An Unquiet Mind: A Memoir of Moods and Madness (7 page)

I
was twenty-one years old when I left Scotland and returned to UCLA. It was an abrupt shift in mood and surroundings, and an even more abrupt disruption to the pace of my life. I tried to settle back into my old world and routines but found it difficult to do so. For a year I had been free of having to work twenty or thirty hours a week in order to support myself, but now I once again had to juggle my work,
classes, social life, and disruptive moods. My career plans also had changed. It had become clear to me over time that my mercurial temperament and physical restlessness were going to make medical school—especially the first two years, which required sitting still in lecture halls for hours at a time—an unlikely proposition. I found it difficult to stay put for long and found that I learned best on my own. I loved research and writing, and the thought of being chained to the kind of schedule that medical school required was increasingly repugnant. As important, I had read William James’s great psychological study,
The Varieties of Religious Experience
, during my year in St. Andrews and had become completely captivated by the idea of studying psychology, especially individual differences in temperament and variations in emotional capacities, such as mood and intense perceptions. I also had begun working with a second professor on his research grant, a fascinating study of the psychological and physiological effects of mood-altering drugs such as LSD, marijuana, cocaine, opiates, barbiturates, and amphetamines. He was particularly interested in why some individuals were drawn to one class of drugs, for example, the hallucinogens, while others gravitated toward drugs that dampened or elevated mood. He, like me, was intrigued by moods.

This professor—a tall, shy, brilliant man—was himself inclined to quick and profound mood swings. I found working for him, first as a research assistant and then as a doctoral student, an extraordinary experience: he was immensely creative, curious, and open-minded; difficult but fair in his intellectual demands; and exceptionally kind in understanding my own fluctuating moods and
attentiveness. We had a kind of intuition about one another that was, for the most part, left unsaid, although occasionally one or the other of us would bring up the subject of black moods. My office was adjacent to his, and he would, during my depressed times, ask about how I was feeling, comment that I looked tired or pensive or discouraged, and ask what he could do to help.

One day in our discussions we found out that each of us had been rating our own moods—he on a 10-point scale of subjective ratings ranging from “terrible” to “great,” and me on a scale ranging from -3 (paralytic and entirely despairing) to +3 (magnificent mood and vitality), in an attempt to discover some sort of rhyme or reason to their comings and goings. Now and again we would talk about the possibility of taking antidepressant medications, but we were deeply skeptical that they would work and wary of potential side effects. Somehow, like so many people who get depressed, we felt our depressions were more complicated and existentially based than they actually were. Antidepressants might be indicated for psychiatric patients, for those of weaker stock, but not for us. It was a costly attitude; our upbringing and pride held us hostage. Despite my swings in mood—for my depressions continued to be preceded by giddy, intoxicating highs—I felt I had a haven in my undergraduate research assistantship with him. Many times, having turned out the light in my office in order to sleep because I couldn’t face the world, I would wake up to find his coat over my shoulders and a note on top of my computer printout saying “You’ll feel better soon.”

My tremendous enjoyment of and education from the work I was doing with him, the continued satisfaction
in my other work with the more mathematically inclined professor with whom I had been working since my freshman year, the strong influence of William James, and the instability and restlessness of my temperament all combined to help me make up my mind to study for a Ph.D. in psychology rather than go to medical school. UCLA was then, and still is, one of the best graduate programs in psychology in the United States; I applied for admission and began my doctoral studies in 1971.

I
decided early in graduate school that I needed to do something about my moods. It quickly came down to a choice between seeing a psychiatrist or buying a horse. Since almost everyone I knew was seeing a psychiatrist, and since I had an absolute belief that I should be able to handle my own problems, I naturally bought a horse. Not just any horse, but an unrelentingly stubborn and blindingly neurotic one, a sort of equine Woody Allen, but without the entertainment value. I had imagined, of course, a
My Friend Flicka
scenario: my horse would see me in the distance, wiggle his ears in eager anticipation, whinny with pleasure, canter up to my side, and nuzzle my breeches for sugar or carrots. What I got instead was a wildly anxious, frequently lame, and not terribly bright creature who was terrified of snakes, people, lizards, dogs, and other horses—in short, terrified of anything that he might reasonably be expected to encounter in life—thus causing him to rear up on his hind legs and bolt madly about in completely random directions. In the clouds-and-silver-linings department, however, whenever
I rode him I was generally too terrified to be depressed, and when I was manic I had no judgment anyway, so maniacal riding was well suited to the mood.

Unfortunately, it was not only a crazy decision to buy a horse, it was also stupid. I may as well have saved myself the trouble of cashing my Public Health Service fellowship checks, and fed him the checks directly: besides shoeing him and boarding him—with veterinary requirements that he supplement his regular diet with a kind of horsey granola that cost more than a good pear brandy—I also had to buy him special orthopedic shoes to correct, or occasionally correct, his ongoing problems with lameness. These shoes left Gucci and Neiman-Marcus in the dust, and, after a painfully acquired but profound understanding of why people shoot horse traders, and horses, I had to acknowledge that I was a graduate student, not Dr. Dolittle; more to the point, I was neither a Mellon nor a Rockefeller. I sold my horse, as one passes along the queen of spades, and started showing up for my classes at UCLA.

Graduate school was the fun I missed as an undergraduate. It was a continuation, in some respects, of the Indian summer I enjoyed in St. Andrews. Looking back over those years with the cool clinical perspective acquired much later, I realize that I was experiencing what is so coldly and prosaically known as a remission—common in the early years of manic-depressive illness and a deceptive respite from the savagely recurrent course that the untreated illness ultimately takes—but I assumed I was just back to my normal self. In those days there were no words or disease names or
concepts that could give meaning to the awful swings in mood that I had known.

Graduate school was not only relative freedom for me from my illness, but it was also freedom from the highly structured existence of undergraduate studies. Although I skipped more than half of my formal lectures, it didn’t really matter; as long as one ultimately performed, the erratic ways that one took to get there were considerably less important. I was married, too, by this point, to a French artist who not only was a talented painter but an exceedingly kind and gentle person. He and I had met in the early seventies, at a brunch given by mutual friends. It was a time of long hair, social unrest, graduate school deferments, and Vietnam War protests, and I was relieved to find someone who was, for a switch, essentially apolitical, highly intelligent but unintellectual, and deeply committed to the arts. We were very different, but we liked one another immediately; we found out quickly that we shared a passionate love for painting, music, and the natural world. I was, at the time, painfully intense, rail thin, and, when not moribund, filled to the brim with a desire for an exciting life, a high-voltage academic career, and a pack of children. Photographs from that time show a tall, extraordinarily handsome, dark-haired, gentle, and brown-eyed man who, while consistent in his own appearance, is accompanied by a wildly variable woman in her midtwenties: in one picture laughing, in a floppy hat, with long hair flying; in another pensive, brooding, looking infinitely older, far more soberly and boringly dressed. My hair, like my moods, went up and down: long for a time, until an I-look-like-a-toad mood would sweep over me; thinking a radical change might help, I
then would have it cut to a bob. The moods, the hair, the clothes all changed from week to week, month to month. My husband, on the other hand, was steady, and in most ways we ended up complementing one another’s temperaments.

Within months of our meeting we were living together in a small apartment near the ocean. It was a quiet, normal sort of existence, filled with movies, friends, and trips to Big Sur, San Francisco, and Yosemite. The safety of our marriage, the closeness of good friends, and the intellectual latitude provided by graduate school were very powerful in providing a reasonably quiet and harbored world.

I had started off studying experimental psychology, especially the more physiological and mathematical sides of the field, but after several months of clinical studies at the Maudsley Hospital in London—which I had completed just prior to meeting my husband—I decided to switch to clinical psychology. I had an increasing personal, as well as professional, interest in the field. My course work, which had focused on statistical methods, biology, and experimental psychology, now switched to psychopharmacology, psychopathology, clinical methods, and psychotherapy. Psychopathology—the scientific study of mental disorders—proved enormously interesting, and I found that seeing patients was not only fascinating but intellectually and personally demanding. Despite the fact that we were being taught how to make clinical diagnoses, I still did not make any connection in my own mind between the problems I had experienced and what was described as manic-depressive illness in the textbooks. In a strange reversal of medical-student syndrome, where students become convinced that they
have whatever disease it is they are studying, I blithely went on with my clinical training and never put my mood swings into any medical context whatsoever. When I look back on it, my denial and ignorance seem virtually incomprehensible. I noticed, though, that I was more comfortable treating psychotic patients than were many of my colleagues.

At that time, in clinical psychology and psychiatric residency programs, psychosis was far more linked to schizophrenia than manic-depressive illness, and I learned very little about mood disorders in any formal sense. Psychoanalytic theories still predominated. So for the first two years of treating patients, I was supervised almost entirely by psychoanalysts; the emphasis in treatment was on understanding early experiences and conflicts; dreams and symbols, and their interpretation, formed the core of psychotherapeutic work. A more medical approach to psychopathology—one that centered on diagnosis, symptoms, illness, and medical treatments—came only after I started my internship at the UCLA Neuropsychiatric Institute. Although I have had many disagreements with psychoanalysts over the years—and particularly virulent ones with those analysts who oppose treating severe mood disorders with medications, long after the evidence clearly showed that lithium and the antidepressants are far more effective than psychotherapy alone—I have found invaluable the emphasis in my early psychotherapy training on many aspects of psychoanalytic thought. I shed much of the psychoanalytic language as time went by, but the education was an interesting one, and I’ve never been able to fathom the often unnecessarily arbitrary distinctions between “biological” psychiatry, which emphasizes
medical causes and treatments of mental illness, and the “dynamic” psychologies, which focus more on early developmental issues, personality structure, conflict and motivation, and unconscious thought.

Extremes, however, are always absurd, and I found myself amazed at the ridiculous level to which uncritical thought can sink. At one point in our training we were expected to learn how to administer various psychological tests, including intelligence tests such as the Wechsler Adult Intelligence Scale, or WAIS, and personality tests such as the Rorschach. My first practice subject was my husband, who, as an artist, not surprisingly scored off the top on the visual performance parts of the WAIS, frequently having to explain to me how to put the block designs together. His Rorschach responses were of a level of originality that I have not seen since. On the Draw-A-Person test I noticed that he seemed to be taking it very seriously, drawing meticulously and slowly what I assumed would be some kind of revealing self-portrait. When he finally showed the picture to me, however, it was a wonderfully elaborated orangutan whose long arms extended along the borders of the page.

I thought it was marvelous and took the results of his WAIS, Rorschach, and Draw-A-Person to my psychological-testing supervisor. She was an entirely humorless and doctrinaire psychoanalyst who spent more than an hour interpreting, in the most fatuous and speculative manner, the primitive and repressed rage of my husband, his intrapsychic conflicts, his ambivalences, his antisocial nature, and his deeply disturbed personality structure. My now former husband, whom I have never, in almost twenty-five years, known to lie, was
being labeled a sociopath; a man who was quite singularly straightforward and gentle was interpreted as deeply disturbed, conflicted, and filled with rage. All because he had done something different on a test. It was absurd. Indeed, it was so ridiculous to me that, after having giggled uncontrollably for quite a long while, thus provoking even further wrath—and, worse yet, further interpretations—I half stormed, half laughed my way out of her office and refused to write up the test report. This, too, needless to say, was obsessed over, dissected, and analyzed.

Most of my real education came from the wide variety and large number of patients that I evaluated and treated during my predoctoral clinical internships. Along the way, I completed the course work for my two minor fields, psychopharmacology and animal behavior. I particularly loved studying animal behavior and supplemented the courses offered by the psychology department with graduate courses given by the zoology department. These zoology courses focused on the biology of aquatic mammals and covered not only the biology and natural history of sea otters, seals, sea lions, whales, and dolphins, but also such esoterica as the cardiovascular adaptations made to diving by sea lions and whales and the communication systems used by dolphins. It was learning for learning’s sake, and I loved it. None of this had any relevance whatsoever to anything else I was studying or doing, nor to anything I have done since, but they were far and away the most interesting classes I took in graduate school.