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Dancing with Fire: A Psychiatrist's Journey Through Madness and Healing
When Kay Redfield Jamison runs across a hospital parking lot at 2 AM in a manic state, accompanied by a medical school colleague, a police officer approaches with his hand on his gun. Her colleague's explanation that they are psychiatry faculty members satisfies him completely. The irony isn't lost on Jamison-within a month of becoming an assistant professor of psychiatry at UCLA, she was "well on her way to madness" at twenty-eight. This remarkable memoir, published in 1995, became an instant classic that transformed how we understand mental illness. Oprah Winfrey called it "the most honest book about manic depression I've ever read," while William Styron praised its "invaluable memoir of manic depression, brilliantly written." Beyond its literary acclaim, the book has become required reading in many medical schools and psychology programs, helping countless professionals develop empathy for what mental illness truly feels like from the inside.
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The Wild Blue Yonder: A Military Childhood
Growing up in a military family meant constant movement-four elementary schools by fifth grade, living in Florida, Puerto Rico, California, Tokyo, and Washington D.C. (twice). This nomadic existence, typical of military families in the 1950s and early 1960s, required constant adaptation to new environments, cultures, and social circles. Despite this transience, Jamison's parents created a secure, warm environment, transforming each new house into a home filled with books, music, and intellectual discourse.
Her father, an Air Force officer and meteorologist, possessed a magical quality when engaged-ebullient, funny, and intensely curious. During his "high-tide moods," his infectious enthusiasm touched everything: classical music and jazz filled the house at all hours, beautiful jewelry appeared unexpectedly for his wife and daughter, and passionate lectures flowed about windmills saving the world or why Russian poetry must be read in its original language. He would spend entire weekends exploring scientific concepts with his children, setting up impromptu experiments in the backyard or drawing complex weather patterns on napkins at the dinner table.
"There was contagious magic to his expansiveness-like having Mary Poppins for a father," Jamison writes. His intellectual pursuits often manifested in grand gestures. Once, after reading about George Bernard Shaw's phonetic alphabet, he bought and distributed nearly a hundred copies of Androcles and the Lion to friends, family, and even casual acquaintances, convinced everyone should understand this revolutionary approach to language. Years later, he gave her a bracelet inscribed with Faraday's words: "Nothing is too wonderful to be true." Though palpably untrue (Faraday himself had breakdowns), the sentiment captured her father's wondrous moments and his belief in life's infinite possibilities.
Her mother-who believed "it's not the cards one is dealt in life but how one plays them"-provided stability and strength through practical wisdom and unwavering support. She maintained routines amid chaos, ensured homework was completed despite constant moves, and created traditions that could travel from base to base. Unlike her intellectual father who reread Shakespeare and Twain, her grandmother approached life with pragmatic social engagement, joining clubs and invariably being elected president. This steadiness, her belief in seeing things through, and her ability to love, listen and change helped keep Jamison alive through years of pain and nightmare. "She had no preparation for madness," Jamison writes, "but handled it with empathy and intelligence. It never occurred to her to give up." Through countless hospital visits, medication adjustments, and emotional upheavals, her mother remained an anchor of stability.
The contrast between her parents foreshadowed Jamison's own internal struggles-her father's mercurial brilliance against her mother's steady resilience. This duality would shape her understanding of her own condition and eventually inform her groundbreaking work in psychiatric medicine. The military backdrop of her childhood, with its emphasis on discipline and adaptability, combined with her father's intellectual passion and her mother's emotional stability, created a unique framework through which she would later understand and explain the complexities of bipolar disorder to both medical professionals and the general public.
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Seeds of Passion: Medicine, Rebellion, and Mood Swings
Both parents encouraged Jamison's interests in poetry, plays, science, and medicine. They distinguished between phases and serious commitments, handling even her intense obsessions with kindness. When she desperately wanted a sloth, her father channeled her enthusiasm into creating a detailed scientific notebook. Her interest in medicine, however, persisted. Her parents bought her dissecting tools, a microscope, and Gray's Anatomy.
At fifteen, Jamison visited St. Elizabeths psychiatric hospital with fellow candy stripers. Despite nervous giggles on the bus ride, the hospital grounds surprised her with their beauty. But entering the wards shattered this illusion with the stark reality of insanity's sights, sounds, and smells. Most striking were the patients' expressions of pain-a suffering she somehow instinctively understood, never imagining she would someday see that same sadness and insanity in her own eyes.
By sixteen or seventeen, her own moods became problematic. After weeks of flying high and sleeping little, her thinking would turn dark and brooding. Senior year brought her first attack of manic-depressive illness. Initially, everything seemed wonderful-she raced about bubbling with plans and enthusiasms, staying up all night, reading voraciously, writing constantly. Her mind felt clear, focused, making intuitive leaps. The universe seemed filled with cosmic relatedness and beauty.
Then she crashed. Her thinking became tortuous; reading became impossible as she'd forget passages immediately. Her mind-previously her best friend-turned against her, mocking her enthusiasms and fixating on death. Exhaustion overwhelmed her. She dragged herself through each day, wearing the same clothes repeatedly, avoiding friends, and sitting inert in the library with "a dead heart and a brain as cold as clay." She drank vodka before school and obsessed about suicide.
Remarkably, she maintained a normal appearance. Other than two concerned friends, a teacher, and one parent who noticed something wrong, no one-especially her family-realized her desperation. She aged rapidly during those months, shocked by how completely she'd lost control of her thoughts and how close she'd come to death.
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The Education of a Mind: College Years and First Diagnosis
At eighteen, Jamison reluctantly began at UCLA rather than her dream school, University of Chicago. Her father's erratic behavior had cost him his job at Rand, making the more prestigious schools financially impossible. Though bitterly disappointed, UCLA ultimately proved perfect for her-providing excellent education, research opportunities, and the space a large university affords a tempestuous temperament.
College was no idyllic experience but rather "a terrible struggle, a recurring nightmare of violent and dreadful moods" occasionally interrupted by periods of fun and high enthusiasm. The seductive pattern included intoxicating moods that filled her brain with ideas and energy. During these times, her conservative style would vanish, hemlines rising and necklines plunging as she embraced sensuality and excess.
In her freshman year, a stroke of luck came during an upper-division psychology course. The professor demonstrated personality assessment using Rorschach cards, asking students to write responses. Jamison's mind was "flying high that day, courtesy of whatever witches' brew of neurotransmitters God had programmed into my genes," and she filled pages with strange associations. When the professor read her responses aloud, the class laughed while she stared mortified at her feet.
After class, expecting to be identified as psychotic, she was instead told her responses were the most "imaginative" he'd ever encountered. This professor cast a "positive rather than pathological hue" over her bizarre thoughts-her first lesson in appreciating the permeable boundaries between bizarre and original thinking. Learning she was a freshman working her way through college, he offered her a position as his lab assistant, allowing her to escape her boring cashier job and learn research skills.
At twenty, after two years of undergraduate turmoil, she took a year to study at the University of St. Andrews in Scotland. This gentle year of "gravely held but joyous remembrances" provided respite from her inexplicable weariness and despair-"the Indian summer of my life."
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Into the Maelstrom: Madness Descends
After completing her dissertation and defending it successfully, Jamison joined UCLA's Department of Psychiatry as an assistant professor. Within three months of this professional triumph, she became "ravingly psychotic." Her descent into madness wasn't sudden but a beautifully seductive acceleration. After joining UCLA's psychiatry faculty in 1974, she threw herself into teaching, clinical supervision, and research with tremendous energy. She slept little, worked constantly, and felt intoxicated by academic freedom.
At UCLA's garden party for new faculty, she perceived herself as irresistibly charming, zipping between conversations, captivating the chancellor. Her future psychiatrist, also attending the party, saw something entirely different: a woman dressed provocatively, wearing excessive makeup, speaking frenetically-clearly manic.
Her mind accelerated beyond control, ideas intersecting at every angle in a neuronal pileup. When manic, money concerns evaporated completely. Credit cards became disastrous weapons of self-destruction. She bought twelve snakebite kits with urgent conviction, precious stones, expensive furniture, multiple watches, inappropriate clothes, and obscure books that momentarily fascinated her. She spent tens of thousands during her manic episodes.
She maintained a frightening pace, working endless hours while barely sleeping. Her apartment descended into complete disorder-books strewn everywhere, clothes in mounds, unwrapped packages and shopping bags scattered throughout. Hundreds of paper scraps filled every surface with incoherent poems and fragments, including one titled "God Is a Herbivore" inexplicably stored in her refrigerator. Eventually, she experienced terrifying hallucinations-seeing a centrifuge filled with blood that shattered, spattering blood everywhere.
Fortunately, a colleague confronted her with the need to take lithium. Despite her agitation, paranoia and physical violence, he gently insisted she had manic-depressive illness and arranged for her to see a psychiatrist. Her psychiatrist conducted a thorough examination, asking detailed questions about her sleep, concentration, speech patterns, energy levels, and thought processes. He unambiguously diagnosed her with manic-depressive illness and recommended indefinite lithium treatment.
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The War with Lithium: Resistance and Acceptance
Jamison's battle with lithium began shortly after starting it in fall 1974. By spring 1975, she had stopped taking it against medical advice. Though lithium worked well for her textbook case of manic-depression, the side effects were brutal. At the high therapeutic levels prescribed then (much higher than today's standards), she experienced severe nausea and vomiting, tremors, ataxia, and slurred speech.
Most devastating was lithium's effect on her ability to read. For over ten years, she couldn't read serious literature cover-to-cover. She threw books against walls in fury, as reading-once at the heart of her existence-became nearly impossible. Poetry remained accessible, as did children's books with their larger print and shorter length.
Psychological issues ultimately proved more important than side effects in her resistance to lithium. She had become addicted to her high moods-their intensity, euphoria, and infectious enthusiasm. Like gamblers or cocaine addicts, she found milder manic states powerfully inebriating and productive. Her upbringing taught her she should handle difficulties without "crutches" like medication.
Reading her medical records years later revealed a disturbing pattern of starting and stopping lithium throughout 1975. By September, she had stopped lithium again, claiming it was "very important to prove she can handle stress without it." The pattern continued with multiple starts and stops. Beneath her resistance lurked a terrifying fear: what if she took lithium and still got sick? Her psychiatrist captured this paralyzing fear in his notes: "Patient sees medication as a promise of a cure, and a means of suicide if it doesn't work. She fears that by taking it she will risk her last resort."
Jamison witnessed the devastating consequences of lithium resistance in one of her own patients. Called to the UCLA emergency room, she found him strapped to a gurney in four-point leather restraints, screaming in terror, completely psychotic. Despite massive antipsychotic medication, he remained delirious, delusional, and hallucinating. Lithium worked remarkably well for him, but once his acute symptoms subsided, he would invariably stop taking it. His terrible disease eventually cost him his life-as it does tens of thousands yearly.
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The Darkest Hours: Depression and Suicide
Jamison's own refusal to take lithium consistently yielded a bitter harvest: a floridly psychotic mania followed by a devastating suicidal depression lasting more than eighteen months. From morning until night, she was unbearably miserable and incapable of joy. Everything required enormous effort. Her mind felt slowed and burned out, tormenting her with a litany of inadequacies and the hopelessness of her situation.
Death became her constant companion-she saw it everywhere. Her thoughts traveled the black line of her mind's underground system, each stop worse than the last. Simple tasks like washing her hair took hours and left her exhausted. During this period, she saw her psychiatrist multiple times weekly and finally took lithium regularly. His notes documented her unrelenting despair and suicidal thoughts.
Despite her psychiatrist's repeated attempts to persuade her to enter a psychiatric hospital, she refused. She was horrified at the thought of being locked up, away from familiar surroundings, forced into group therapy, and subjected to the indignities of a psychiatric ward. More critically, she feared her clinical privileges would be suspended or permanently revoked if her hospitalization became public knowledge.
When nothing seemed to be working despite excellent care, she resolved to kill herself. She cold-bloodedly concealed her intentions, successfully appearing merely "severely depressed" and "very quiet" to her psychiatrist. She decided on a massive lithium overdose, finding poetic justice in using the very medication meant to save her. She obtained anti-emetic medication to prevent vomiting the pills back up and took handful after handful of pills before curling up to die. Her drugged brain betrayed her plans when she instinctively answered a phone call from her brother, whose concern about her slurred speech prompted him to alert her psychiatrist.
A psychiatrist friend redefined friendship for her during this period. Warm, whimsical, and intensely loyal, he spent countless evenings with her, enduring her choleric moods. After her suicide attempt, he and her psychiatrist arranged her medical care, with her friend keeping constant watch, drawing blood for tests, and walking her repeatedly to keep her from slipping deeper into her drugged state.
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Professional Success Against All Odds
Tenure represented both possibility and transformation-a symbol of stability Jamison craved and recognition for surviving in the normal world. For someone who had experienced the destabilizing effects of manic-depressive illness, the permanence of a tenured position held particular significance. Yet pursuing it as a woman, non-physician, and manic-depressive in academic medicine was extraordinarily challenging. The tenure process was intensely competitive, all-consuming, and rather brutal-a blood sport of first-class universities, made more demanding by the clinical responsibilities layered upon research and teaching requirements. Each day brought scrutiny of her publications, teaching evaluations, and clinical work, while she simultaneously managed her illness.
Determined to make a difference in how manic-depressive illness was seen and treated, she established the UCLA Affective Disorders Clinic with two colleagues in 1977. Despite significant opposition to a non-physician directing a medical clinic, she received crucial support from medical leadership, particularly from the department chair who recognized her unique insights into mood disorders. Within years, they transformed it into one of the country's leading teaching and research facilities that evaluated thousands of patients annually, conducted groundbreaking studies on medication efficacy and therapeutic approaches, and trained generations of psychiatric residents and psychology interns. The clinic became known for its innovative treatment protocols and comprehensive approach to patient care.
To help others understand the lived experience of mood disorders, she encouraged clinic staff to read firsthand accounts from patients and historical figures. She began giving Christmas lectures featuring music by composers who had suffered from depression or manic-depressive illness, analyzing their works through the lens of their mental health struggles. These educational initiatives evolved into a landmark concert with the Los Angeles Philharmonic in 1985 highlighting works by Schumann, Berlioz, and Wolf-composers who had the illness. The concert demonstrated the complex relationship between creativity and mental illness, drawing packed audiences and critical acclaim.
The academic environment presented additional challenges as one of few women in adult psychiatry during the 1970s and 1980s. She faced subtle discrimination, exclusion from informal networks, and heightened scrutiny of her work. Despite these obstacles, she published extensively, maintained a heavy clinical load, and developed innovative teaching methods. After successfully navigating the academic maze for several years, she received tenure in 1983 and celebrated with family and friends who understood this represented not just professional achievement, but triumph over both institutional hurdles and severe mental illness. The tenure marked a validation of her unconventional path and proved that managing mental illness while maintaining a demanding career was possible.
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Love and Healing: Finding Balance
After believing she'd endured her share of pain through manic-depression, Jamison found unexpected love with David, a visiting British psychiatrist she met at UCLA during a medical conference. Their connection was immediate and profound, built on shared intellectual passions and mutual understanding of the complexities of mental health. When she accidentally dropped her lithium pills on the ancient stones of Canterbury Cathedral during their visit to England, she was forced to confront her greatest fear - revealing her illness to someone she deeply cared about. Instead of the rejection she'd come to expect, David responded with characteristic British understatement and compassionate acceptance: "I say. Rotten luck." This moment marked a turning point in her ability to trust and be vulnerable.
Though they maintained a long-distance relationship with frequent visits between London and Los Angeles, building a life through letters, phone calls, and precious time together, tragedy struck without warning. David, who had recently taken a position at a prestigious hospital in Hong Kong, died suddenly of a heart attack at forty-four, leaving her devastated at thirty-two. The loss was particularly cruel given their plans for a future together and their shared dreams of combining their medical practices.
The accumulated pain from David's death and her ongoing battle with manic-depression profoundly altered her worldview and lowered her expectations of life for several years. She withdrew emotionally while maintaining an almost frantically busy professional life - publishing papers, seeing patients, and teaching became both shield and distraction. Still raw inside after eight years without taking extended time to properly grieve and heal, she made a decisive change. She decided to spend a sabbatical year in England, a choice both practical and deeply personal, studying mood disorders in British artists and writers while working on a comprehensive medical text about manic-depressive illness.
This year in England proved transformative, helping her realize she'd been merely treading water in her emotional life, going through the motions without truly engaging. The distance from her routine life and immersion in creative works gave her back her high hopes for life and renewed her belief in love's possibility. With her new English lover's thoughtful encouragement, she cautiously reduced her lithium dosage under careful medical supervision. The effect was dramatic - like removing bandages from her eyes after years of muted perception. Colors brightened to their former intensity, sounds clarified and became more nuanced, and her mind sharpened noticeably. With her carefully calibrated lower lithium dose, she finally regained the vividness that had once formed her core temperament, while maintaining the stability essential to her well-being and professional life.
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Living Fully With Mental Illness
Thirty years with manic-depressive illness taught Jamison about both its restraints and possibilities. The darkness remains integral to who she is-those months of relentless blackness, exhaustion, and memories of disturbing behavior that affected others terribly. She recalls specific episodes where she would stay awake for days, spending recklessly and making grandiose plans, followed by crushing periods of depression where even getting out of bed seemed impossible. Yet these dreadful moods have always been counterbalanced by periods of extraordinary elation and vitality, during which her creativity and intellectual capacity seemed boundless.
The genetic nature of manic-depressive illness brings complicated emotions and ethical dilemmas. Despite being a vocal supporter of genetic research on manic-depressive illness, she wrestles with profound concerns about the potential consequences of identifying the responsible genes. While better diagnosis and treatment would benefit countless individuals, the prospect of prenatal testing raises serious ethical concerns. Would prospective parents choose to abort fetuses carrying genes for what is, fundamentally, a treatable condition? She points to historical figures like Vincent van Gogh, Virginia Woolf, and Robert Lowell, questioning whether eliminating these genes might make the world "blander" by removing the very risk-takers and creative minds who have historically driven advances in arts, science, and leadership.
She's often asked herself whether, given the choice, she would choose to have manic-depressive illness. Without lithium, the answer would be an unequivocal no. Depression is beyond words-it bleeds relationships dry, destroys self-confidence, and makes even the most basic aspects of normal life seem impossible. She describes how depression robs one of the ability to love or be loved, to work, to find meaning in everyday experiences. Yet strangely, with lithium working effectively, she thinks she would choose this illness. Through it, she's felt more deeply, experienced life more intensely, loved more passionately and been more deeply loved. She's laughed more often for having cried more often, appreciated the warmth and renewal of springs more deeply for all the cold, dark winters, and worn death "as close as dungarees."
Even at her most psychotic moments-when she was delusional and hallucinating-she's discovered new corners in her mind and heart that would have otherwise remained unknown. Some were breathtakingly beautiful, filled with intense creativity and insight; others were grotesque and ugly, revealing the darkest aspects of human consciousness. But these limitless corners with their limitless views have made it impossible to become jaded to life. Her illness has given an intensity to existence and forced perspective, making her repeatedly test the limits of her mind, upbringing, family bonds, education and friendships. After each seeming death within her mind or heart, love has returned to re-create hope and to restore life, teaching her that renewal is possible even from the darkest places.
