So if you're going to regiment anything in your life, it's gotta be sleep.

You've gotta keep a pretty systematic schedule.

Now that's not so easy to do with people who are in their early twenties.

You're telling them to stop, not drink so much, not use drugs, and to regulate their sleep.

Tendency, people wanna stay up all night, you know.

Again, you gotta try and be convincing on that one but that certainly is, that's hugely important.

Taking your medication.

I think psychotherapy when it's necessary, when it's recommended.

Not everybody probably needs to be in psychotherapy, but a lot of, lot more people need to be in psychotherapy than are in psychotherapy.

Easier said than done in our healthcare system 'cause it doesn't get reimbursed as well as 15 minute medical check.

I think getting people to cultivate what gives them great life, you know, what they love.

I think of it as you create your own islands in life and you bring to them books and music and people that you care about and trust, and places you can go to and escape to, and places that will challenge you.

I think you have to make a very strenuous effort in life.

And it's not just sitting around meditating and being quiet and so forth.

I think it's being actively involved with creating a world that is going to be, not just safe for you, but really interesting.

- One of the ways you did that is speaking publicly about your condition.

And I'd like you to tell us a little bit about the decision to do so and what that's been like for you.

- It wasn't an easy decision to make.

I mean, primarily because of privacy concerns.

I wasn't wild about talking about my personal life or writing about it.

I mean, there were consequences to that.

I didn't like the thought that I could lose my job, that I could not work again, and certainly have my clinical licenses suspended.

I had, from the beginning of my diagnosis, I had been living under the terror that California licensing board would catch up with me.

And then when I moved back east, the same thing.

The District of Columbia or Johns Hopkins, that I could just really, you know, you lose your job.

I mean, that's maybe not the end of the world but it is something that I had put a lot of time and effort and caring into.

And what my colleagues would think, what my friends would think.

It's just, I think for anybody to go public about anything that's very personal, it just carries costs to it.

The other, the cost on the other other side, was just being a hypocrite and thinking that I might be able to do some good and not doing it.

I mean, those two things were really, really unattractive.

And it seemed at some point cowardly.

I was a full professor at John Hopkins.

I wasn't taking the same kinds of risks as somebody much younger would've been.

I mean, different kind of job risk but not the same as somebody.

So I did it and I, Johns Hopkins could not have been more supportive if they tried.

They were, they completely backed me up.

The president, the Johns Hopkins Hospital at the time, the chairman of my department at the time, were enormously supportive and they said, this is exactly what we should be doing.

We should be making it easier for people to talk about these things, getting treatment.

We should be able to, you know, the chairman of my department said, "Here at Hopkins, if somebody has a medical issue or a surgical issue, they always come into Hopkins to have it done.

If they have a psychiatric issue, they can't get out of Hopkins fast enough for privacy reasons.

And they go and see somebody in the community who may not be, know as much about these illnesses as the department does."

He said, "I want my residents and house staff to come to here, to Hopkins to be treated.

This is ridiculous."

So they made it very, very easy as far as the profession goes.

And I think most of my colleagues were deeply supportive.

- Was writing the book for you in any way therapeutic?

What did it do for you to sort of put the words to paper as to what you had lived through?

- I wouldn't say so.

I don't think it's particularly therapeutic.

I think the act of being honest and having to figure out, writing always forces you to structure events.

So in that sense it was helpful.

I think what was therapeutic was the decision to do it rather than actually doing it.

The actual writing of the book was so much easier and more enjoyable than writing, I'd just come off co-writing a 1400 page textbook on bipolar disorder and recurrent depression, which was, every time you wrote a sentence it was footnoted and you had three footnotes.

That to me is not easy writing, whereas a memoir has no footnotes, right?

I mean there's, you know, I mean it's, the practicalities of it and actually writing in a style in which I felt comfortable was good.

But what was definitely therapeutic was making the decision and then going through all that I had to go through.

And what was really therapeutic, or I don't know if it's therapeutic, but was nice, was talking to so many people afterwards, since I'd never really talked about my illness to anybody.

All of a sudden, at book signings and around the country and with colleagues, I could say what I'd gone through, and I think that's true for a lot of people.

Just the experience of being able to be honest with other people was good.

- I'd like to shift gears and ask you a little bit about the issue of creativity and bipolar disorder.

Tell us about that.

- I think the relationship between imagination and creativity and madness and mania and depression has been discussed for thousands and thousands of years.

I mean, that's one of the oldest discussions in literature and philosophy, and then psychology.

It's controversial because again, people don't, for two reasons.

One is that people don't like the idea that you might be romanticizing bad illness.

The other is that people in the arts don't like the idea that you are reducing art to something that is pathological.

And both of those have very strong (pauses) logic to them and they just, it just happens to be that there's a very large literature showing that there's an elevated rate of, particularly bipolar illness, in creative populations.

And this has particularly been true in the, there were always a lot of biographical studies showing this and there were always a lot of studies of cohorts.

You know, you could take 200 artists and writers and diagnose them and so forth, interview them.

But what's been more interesting in recent years, is very large scale studies, from 50,000 to over a million people, looking at (pauses) hospitalization rates for various psychiatric illnesses and no hospitalization.

And signs of creativity, measures of creativity and achievement.

And those just overwhelmingly demonstrate the relationship with bipolar disorder.

There're some genetic studies that are beginning to be done on that, so it's very interesting.

It is not so surprising in terms of what we know about how people think when they're manic, that they're thinking is very rapid.

It is very loosely associated and so forth.

I mean, it's a very complicated field but there's a lot of logic to it and a lot of reason why it's not so surprising that these things exist.

But it's a very exciting field.

It's a field that has a lot of ethical questions attached to it.

Would you get rid of this illness outta the gene pool if you could?

Is this?

It's a question.

- I'm gonna shift gears and go back to the issue of stigma and discrimination.

And in many ways stigma really is a stigmatizing term.

Could you speak about that?

- Sure, I mean, I think that people use the word stigma just because there's no other good word, probably.

And because people have always used it.

I think it's not a great word.

You can't help but use it, but it's not a great word, and I think discrimination is much more on the point.

I think in the same way that other people who have their civil rights violated, whether you're gay or black or whatever, people with mental illness have their civil rights violated.

They have, they don't get care.

They're discriminated against.

Discrimination has an active component to it.

Stigma, it's just kind of like, and not only does it imply you have something to be stigmatized about, but it doesn't necessarily imply you've gotta do anything.

People, when they talk about stigma, say, "Well we've got to educate people."

Well, yeah, sure.

I mean of course we need to educate people.

Well where does that get you?

There's no indication that that works as well as we would like.

But I do think discrimination laws have some impact and it's always a source of annoyance, I'm sure, to some of my colleagues in diversity programs, when I keep, I talk about, people have different brains and those brains cause them a lot of problems.

And if they're not given some accommodation, then that is active discrimination.

And not talking about it is a form of discrimination.

It's one of those things that's something I think we don't talk about enough.

We don't talk about the law enough, probably.

- In terms of talking about (pauses) bipolar disorder, I know you speak often about it.

Tell us about some of the responses that you have had from people who listen to you speak, maybe are inspired by what you have to say 'cause they themselves have bipolar disorder.

Tell us about that feedback that you receive.

- Well, I think people are, you know, and I think I've found this when "An Unquiet Mind" came out, was that people are very alone with these illnesses.

Certainly I was, and I came from a really nice family, I mean, very supportive family.

But people didn't talk about it, despite the fact that we had a lot of bipolarness in my family.

And I think as a result, you are, you end up being very alone.

You don't have people you can talk to about it.

So not only hope goes, just camaraderie goes.

And you're forced, every time you put that aside and you don't talk about it because you think people don't want to hear about it or don't wanna discuss it, you're saying something about yourself to yourself.

You know, you're making yourself a lesser person than you need to be.

And I think that that's unfair.

I think that the response that I got from people was just people wanna talk about it.

People wanna know that they, that there's hope.

People wanna know that they're not going to be forced outta high school, they're not gonna be forced outta their jobs, people wanna know that something can be done for them.

And I think that's a very human reaction.

I mean, it's been quite wonderful to talk to people about it in that sense.

And family members, you know, that just, families go through a great deal with these illnesses and we don't talk about that perhaps as much as we should.

- For somebody who's watching right now, a person who may not have been diagnosed yet, but maybe having some of the symptoms that you've described and are having difficulty, what do you say to them right now?

- I would say talk to a friend you really, really trust.

If you have a parent that you can talk to, and even if it's difficult.

And if it's difficult to talk, write it out in an email.

Because one of the advantages of writing something out is that you can get down on paper what you're going through.

And if you're talking about it with a parent, for example who is less than receptive or very awkward or concerned, then just the merest, slightest disapproval on the parent's face, or concern, makes people clam up.

So I think sometimes writing it down, sometimes priest, rabbi, chaplain, whatever.

I think talking to people, certainly if you have a doctor you can talk to, all those things.

I mean, there are a lot of people out there.

It's just that you don't think about, particularly when you're depressed, you don't, the last thing you do, you don't feel like getting outta bed, much less, you know calling up somebody and telling somebody you're depressed, much less getting in a car and going someplace.

I mean, it always sounds good to say we'll just call somebody and get together for dinner.

But it doesn't always work that way.

But I think you have to let a good friend know.

And if it's very hard for you to talk to your parents maybe ask that friend to sit in with you, just as you would with a doctor, to sit in as a family member, to learn, and so forth.

I know that in the case, my mother, who was an unbelievably warm and wonderful, intelligent, a mother's mother, wonderful person, but she's completely normal, you know?

Well, it was very hard for her to have any idea of what I was talking about.

When I talked about mania, she just, or suicide, those were things that just weren't in her purview.

But she went to my psychiatrist two or three times and sat down and listened and asked, and so forth.

And I think that can be enormously helpful because one of the hardest things when you're depressed, for sure, is expressing anything to anybody, much less that you're feeling like killing yourself.

- Well, I think that's extremely important guidance.

Getting help.

Don't suffer in silence.

Get help from someone that you trust so that you're not alone and can get that support.

That makes such a difference.

Kay, I want to thank you so much for all that you've done, all that you continue to do.

And thank you for joining us today.

- Well, thank you.

Nice to talk to you.

Nice to see you again.

- Good to see you again too, virtually.

And hopefully we'll be together in person soon as well.

- Okay, great.

Thanks.

- I am inspired by Dr. Jamison.

By sharing her experiences with bipolar disorder and her expertise, she's helped countless people around the world.

She's shown us that with help, there is hope.

(calming piano music) - [Dr. Jeff] Do not suffer in silence.

With help, there is hope.

This program is brought to you in part by: the American Psychiatric Association Foundation and the John and Polly Sparks Foundation.

(calming piano music continues)