Selling Mental Illness and Its Cure

Last night I attended a lecture at NYU Law School by Johns Hopkins professor of psychiatry Kay Redfield Jamison (Jamison, a Ph.D., is Dalio Family Professor in Mood Disorders). She lectured about her new biography, “Robert Lowell: Setting the River On Fire," based on Lowell's bipolar disorder. Jamison is noted for her memoir of her own bipolar disorder, "An Unquiet Mind," which is described in her Hopkins biographical sketch as letting "patients read for themselves how destructive not taking their medicine can be."

And, so, Jamison wrote her biography with this mission in mind.

This created one of several anomalies at her lecture, which I enumerate here:

I. Lithium Therapy

First and foremost, Jamison acclaimed the value of lithium as a miracle drug for bipolar disorder, one she indicated in her lecture has no side effects and, rather, remedies over time the brain disease that causes bipolar!

Is that what they teach at Johns Hopkins' medical school?

Lithium has a long history, and has been used for mania and depression since World War II. However, anti-depressants are more often prescribed for bipolar in the U.S. I won't comment on which therapy is superior; but I will note the strong evidence for the negative long-term impacts of virtually all psychiatric medications, which have been extensively demonstrated by Robert Whitaker in "Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America," as reviewed here by Marcia Angell in the New York Review of Books.

But one needn't turn to Whitaker and Angell to discover this brain deterioration and resulting exacerbation of mental condition due to it — one can simply reference the book in question (for convenience, I refer to the review of Jamison's book in The New York Times by Patricia Bosworth, herself a distinguished biographer of such troubled artists as Diane Arbus).

Jamison describes the beneficial wonder of lithium for Lowell (per Bosworth):

Lowell’s agonizing episodes would continue until 1967, when he was given the new [lithium had been widely used since the 1950s] wonder drug lithium to balance the extremes of elation and depression in his brain. Lithium seemed to have no side effects, and provided relief from his madness. Lowell was productive in those years. He wrote poetry, worked on translations, taught at Harvard — but he was also restless. With lithium, Helen Vendler tells Jamison, he wanted to create another life “with someone who would not think of him as a potential madman.”

That sounds good, although my personal experience with people who have taken lithium is that its effects are not so benign — people I know have found it embalmed them in a fog.

However, within Jamison's own book's covers we discover later, that (per Bosworth), with lithium, Lowell "was slowly going mad again. The lithium stopped working. Lowell became poisoned with it and had to be hospitalized."

The ultimate health outcome for Lowell, whose medical condition is reviewed in an appendix to Jamison's book by her husband, a cardiologist, was not good — he died suddenly at age 60 in the back seat of a New York City cab.

(Although this is far from a definitive comparison, note that Howard Markel's "An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine" describes in lurid terms the destructive effects of an illicit drug. Freud lived to be 83, Halsted 70. Markel decries "celebrity endorsements" of cocaine by Jules Verne, Henrik Ibsen, Thomas Edison, Robert Louis Stevenson, Alexandre Dumas and Arthur Conan Doyle. In my review of the Markel book, I point out that these men didn’t die young or suffer shortened careers: Verne lived to be 77; Ibsen, 78; Edison, 84; Dumas, 68; Doyle, 71.)

II. Lived experience

One of the marvels of the lecture and following panel discussion was the wide panoply of views of Lowell that were presented. But none were more fascinating than the views presented before the lecture! The first came from Philip Kunhardt, the founding director of The Center for the Study of Transformative Lives, which sponsored Jamison's talk. While he was still in his teens, Kunhardt's parents offered their Maine home to Eugene McCarthy to recuperate before the disastrous 1968 Democratic National Convention in Chicago.

In the course of his week-long stay, McCarthy had his friend Lowell up from Cambridge for a dinner party. This yielded an intellectual celebration extending far into the night during which Kunhardt was bedazzled by Lowell's brilliance, engagement, and alternating recitations of poetry with McCarthy and another guest. This evening reverberated in Kunhardt's memory fully fifty years after it occurred, and Kunhardt clearly regarded it as a lifetime-affirming experience.

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Kunhardt's remarks were then followed by those of James Atlas, himself a remarkable biographer and writer for The Atlantic. Atlas described a virtually identical experience with Lowell he had when Lowell joined Atlas and his wife for dinner in the early 1970s. Atlas — a man who has known many such people — said Lowell was among the three most charismatic people he has known. Kunhardt's and Atlas's stories call to mind Bosworth's noting in her review:

the breakdowns aren’t the entire story: “The real life was full of unknowns and possibilities,” Harriet [Lowell's daughter, who was present last night but didn't speak] tells Jamison at one point. It’s a lesson Jamison might have done more to heed. Two narratives are at war in this book: one about Lowell’s mania and one about his enthralling private life separate from the psych wards.

People are more than their mental disorders — something I and Ilse Thompson repeatedly describe in the case of addiction in our book, "Recover!: An Empowering Program to Help You Stop Thinking Like an Addict and Reclaim Your Life": "Mindfulness allows you to see that you are not your addiction." You are so much more, the sum total of all of your here-and-now moments and gifts and interactions and successes.

Indeed, one of the panel members described how Lowell regarded his own experience as an enlarged version of ordinary experiences that everyone feels, a gift he was granted that fueled his genius (which panelist-poet Pal Muldoon observed Lowell was well aware he was — to everyone's amusement).

(As a reflection of the conflict between the pathological and the living, creative person, I apologize for neglecting the contributions to the evening of Katie Peterson, editor of Lowell's "New selected Poems," and Ishion Hutchinson, a Jamaican poet and essayist, who were too young to know Lowell and who could only speak of their appreciation of his work.)

III. Geneticism

For me, one of the large disappointments of the presentation and discussion was Frank Bidart, a distinguished poet in his own right who was presented as among Lowell's oldest friends. But Bidart said nothing about their friendship, or the man. Instead he read from Jamison's book's prologue, emphasizing almost entirely the family burden from Lowell's great, great, great grandmother's madness.

While Bidart and Jamison, in introducing her biography with it, were struck by that inheritance, now that the idea of a specific gene for bipolar (or any other mental disorder) has been decisively rejected, the notion that an illness can be passed through six generations is simply nonsensical (if that was in any way intended).

And, so, somehow I felt the man was lost to madness. Muldoon and Jamison each read one of Lowell's poems — delightful. In particular, Jamison read the poem whose lyric included the line "setting the river on fire," an image that describes the aliveness of Lowell's fraught life. I wish I could have seen more of his pyrotechnics last night.