Training Directors Urged to Reach Out To Residents With Mental Illness

Instead of discouraging Kay Redfield Jamison, Ph.D., from pursuing her professional goals, her former boss offered the following advice upon learning that she was struggling with bipolar disorder: “Learn from it and teach from it.”

Since that time, Jamison has lived by his advice. By going public with her illness, she has shared with the world what it is like to be manic, how it feels to be caught in the grip of a suicidal depression, and what it means to admit that lithium is necessary for survival. Many of her experiences are eloquently narrated in her 1995 bestseller An Unquiet Mind. She is also the co-author with Frederick Goodwin, M.D., a former director of the National Institute of Mental Health, of Manic-Depressive Illness, the first psychiatric text to win the Best Medical Book Award from the Association of American Publishers.

In March she brought her message to the nation’s psychiatry training directors—more than 500 of whom met in Puerto Rico for the annual meeting of the American Association of Directors of Psychiatric Residency Training (AADPRT).

“I’m aware, after having gone public with my own mental illness, how common a problem mental illness is among residents, house staff, and medical students,” said Jamison, who is a professor of psychiatry at Johns Hopkins University School of Medicine. “We haven’t done a good job of dealing with the issue of how you protect patients from impaired doctors, and how you protect doctors [with mental illness] to ensure that their problems don’t go underground or lead to suicide or drug and alcohol abuse.”

She urged the training directors to take a proactive stance in talking to residents about their experiences with mental illness and to offer their support to trainees.

“Writing and talking in a very personal way about severe mental illness began for me with teaching residents” as the director of the Mood Disorders Clinic at UCLA, she said.

Although she found that many of the residents knew how to diagnose the illness or could prescribe drugs to combat its symptoms, “many were not exactly on intimate terms with the subjective experience of manic depression and its treatments,” she noted.

So Jamison anonymously wrote some passages for them about what it is like to live with a psychiatric illness.

“There is a particular kind of pain, elation, loneliness, and terror involved with this kind of madness,” Jamison wrote. “When you’re high, it’s tremendous. The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the power to captivate others a felt certainty. . . . But somewhere, this changes. The fast ideas are far too fast, and there are far too many. Overwhelming confusion replaces clarity. Memory goes. Humor and absorption on friends’ faces are replaced by fear and concern. Everything previously moving with the grain is now against.

“You are irritable, angry, frightened, uncontrollable, and enmeshed totally in the black of the caves of the mind. You never knew those caves were there.

“It will never end. It goes on and on and on, and finally there are only others’ recollections of your behavior—your bizarre, aimless, frenetic behavior. For me, it has at least some grace in partially obliterating my memory.”

Jamison also wrote about the difficulties of taking medication, “because many of the young doctors found it incomprehensible and infuriating that patients would stop taking the drugs that so clearly worked when they had such devastating illnesses” (see box on facing page).

She told the residency directors that by disclosing her mental illness to the public, she risked her career but hoped that she’d give others the courage to do the same. “Like most of you, I was brought up to be private about personal matters. But privacy and reticence kill,” she said, and far too many professionals are afraid to discuss their mental illness in public because they may face personal and professional reprisals.

Jamison disclosed her illness in a 1995 article in the Washington Post and soon after in An Unquiet Mind.

Reaction to her disclosure was mixed, she said. Her patients were stunned, for the most part, but supportive. When Jamison entered a seminar she taught to psychiatry residents at Johns Hopkins University, she was met with “an unnerving silence” that was eventually replaced by “warmth and unspoken support.” In fact, some of the residents came to her to talk about their own struggles with mood disorders, she pointed out.

A few weeks later at APA’s annual meeting in Miami, Jamison said, some colleagues spontaneously hugged her and wished her well, while others looked at the floor in discomfort.

“All things considered,” Jamison said, “speaking out about my illness has had a very freeing effect.” She urged the training directors to take a proactive stance with residents and other trainees who may have mental illnesses.

“We need to make it easy for them to seek and receive good care,” she said. ▪