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Mind race: an excerpt


This Monday I’m introducing a series of books we will revisit often on the OUPblog. The first, Mind Race: A Firsthand Account of One Teenager’s Experience with Bipolar Disorder, was written by Patrick E. Jamieson, PH.D with Moira A. Rynn, M.D. Mind Race, a indispensable book for young men and women with bipolar disorder, is published in conjunction with the Annenberg Foundation Trust at Sunnyland’s Adolescent Mental Health Initiative. Written for teens and adolescents the books in this series provide an accessible guide for those struggling with mental illness. Below is an excerpt from Mind Race. Later today we will post an article by the author of this book, Patrick E. Jamieson.

Philadelphia, Pennsylvania


…I was 15, and by late summer I had been transformed from someone who slept more than most to someone who didn’t seem to need to sleep at all. My energy was back. That fall I had a full course load—history, English, French, and my worst subject, algebra 2—and I fell behind almost from the start. My mind was racing and my ability to focus in class came and went. The school principal called my mother. “We are concerned about Patrick,” she said. “He isn’t focusing, his speech is rapid, he’s not making a lot of sense. I think you should take him to a doctor.”

After three years in Austin, the move to Philadelphia had put me and my family in touch with a local medical teaching hospital, and with it experts who not only recognized but also studied adolescent bipolar disorder. Confronted with a 15-yearold who hadn’t slept in days, could not control his thoughts, and was increasingly verbally aggressive, my primary care physician at the hospital offered two hypotheses—a thyroid malfunction or bipolar disorder. The doctors in Austin had already checked for a thyroid malfunction and found none. A blood test confirmed their conclusion, leaving a diagnosis of bipolar disorder.

When I asked if that meant that I was schizophrenic, the only label of mental illness I could readily summon, the doctor clearly ruled it out. Now I know that it is sometimes difficult to draw a line between mood or “affective” disorders like bipolar disorder and schizophrenia. Indeed, there are cases in which individuals have the symptoms of both and are diagnosed as schizoaffective.

Later, my middle-aged parents sat with me in the Youth Guidance Center, next to a middle-aged male psychiatrist with short black hair, glasses, and a graying beard. Dr. Gottstein said, “There’s a good chance we’re dealing with manic depression or bipolar disorder.” My reaction is the same as it was when the diagnosis was first offered by my family doctor. I am stunned. Five minutes later my disbelief is still bristling. He can’t be right, I think, there’s nothing wrong with me but Epstein-Barr syndrome or an immune disorder. That was what the doctors in Austin had said, and I now desperately wanted to believe them. My symptoms are real. They are physical. My heart is racing. My throat is dry. This is not all in my head, I repeat to myself. I am not “mental.” I am not crazy.

If I was ill, I wanted a physical illness, not a mental illness— and I resolutely believed at the time that there was a clean distinction between the two. I wanted an illness caused by a bacterium that could be treated with an antibiotic or one produced by a splinter that could be removed by surgery. Psychiatric illness wasn’t real; it was “all in your head”—the ultimate form of self-indulgent hypochondria, I thought, a copout for those too lazy or inept to cope with the world, a con used to bilk insurance companies and trick employers.

If it is difficult at 15 to accept a chronic illness, it is even more difficult to accept one about which much is unknown. When bipolar disorder entered my vocabulary, years after it had entered my life, I believed the stereotypes of so-called “mental illness” as much as anyone else. And one of the insidious things about stereotypes is that you think they are facts. I started trying to find information that would make sense to me and would reveal what about this condition was fact and what was fantasy. I wanted to know what this diagnosis meant for me. But the problem is that, although researchers and doctors have made great strides in understanding and treating bipolar disorder, there is still much that remains unknown about the illness, especially in adolescents, an understudied population. And so, some of what I found answered my questions, while other materials raised more concerns than they quieted.

As it was, the doctor addressing my family was a psychiatrist specializing in treatment of adolescents with bipolar disorder. I didn’t want him to be right. I didn’t want the stigma of a “mental illness.” And I didn’t want the treatment. “If this is bipolar disorder, you’ll have to take lithium for the rest of your life,” he said. I thought, “It’s impossible! I can’t even brush my teeth twice a day.” I picked up fragments of what he was saying. No beer. No booze. No drugs. No dope. Weekly appointments. I felt 15 going on 40. From now on I was supposed to act grown up. I felt cheated out of being a teenager.

Although they are slowly changing, widespread Western societal stereotypes hold that being physically ill is preferable to being mentally ill, seeing a minister is better than seeing a psychotherapist, seeing a psychotherapist is better than seeing a psychiatrist, being treated as an outpatient is preferable to being treated as an inpatient, and voluntary hospitalization is preferred to involuntary hospitalization. Unfortunately, many of us deny our own conditions, even to ourselves.

Seeing a psychiatrist seemed to be an admission that I was crazy. I resented his presuming to interpret my attitudes and behavior. I resented the assumption that I was abusing alcohol and street drugs. My resentment took the form of sarcastic and sometimes savage words and a war of wills. I responded to a difficult situation by blaming my predicament on my “shrink” (as I referred to him when I was angry).

My belief that I didn’t need anybody’s help added to my disdain for psychiatrists. Asking for help seemed to me a sign of weakness. I was also hard on myself for not being able to solve my own problems. I felt incompetent for having to rely on a doctor and a hospital bed as tools for staying alive. Maybe this self-reliance is a macho male weakness. Like the great baseball star Joe DiMaggio, men are supposed to be able to play with pain. This thinking got me into trouble when I felt fine for an extended period, decided I had either been misdiagnosed or cured, stopped taking lithium, and relapsed.

Another reason that I disliked psychiatrists was that I associated them with the seemingly endless urine samples and blood tests a freshly diagnosed person encounters when attempting to get new medications balanced. I couldn’t walk out of my doc’s office without new prescriptions in hand. I also associated him with long lines and large bills. (Insurance that covers 100% of a so-called physical illness will often cover only half of the cost of a so-called mental one.)…

…Now I know that my relapse rate is much lower because I see a psychiatrist regularly. The National Institute of Mental Health says, “Studies have shown that psychosocial interventions can lead to increased mood stability, fewer hospitalizations, and improved functioning in several areas.” In other words, seeing a therapist or psychiatrist is important.

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