The allure of mania can be utterly spellbinding, like the solo voyage to Saturn that Kay Redfield Jamison vividly recalls taking in her mind many years ago.
“People go mad in idiosyncratic ways,” the Johns Hopkins psychiatry professor said during a recent visit to the Anschutz Medical Campus. “Perhaps it was not surprising that, as a meteorologist’s daughter, I found myself, in that glorious illusion of high summer days, gliding, flying, now and again lurching through cloud banks and ethers, past stars and across fields of ice crystals.”
Jamison said she still remembers the “ravishing colors laid out across miles of circling rings.”
She knows she was experiencing a psychotic episode. Nonetheless, it was beautiful, and the memory is real.
Jamison revolutionized her field when she stepped forward to publicly share her personal struggles with bipolar disorder in her book, An Unquiet Mind.
During her Colorado visit, Jamison shared passages from her book and highlighted the need for medical providers to understand why their patients might refuse to take medication. Some love feeling manic until their insanity spins out of control and they sink, as Jamison did, into devastating, suicidal depressions.
The need for diagnosis and treatment is urgent, Jamison said. Bipolar disorder and other mood illnesses are treatable and common.
“Depression is the common cold of psychiatry. It’s very, very common,” Jamison said. “We tell our medical students, ‘A lot of you are going to get depressed. It’s in the cards. What we can’t tolerate is not getting treated. We can’t have impaired doctors.’”
About one in 100 people will get the severe form of bipolar disorder that Jamison has suffered, which includes severe mania and depression.
Another two or three people out of every 100 will get a milder version and one in five people will cope with clinical depression.
“We all will have a friend or a colleague who gets depression,” Jamison said.
Unlike illnesses such as heart disease that typically strike older people, mood disorders often hit the young, emerging most often in late adolescence and early adulthood.
Jamison was 17 when she suffered her first breakdown. And she didn’t see a psychiatrist until she was 27 and working, herself, as a psychiatry professor at the University of California Los Angeles. Now 71, she said lithium has saved her life and she knows both personally and professionally that mood disorders can be deadly or debilitating for decades.
Making behavioral health a cornerstone of primary care
Jamison saluted primary care leaders at the University of Colorado’s Department of Family Medicine and UCHealth for their ongoing efforts to integrate behavioral health providers into primary care clinics. She said people suffering from mood disorders often don’t get diagnosed. Having trained experts in primary care clinics can be critical to getting patients help.
Within the next month, full-time behavioral health providers will be joining Denver-area primary care clinics to work hand-in-hand with medical staffers. For years, some clinics have experimented with having part-time behavioral experts. Now, patients will have access to help from full-time staffers.
“We are committed to operating all of our primary care clinics on a team basis, with one of the core members being a behavioral health clinician,” said Dr. Frank deGruy, Chair of Family Medicine at the University of Colorado.
The new behavioral health staffers will start by early summer at multiple clinics including the UCHealth Family Medicine Clinic –Boulder, UCHealth Family Medicine Clinic – Westminster, the UCHealth Primary Care Clinic – Lone Tree, the A.F. Williams Family Medicine Clinic – Stapleton and the UCHealth Women’s Integrated Services in Health (WISH) Clinic at Anschutz.
“We are going for complete penetration, so it becomes a normal primary care experience to have access on every visit to behavioral health care,” deGruy said.
Depression grips one in five
The need for more help is clear.
“About two-thirds of patients who come to see us have psychological symptoms or psychosocial distress,” deGruy said.
Of those patients, about half already have a mental health diagnosis such as depression, post-traumatic stress or anxiety. Others are experiencing substance abuse, suicidal feelings or physical symptoms that could be signs of mental health challenges, like insomnia and fatigue.
Untreated substance use and mental health challenges can exacerbate physical problems like diabetes. That’s why it’s so critical to integrate physical and behavioral health care, deGruy said.
Cost traditionally has been a big obstacle to integrated care since insurance reimbursements in the past have not covered behavioral health. To pay for the new staffers, deGruy said UCHealth and the Family Medicine Department are teaming up to subsidize costs.
Not all behavioral health woes can be treated in a primary care setting. About 10 percent of patients experiencing mental health challenges have what deGruy describes as “deep end,” severe challenges. For those patients, the primary care clinics are building better partnerships with psychiatrists or psychiatric nurse practitioners.
Once the new experts are in place, deGruy said providers plan to screen every patient at some point during their care for a range of mental disorders and symptoms.
“When we get a positive screen, our behavioral health clinicians will meet with them,” he said.
From a regular childhood to crushing depression
Jamison said the Colorado model of anchoring behavioral health providers within primary care is exceptional and could be extremely beneficial.
Stigma and silence continue to prevent many people from ever getting diagnosed or seeking treatment.
Jamison said that when she was young, no one discussed mental health issues.
“It wasn’t done,” she said.
Jamison had had a perfectly normal childhood when she suffered her first breakdown at age 17.
“I was involved with sports. I loved school. There was no reason to expect that anything would go wrong,” she said.
She’s grateful to her friends and family for helping her survive.
“When you are 17 and there’s not much public education, it’s terrifyingly beyond belief. I got suicidally depressed. Then I got well. By the time I graduated, I was perfectly fine to go to college. I joined the faculty at UCLA. Then I went manic and had hallucinations and delusions.”
Life-changing advice: ‘Learn from it. Teach from it. Write from it.’
Before writing a medical textbook on mood disorders and penning An Unquiet Mind, Jamison anonymously shared insights with colleagues and students on what it feels like to have bipolar disorder.
“When you’re high, it’s tremendous. Ideas are fast and frequent, like shooting stars. You have the ability to captivate others. Interests are found in uninteresting people,” she said.
But then, the ideas flow too fast and there are far too many, she said.
“Confusion replaces clarity,” she said.
Then comes great despair.
Jamison recounts her own suicide attempt.
“I took a lethal dose of pills, was in and out of a coma and nearly died,” she said. “Then I started taking lithium.”
Throughout her ordeal, Jamison feared she would lose her job. She credits a remarkable leader.
“My chairman stuck by me. He said, ‘I understand you have a problem with your moods. Keep seeing your doctor. Keep taking your medication. Learn from it. Teach from it. Write from it.’”
Thanks to that advice, Jamison opened up, wrote about her life and her mind and students and patients continue to learn from her.
At the Anschutz Medical Campus, leaders decided to have all students from all schools read and discuss a single book. For their “One Book, One Campus” program, they selected An Unquiet Mind and brought Jamison to campus through the Levitt Distinguished Speaker Series.
During her visit, she talked about the genetic links with mood disorders. After writing her book, she showed it to her family and her father said, “I think I might have this illness.” Jamison agreed with him.
Stigma still prevents some from being open about mood disorders
She urged families to be open about relatives who have struggled.
“I spend a lot of time on college campuses and I’m amazed how many kids found out about their family history only after they were in the hospital,” she said.
She urges parents to tell their children about mood disorders, just like they would discuss other illnesses that run in the family.
“Talk about it very frankly. This is how it looks early on. Say that you are unlikely to get it, but if you do, what you don’t want to do is ignore it,” Jamison said.
She also said it’s vital to speak to people when they are healthy.
Jamison, herself, has given her husband the power through a living will and advanced directives to make care decisions for her.
“It gives them the authority to know what my wishes are,” she said. “If you have to commit someone against their will, it’s really hard to do it. It breaks families apart.”
By granting her husband permission in writing to make decisions on her behalf, she has made his life much easier.
“If I get manic or suicidally depressed again, my husband can do what he sees fit. If he thinks I need to be hospitalized or taken in by the police, fair enough.”
Medication and therapy are critical
And, as difficult as it is, she pressed medical providers to keep urging their patients to stay on medications.
“It’s very hard, particularly in young people,” she said, noting that about 50 percent of mentally ill people don’t take their medications.
“Sometimes education helps. That’s one of the goals of psychotherapy. Say, ‘Look, we’re in this together,’” she said.
Having patients track their own moods to discover patterns can also be effective.
“Patients can feel cornered,” she said.
Jamison urged people who think they might have a mood disorder to get help.
“Depression and bipolar disorder are very treatable with medication and psychotherapy,” she said. “It’s very important to get treated early on. If you feel like you have any symptoms and you aren’t sure, get help.”