Jamison begins An Unquiet Mind by taking us into the heart of her madness. Jamison is on a run in the UCLA Medical Center parking lot at 2 AM, circling back and forth as a colleague sits by. The colleague, who embarked on this run with her but tired out an hour before, complains about his exhaustion to no avail. Jamison is not ready to stop running—she is full of a “boundless, restless, manic energy” (3). The night began with drunken revelry, and it was the “endless hours of scotch, brawling, and falling about in laughter” that led her to the parking lot and filled her with endless energy, even as it took a clear toll on her companion. As she runs, her hypersensitive nervous system takes in all of her surroundings, and the hospital she spends her days at becomes the focus of a new viewpoint.
Jamison notes the activities she should be doing instead of running around the parking lot at 2 in the morning—activities she might have turned to if it weren’t for the ferocious drive of her mania. She and her colleague should have been working instead, “publishing not perishing,” but her manic energy blocks the possibility of doing anything else with her time. In the middle of the night, Jamison’s professional persona has been overtaken by an internal madness, and she is incapable of turning to the activities she knows she should. The running offers little relief from the madness, it is a symptom rather than a solution. “I was running fast,” Jamison recollects, “but slowly going mad” (3).
Her unusual activity draws the attention of a patrolling policeman. He is wary of the runner and leaves his patrol car on the defensive. Jamison, even in her “less-than-totally-lucid state of mind”, can see that he has his hand on his gun. The officer demands to know exactly what she is doing running across a parking lot in the middle of the night. It is her colleague that quickly diffuses the situation by telling the officer: “We’re both on the faculty in the psychiatry department” (4). This immediately calms the police officer, who smiles at the two and goes back to his car to drive away. As Jamison writes, “Being professors of psychiatry explained everything” (4). At this point, Jamison takes the reader out of the lens of her memory and adopts the narrative voice she will hold for the majority of the rest of the novel: one of a clinical recollection of her past.
Jamison provides the reader with a context for her manic activity and places the story in the timeline of her life. At 28 years old, a month after receiving tenure at the University of California, Los Angeles, Jamison is “well on [her] way to madness” (4). Within months she will be diagnosed with manic depressive illness and prescribed lithium. This prescription begins a “costly personal war” against the medication, one that lithium will eventually win. This moment is the height of her sickness and is a sign of her loss of control over her life. She will struggle with her diagnosis and medication for years, and as a result, she will delay her healing process. “My illness,” Jamison writes, “and my struggles against the drug that ultimately saved my life and restored my sanity, had been years in the making” (4).
Thus Jamison launches into a rumination on the historical basis for her madness: “For as long as I can remember I was frighteningly, although often wonderfully, beholden to moods” (4). Moods have influenced Jamison’s life from the beginning—“intensely emotional as a child, mercurial as a young girl, first severely depressed as an adolescent, and then unrelentingly caught up in the cycles of manic-depressive illness by the time I began my professional life”—and this has caused her to become “both by necessity and intellectual inclination, a student of moods” (4). The study of moods is the only way that Jamison is able to understand, and therefore accept, who she is and the illness she has. Her moods also influence her to look outwards, and within her grows a desire to help others who struggle with their moods in the same way that she does. The illness, which has almost taken her life multiple times, and kills thousands every year, becomes the “beast” that she must conquer over the course of her lifetime.
Manic depressive illness has certainly become a beast in Jamison’s life, and not just this but also a “seductively complicated” companion (5). As an opponent, the illness has to be understood before it may be conquered. Jamison must separate manic depressive illness from herself despite the fact it seems to be an extension of herself. She must accept that she cannot conquer it on her own, even if she thinks she “ought to be able to handle [her] increasingly violent mood swings by herself” (5). Only after this happens does Jamison seek treatment for her illness, despite it becoming a medical emergency, and it is her knowledge of the sensible ways to contend with the beast, learned through her training and clinical research, that will help her in the end. One of the factors hindering Jamison from seeking clinical help was the early forms of her manias, which were “absolutely intoxicating states that gave rise to great personal pleasure” (5). Not only did medication dull these magnificent experiences, but they also brought terrible side effects with them.
Medication is the crux off of which Jamison builds her narrative. Her struggle with manic depression is also a struggle against medication; as Jamison explains it, manic depressives everywhere “wage wars against [themselves]” by struggling with medication compliance. This is the major complication in treating manic-depressive illness: “not that there are not effective medications—there are—but that patients so often refuse to take them” (6). Worse yet, many don’t seek medication at all, because of fear of ramifications in their personal and professional lives, stigma, misinformation or ignorance, and poor medical advice. But the beast Jamison faces is a large one: “Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live” (6). It is an illness that is completely created within the body—it is biological—but to those who experience it, it feels psychological. This duality of the disease—between a biological, clinical and scientific reality and a psychological, emotional and cerebral experience—is a central theme of the book. The duality of manic-depressive illness is one of the main contributing factors to issues with medicine compliance, as well as roadblocks to its competent care. Jamison uses both her personal experience and medical background in order to influence the work she does and help others with the illness. While difficult at times, this binding of “raw emotion to the more distanced eye of clinical science” is what has provided her with “the freedom to live the kind of life [she] want[s], and the human experiences necessary to try and make a difference in public awareness and clinical practice” (6). It is for this reason that she has written this book, despite the anxieties she continues to have about the personal or professional consequences that might arise from her doing so.
Jamison’s identity as a professor of psychology at the University of California, Los Angeles guides her relationship with her mental illness, and in truth, her experiences with madness are inseparable from her identity as a scientist. Through her identity as a professor of psychology, Jamison finds leeway in both private and public norms, as is shown by the anecdote that opens her story, when the cop leaves her alone once she is identified as a professor. Although Jamison’s actions are irrational and inconsiderate, she is allowed to indulge the overpowering demands of her manic energy despite a reluctant colleague and suspicious police officer. As she writes of the words that made the police officer smile and turn away from his aggressive questioning of them: “Being professors of psychology explained everything” (2). This protection afforded to Jamison emerges plainly many times throughout the work, and in many ways allows her to cope with her illness more easily than most others suffering from manic-depressive illness might. This cove of protection ultimately gives Jamison the tools she needs to understand and overcome her illness, but she must first contend with the “beast” that is the innate paradox of manic-depressive illness.
In our first glimpse of madness, Jamison paints a picture of a force of separation that divides her from who she should be. Not only does mania distort her perception and understanding of her surroundings, but it also causes her to act in ways that are incompatible with the roles that she takes in society. Jamison describes mania as a state in which she cannot trust either her senses or her judgment, describing herself as “less-than-totally-lucid” and with “few remaining islets of judgment” (3). Her mental capacity is diminished, and she cannot understand the world as easily as she does when she is sane. Jamison is also isolated from her role as a professor. If she were to act accordingly, she “should have been sleeping or working, publishing not perishing, reading journals, writing in charts, or drawing tedious scientific graphs that no one would read,” not running around a parking lot at 2 AM. Furthermore, a manic state denies Jamison the ability to operate successfully as a member of society. Without her colleague, Jamison would not have been able to diffuse the tense situation she found herself in with a police officer in the parking lot at 2 AM. If it was not for her colleague, her behavior would not been excused, as she was unable to make excuses for herself: “My colleague, fortunately, was thinking better than I and managed to reach down into some deeply intuitive part of his own and the world’s collective unconscious and said, ‘We’re both on the faculty in the psychiatry department’” (3). All of this works to paint her illness as a force that seriously affects every part of her life.
The seduction of mania is another central conflict in Jamison's journey with manic-depressive illness. Throughout the book, Jamison makes clear that if she could somehow separate the exhilarating effects of mania from the devastating effects of depression, she would do so without hesitation. Mania causes one to be more creative, electric and social—it is the chaotic production of vivid life. As Jamison writes, these were “absolutely intoxicating states,” which ignited an “incomparable flow of thoughts, and a ceaseless energy that allowed the translation of new ideas into papers and projects” (5). Understanding this is central to understanding Jamison’s story, as it is key in understanding the manic-depressive’s reluctance to sacrifice mania. Mania, although it causes utter isolation of the self, is seen as a higher state. This state becomes part of the manic-depressive; instead of an experience, mania becomes an extension of the self.
The seduction of mania paired with the dangerous effects of its going unchecked is what propelled Jamison to write this book. Jamison writes of a woman who is mad, out of control, and a bit addicted to being so. She believes that her illness is nothing more than a cognitive experience which feels like moods, and a young Jamison believes that she should be able to control her moods herself. This conflict, between the biological origins of her illness and the psychological effects of its existence, propels her to reject the medication that will help her out of this madness. She wars against her medication even though she knows better, as she has seen firsthand how issues with medication compliance can worsen the effects of manic-depressive illness.
As Jamison writes, “the war that I waged against myself is not an uncommon one” (5). It is, in fact, a war that many manic-depressives wage, motivated by their inability to believe that medication might actually help with managing their troubles. According to Jamison, medication compliance is the largest issue facing the proper care of manic-depressives and leads to more deaths than any other aspect of the illness. Jamison shows that her existence at this crossroads of both clinical and emotional intelligence about manic-depressive illness placed her in a unique position to help herself out of the madness. She finds the motivation to write this book, despite concerns about consequences in her private or professional life, in the hope that she may help others to more readily accept treatment. Not only does she attempt to “persuade [her] colleagues of the paradoxical core of this quicksilver illness that can both kill and create,” Jamison writes for her fellow manic-depressives who might be struggling with medication compliance or any other aspect of the illness, in the hope that she may spare their suffering and potentially save their lives.