Psychosocial assessment of Kay Redfield Jamison's bipolar disorder

Psychosocial Assessment Of

A Person With Bipolar Disorder

psychosocial assessment of a person with bipolar disorder

"Personal accounts of mood disorders are an undervalued asset in understanding the manifestations of mental illness and in drawing attention to current issues"

Kay Redfield Jamison, Ph.D (Jamison, as cited in Evans, 2006)

One Personal Account

In the article, "Personal accounts of mood disorders often undervalued," J. Evans (2006) relates the quote introducing this study, stressing the value of personal accounts of mood disorders. Evans asserts that personal accounts significantly contribute to understanding symptoms evidenced by those experiencing mental illness. Kay Redfield Jamison, Ph.D., a prolific author on manic-depressive illness, also a professor of psychiatry at Johns Hopkins School of Medicine and, currently admits she is "afflicted (or blessed, as she sometimes feels) with manic-depressive ill-ness" (Jamison, 1996, p .91). In this study, the researcher utilizes Jamison's autobiography, An unquiet mind, to develop a psychosocial assessment of a person with bipolar disorder.

As a survivor of a manic-depressive illness, Jamison (1996) reportedly serves as the foremost authority on manic-depressive illness. Jamison's dual perspective, as a healer and one who is healed, contributes to her effectiveness. Even when pursuing her psychiatric training, Jamison regularly succumbed to "the exhilarating highs and paralyzing lows that afflicted many of her patients" (Jamison, Inside cover section). At times, due to her illness, Jamison reported she possessed boundless energy and mercurial creativity. At other times, albeit Jamison notes the disorder propelled her to engage in spending sprees, experience episodes of violence, and attempt suicide. During this paper, the researcher also utilizes information from DSM IV, and Essential Psychopathology and its treatment by Maxmen J.S. And Ward. (1995) to relate knowledge regarding Jamison's illness to her family.

In The Age of Depression, A.V. Horwitz and J.C. Wakefield (2005) relates a series of questions and answers regarding the DSM, explaining that DSM, published by the American Psychiatric Association, stands for "Diagnostic and Statistical Manual of Mental Disorders." The following section relates the DSM-IV criterion denoting Bipolar II Disorder, the mental illness Jamison (1996) experiences. Diagnostic features of Bipolar II Disorder include Jamison experiencing "one or more Major Depressive Episodes accompanied by at least one Hypomanic Episode" (DSM-IV, p. 359). Jamison regularly experienced more than five of the following symptoms; present during the same 2-week period. Her behavior(s) reflect a change from her previous functioning. More than one of the symptoms "is either (1) depressed mood or (2) loss of interest or pleasure" (Ibid.).

Jamison reports:

Feeling depressed most of the day, almost every day.

Experiencing diminished interest or pleasure in activities most of the day, nearly every day.

Although not dieting, losing a significant amount of weight in a short period of time.

Experiencing psychomotor agitation early in the day; almost every day.

Feeling fatigued; with little energy nearly every day.

Regularly feeling worthless and guilty for no obvious reason nearly every day.

Being unable to concentrate and/or think clearly almost every day.

Having recurring thoughts of death; repeated suicidal ideations, with several specific plans leading to attempting suicide.

During her manic episodes, Jamison reports she experienced:

1. Having an inflated self-esteem or grandiosity.

2. Not needing sleep, and that she feels rested after only 4 hours.

3. Talking excessively.

4. Being easily distracted.

5. Being more goal-directed at work.

6. Being excessively involved in a number of pleasurable activities with a high potential for painful consequences (DSM-IV, p. 332).

E. Urdang (2002) points out in the book, Human behavior in the social environment: interweaving the inner and outer worlds that Jamison shares snippets of her battles evolving from her mental illness in her autobiography, An Unquiet Mind. Urdang purports that even though Jamison is a person of unques-tionable strengths; her chronic illness tenaciously remains with her. Jamison describes her resistance to fighting this illness.

Even though I was a clinician and a scientist, and even though I could read the research literature and see the inevitable, bleak consequences of not taking lithium, I for many years after my initial diagnosis was reluctant to take my medication as prescribed.... Why did it take hav-ing to go through more episodes of mania followed by long suicidal depressions before I would take lithium in a medically sensible way?

Some of my reluctance, no doubt, stemmed from a fundamental denial that what I had was a real disease…Moods are such an essential part of the substance of life, of one's notions of oneself, that even psychotic extremes in mood and behavior somehow can be seen as temporary, even understandable, reactions to what life has dealt. In my case, I had a horrible sense of loss for who I had been and where I had been. It was difficult to give up the highlights of mind and mood, even though the depressions that inevitable followed nearly cost me my life. (Jamison, 1996, p. 91)

20-25 High probability

The optimum threshold for positive diagnosis would be a score of 13 or above. The researcher may need to submit to a physical soon. Jamison scored 23 on this particular test.

From a book review of Exuberance, Jamison, reviewed by R.A. Munoz (2005), the researcher learned that at times Jamison, as some other battling mental illness, even though experiencing challenges of bipolar disorder, discovered that not everything is bad about this disorder. In addition to the depressed times, among its symptoms, this disorder sometimes includes enhanced initiative and merriment. In the article, "Aesthetic phantoms," B. Allen, (2008) purports that creativity, another sometimes constitutes another possible "side affect" of bipolar disorder. In fact, during the last few decade, much scientific research and speculation regarding the correlation between creativity and mood disorders, particularly bipolar disorder or manic-depressive illness has been researched.

This type research primarily supports the theory the two phenomena, creativity and mood disorders, are related. Two centuries ago, Lord Byron flatly stated: "We of the craft [that is, poets] are all crazy. Some are affected by gaiety, others by melancholy, but all are more or less touched" (Allen, 2008, ¶ 1). Another of Jamison's books, Touched with Fire: Manie-Depressive Illness and the Artistic Temperament having had a particularly strong impact. (Allen, 2008, ¶ 1) relates that one recent study found that adults with bipolar disorder, as well as their children appear to reveal greater perceptual creativity than the control subjects in the study did. Jamison's work, Allen notes, has drawn public attention to the intertwined relationship or creativity and manic depressive disorder.

Poets, out of all the artists, appear to suffer most often from mood disorders. One study Jamison notes, estimates that 50% of poets are adversely affected. A recent study of poets, however, at the famous Iowa Writers' Workshop, reported 80% are affected. Jamison likely felt confusion at one time regarding this contention. Strong evidence also indicates that mental illness impedes the creative process. Gwyneth Jones writes -- and a number of others appear to concur: "There is a very close connection between depression and creativity, but it's not of the crudely co not be the most representative" (Evans, 2006, ¶ 7). One common theme linking depression and creativity appears to concur that the depression contributes to vision while it impedes creation. David Budbill, another bipolar survivor, however, stated he had come to understand his periods of depression.

He did not see these disruptive times at both ends of the emotional pole as useless periods in his life, periods that were to be fought against and resisted. He viewed the challenging times, instead, "as dormancy periods, gestation periods, to be accepted, given in to; welcomed." Much later Evans (2006) realized during the depressed period of emptiness, he was simultaneously full of something new. Another survivor of bipolar disorder, Liza Porter, attributes to her ability to write (with medication) to gaining the focus and follow-through in her work. Allen (2008) points out the following:

The process of permanently altering one's consciousness, either through chemical or psychotherapeutic means, almost inevitably raises questions about the "self"; the true self, the core self, the soul, if you will. Just what is this "self"? Can it be essentially altered, and if so, is the new self on some level false or artificial? These poets consider the issue; by and large, they seem to prefer their new, altered ones. "My consciousness still seems wholly mine," Andrew Hudgins says, "and the things about me that had seemed crazy have ameliorated. Is something missing and I'm unable to see it? Who knows? If so, I can't discern the loss." Chase Twichell expresses most eloquently what many of the essayists seem to feel: "I never forget that what I call my 'mind' is being chemically altered on an ongoing basis," she writes. "But am I less 'myself than I would otherwise be? Maybe the drugs make me more like my essential self, since they presumably compensate for the brain's shortcomings. So, what am I? A screwy mix of brain chemicals? ... Why, too, cling to the memory of consciousness as it once was? Maybe someday I won't even remember what my 'natural' mind was like. I certainly wouldn't ask for it back." (Allen, 2008, ¶ 9)

In the newspaper account, "Mad Geniuses? Johnston, Van Zandt and the Trouble

with the Myth," (2006), Jamison (1996), notes that individuals such as Vincent van Gogh, the famous painter the novelist-suicide, along with Ernest Hemingway and Virginia Woolf; and the opium-addicted poet Samuel Taylor Coleridge were manic depressive (Mad Geniuses…, 2006).

Maxmen, Ward and Kilgus (report in Essential Psychopathology and its treatment is a "no-nonsense" book that a number of psychiatric text are written as if students did not understand anything more than the "most basic facts" (p. 2009). Spitzer (1976) points out that psychiatric diagnosis serves to define clinical entities so the clinicians possess the same understanding of what a diagnostic category means.

One might note, Evans (2006) points out, that an emphasis on memoirs of people diagnosed with disorders, including bipolar disorder, would complement psychology or psychiatry. No school in the United States, however, Jamison (1996) states, requires students to read first-person accounts of mental illness. According to Jamison, mood disorders may be understood in a number of ways other than personal accounts. These venues include "through clinical, biologic, and psychological studies" (Evans, ¶ 3). Those type studies, however, related by third-person perspectives, do not provide the kind of understanding that first-person accounts relate.

First-person accounts do not compete for information relating to [or understanding mood disorders] ... But they are ways that work together," Jamison purports. Memoirs of mania and depression can enhance the general understanding of such illnesses as they describe or provide:

The phenomenology of symptoms, course of illness, and subjective experience of the illness.

Perspective on treatment and healing.

A view of the illness as a part of larger human issues and struggles.

Insight into the continuum of normal and pathologic mood states, behavior, and thinking.

A basis for clinicians and scientists to generate hypotheses.

A way of reaching a wide and diverse audience while being able to influence public policy, clinical practice, and research. (Evans, 2006, ¶ 4)

As noted at the start of this study, personal accounts of mood disorders serve as undervalued assets. When families, as well as the survivors of mental illness understand its manifestations, the invested effort will help draw attention to current issues. Books by Jamison, (2006) and others, also as Evans (2004), notes, may proffer the power to transform and/or positively influence lives.