In this section of her memoir, Jamison discusses the heights of her illness and describes the events that lead her to finally reach out to a psychiatrist for help. Before this can happen, she must spiral out of control, and then must face piecing her life back together. “What then, after the medications, psychiatrist, despair, depression, and overdose?” Jamison asks. “All those incredible feelings to sort through.” (67) She reintroduces one of the central theses of this work—the nature of mania that it confers both pleasure and pain. Along with these fragments of pleasure come the “bitter reminders—medicine to take, resent, forget, take, resent, and forget, but always to take” (68).
Jamison opens this part of her memoir with a memory of her most manic state. She attempts to describe mania for someone who has never experienced it and uses imagery and similes in order to paint a vivid picture of the illness. She also uses images of the sky and space in order to capture the deeply psychological effect of this illness: “The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones” (67). She describes a state of little shyness, full of interests, sociability, sensuality and “feelings of ease, intensity, power, well-being, financial omnipotence and euphoria” (67). But this isn’t a purely positive experience, and Jamison is quick to remind readers of how quickly mania can turn dark: “The fast ideas are too fast, and there are far too many; overwhelming confusion replaces clarity” (67).
Jamison became aware of her madness only gradually, noting how her life became more and more chaotic until it finally spiraled out of control. The problem with losing one’s mind is that the “acceleration from quick thought to chaos [is] a slow and beautifully seductive one” (68). At the time, she is settling into her new job on the faculty at UCLA. She enjoys the freedom she has to pursue her own academic interests, and as a result, she sleeps very little. This is dangerous, as “decreased sleep is both a symptom of mania and a cause” (69). Around this time, Jamison attends a garden party held by the chancellor of the faculty at UCLA. Unbeknownst to her, her future psychiatrist also attends the party. Much later he tells her that her behavior at the party was evident of intense mania, even though at the time she thought there were no issues with her behavior.
Around this time, Jamison’s first marriage finally ends. Although the surface reason for the split was the fact that she wanted children and he did not, Jamison’s illness has a large part in influencing the split. She writes: “I was increasingly restless, irritable, and I craved excitement; all of a sudden, I found myself rebelling against the very things I most loved about my husband: his kindness, stability, warmth and love” (73). She moves out of her home with him and moves into an apartment in Santa Monica. She spends much more money than she has and digs herself deeply into debt. “When I am high I couldn’t worry about money if I tried,” Jamison writes, “So I don’t” (73). She spends exorbitant amounts of money—“more than thirty thousand dollars”—during her biggest manic episodes (74). She has to call in her brother, who takes out a personal loan so that he can pay off her debt. She pays him back slowly over the years but writes that she might never be able to repay the care and protection her brother offered her in her times of sickness.
Jamison begins having vivid hallucinations. One night as she is watching a red sunset, she begins to imagine herself in a ballgown placing a vial of blood into a centrifuge. To her horror, the image transplants itself out of her mind and enters her living room—the centrifuge explodes and blood splatters everywhere, covering her rug, her curtains and herself. She loses the ability to distinguish between these two worlds and begins to scream. She screams over and over until the hallucination slowly recedes. This is the last straw. She phones a friend, who confronts her with the need to take lithium and see a psychiatrist. He helps her research the illness, talks her family through supporting her, and prescribes her first dosage of lithium and antipsychotics until she can meet with her psychiatrist. He encourages her to take time off work and arranges for her to be looked after constantly. She remains in a state of racing thoughts and dark moods until her medication takes effect.
Jamison ends this segment by describing her first visit with her psychiatrist. She arrives at the appointment afraid and embarrassed, indignant at being on the other side of the psychiatric care process. She finds the whole experience emotionally exhausting and deeply humiliating. Once in her psychiatrist’s office, Jamison cannot form clear thoughts. She does not recall what she said during that first session, but her doctor sat patiently and waited for her to say all she had to before he began his own evaluation of her mental health. His evaluation is a typical one that Jamison herself has administered in the past, but she finds herself shocked at being on the other side of this practice. The experience helps her appreciate how confusing the whole process is to patients.
Jamison’s psychiatrist diagnoses her as manic-depressive and tells her he thinks she should be on lithium indefinitely. The thought is both frightening and relieving to Jamison, but she still “flails” against the diagnosis. He is patient with her but unbudging. Thus Jamison begins a relationship with a man who she will see at least once a week for the next many years. She is grateful to the work he does with her, writing “He kept me alive often. He saw me through madness, despair, wonderful and terrible love affairs, disillusionment and triumphs, recurrences of illness, an almost fatal suicide attempt, the death of a man I greatly loved, and the enormous pleasures and aggravations of my professional life—in short, he saw me through the beginnings and endings of virtually every aspect of my psychological and emotional life” (87). Jamison stops reminiscing here to affirm that she cannot imagine leading a normal life without both lithium and psychotherapy. Lithium made psychotherapy possible, but it is psychotherapy that truly heals her.
The opening passage of this section is written in the second person, which helps Jamison describe the particular effects of mental illness on her psyche to those who are unfamiliar with the illness. She uses vivid imagery in an effort to paint the clearest picture possible of an intensely complex and intangible state. A motif of the memoir is outside reactions to Jamison’s behavior, as she uses these external states to gauge behavior she is completely incapable of being objective about. She uses this motif to exemplify the sudden nature of the changes she experiences now and to introduce the dark turn her mental state is about to take: “Humor and absorption on friend’s faces are replaced by fear and concern” (67). After Jamison loses control, she must turn to other people’s memories in order to understand what happened to her. But this can never be an accurate judge of her behavior, as she can never be sure that people aren’t withholding information.
Jamison’s experience at the garden party is a notable one. She finds out later that her future psychiatrist was also in attendance at the party. While she remembers it to be a time full of fun and sociability, her psychiatrist remembers Jamison’s behavior to be provocative and irresponsible. This highlights the divide between a manic-depressive’s self-perception and objectivity in illness. When we get caught in our heads, it becomes almost impossible to step out so that we might peer in. Jamison describes her experience: “My recollection of the situation was that I was perhaps a bit high, but primarily I remember talking to scads of people, feeling that I was irresistibly charming, and zipping around from hors d’oeuvre to hors d’oeuvre, and drink to drink” (70). But her psychiatrist sees something else: “I was, he said, dressed in a remarkably provocative way, totally unlike the conservative manner in which he had seen me dressed over the preceding year. I had on much more makeup than usual and seemed, to him, to be frenetic and far too talkative” (71). It is important to note this discord between self-perception and reality, as it is an important aspect of Jamison’s behavior. It helps highlight how little control Jamison had over her actions and mental state, and helps to show how acutely she needed medication and psychotherapy.
Often throughout her memoir, Jamison invokes images of animals in order to explain her complex thoughts and emotions in a given moment. In facing the role reversal of becoming the patient, she compares her situation to that of a lab rat. She faces a wall of lit and unlit buttons that will let her psychiatrist know she has arrived. She writes: “I felt like a large white rat pressing paw to lever for a pellet” (85). This helps to convey the humiliation Jamison feels at being on this side of the patient / medical practitioner relationship. At the same time, we infer the relationship Jamison has been taught to have with patients up to this point: one of the all-knowing benevolent beings, like humans to rats. Part of the important work Jamison does through publishing her memoir is bridging this divide. Only by creating more understanding between patients and practitioners might the stigma that keeps so many of them silent about their own mental health problems be removed.
Mental health professionals aren’t the only ones who face stigma about mental health. A central theme in the memoir is how stigma can severely affect those dealing with mental illness and prevent them from receiving adequate care for their illness before it is too late. Jamison’s psychiatrist's list of questions helps to remind her that her illness is primarily biological, and her behavior has discrete medical causes. These questions include: “Had I been more talkative than usual?”; “Had my thoughts been going so quickly that I had difficulty keeping track of them?” and “Had I been spending more money?” (86). Although the questions are familiar, Jamison finds it “unnerving not to know where it all was going”; this causes her to gain an appreciation for how confusing it is to be a patient. The applicability of the questions to her behavior causes her to answer yes to many of them, and this causes her to gain “new respect for psychiatry and professionalism” (86).
Jamison’s psychiatrist comes to take a large presence in her life. She spends a large portion of this section describing his characteristics so that the reader might be able to understand why only he, in particular, could help her through this difficult time. He is described as a commanding presence, taller and older than Jamison herself. He is experienced and confident. Although Jamison rejects his diagnosis at first, he listens patiently only to unequivocally reaffirm his diagnosis. This causes Jamison to respect him more, for “his clarity of thought, his obvious caring, and his unwillingness to equivocate in delivering bad news” (87). His kind-but-tough approach works well on Jamison. Ultimately, Jamison’s psychiatrist not only helps her through the devastations of her illness, but he also teaches her how to be a good psychiatrist herself.