Dualism
The allure of dualism—the belief that body and mind exist as separate entities—is one that Jamison never fully learns to ignore. It is a philosophy she leans towards in the early years of her coping with her illness. The tension between the biological origins of manic-depressive illness and the way it affects the psyche of those experiencing it is difficult for many people with manic-depressive illness. In order to contend with her illness, Jamison must separate manic-depressive illness from herself despite the fact it seems to be an extension of herself. She must accept that she cannot conquer it on her own, even if she thinks she "ought to be able to handle my increasingly violent mood swings by myself" (5). Only after she accepts that her illness is primarily biological is she able to accept treatment for it.
Often throughout the memoir, Jamison's physical reality does not mirror the reality she experiences in her mind. Although her moods are connected to her body's natural processes, they take her to places beyond the confines of her body and directly affect her mental processes and behavior. This tension is mirrored by the tension between the two academic disciplines discussed in the memoir: classical literature and poetry on the one hand, and science on the other. Jamison turns to poetry in order to make sense of her many moods, even as she is studying as a scientist. Discussions of genetics and chemicals in the body do not afford her sufficient grounds by which to understand herself. Even as Jamison accepts her medication and alters her body chemistry in order to control her moods, she holds that one must still pay particular attention to the mind. According to Jamison, medication is not the ultimate healing device. All medication succeeds in doing is giving a patient the strength to seek out psychotherapy, where true healing occurs.
Duality of Experience
There exists an inherent paradox within manic-depressive disorder, where a cycle of mania and depression causes an experience that is never solely negative. Although manic-depressive illness is very much a disease, certain aspects of mania cause immense amounts of pleasure in those who experience it. This pleasure can be intoxicating and addictive. It can cause those suffering from manic-depressive illness to reject psychiatric help. This duality of experience is a recurring theme in the memoir. It reemerges whenever Jamison is forced to contend with her illness; only when the bad becomes intolerable does Jamison even consider sacrificing the positive effects of mania on her life. This is what causes manic-depressive illness to be such a strong contender against medical intervention. The duality of the manic-depressive's experience keeps them stuck in an endless cycle of reward and punishment.
This is exemplified when Jamison discusses her reluctance to begin medication, lest it interfere with her manic moods: "Like gamblers who sacrifice everything for the fleeting but ecstatic moments of winning, or cocaine addicts who risk their families, careers, and lives for brief interludes of high energy and mood, I found my milder manic states powerfully inebriating and very conducive to productivity. I couldn't give them up (98)." Understanding this duality of experience is a necessary step in understanding manic-depressive disorder and the unique challenges facing those who attempt to treat it: "Through writing and teaching I have hoped to persuade my colleagues of the paradoxical core of this quicksilver illness that can both kill and create; and, along with many others have tried to change public attitudes about psychiatric illness in general and manic-depressive illness in particular" (6).
Stigma
Stigma about mental health disorders is another major theme of the memoir. Stigma about what it means to be mentally ill plagues Jamison, who is unable to accept that she cannot face her terrible moods on her own. She is terrified of asking for help, and when she finally does it is reluctantly and with a lot of shame. She recounts this shame in her first meeting with her psychiatrist: "I was not only very ill when I first called for an appointment, I was also terrified and deeply embarrassed" (84). Stigma has caused her to submit to the wild demands of her illness for too long, and she has waited until the last possible moment when she "had completely, but completely lost [her] mind" (84). Not only does stigma impede Jamison's healing process, but it also impedes her successful performance as a psychologist. As readers, we are unaware of this until Jamison describes her "indignity and embarrassment" at the role reversal present in her being the patient for the first time in her life (84). Mental illness is something she thought she could help others with, but whose burden she never thought she herself would have to bear. Jamison believes for a long time that she is stronger than those who seek out psychiatric help.
This dangerous stigma makes up a large part of Jamison's motivations for writing and publishing her memoir. In an industry where professionals were encouraged to keep their conditions secret, lest it impedes how their colleagues see and treat them, mental illness is highly stigmatized. In our society at large, mental illness is often seen as a mark of weakness or inferiority. People are taught to be ashamed of their conditions. This shame gets in the way of their healing, be it through stopping them from seeking out medical health, or encouraging them to keep it a secret from their friends, families, and coworkers.
Self-Acceptance
The journey to self-acceptance can be understood as one of the major conflicts of the memoir, as Jamison's inability to accept herself, and therefore her illness, continually impede her ability to grow and heal. The publication of An Unquiet Mind is in many ways a declaration of self-acceptance, as she shows in the prologue when she writes, "I am tired of hiding, tired of the hypocrisy, and tired of acting as though I have something to hide. One is what one is" (7).
It is only in the heights of her madness, at a moment when she is about to lose her job, marriage, and even life, that Jamison seeks help for her illness. Part of this reluctance to do so comes from thinking of herself as being above mental illness. Upon her first visit with her psychiatrist, Jamison describes herself as "confused and frightened, and terribly shattered in all of my notions of myself" (85). She loses her self-confidence, which has been a trait by which she long defined herself. This causes her to reject her psychiatrist's help for a long time, and although she finds solace in his understanding nature and feels as though psychotherapy works wonders for her psyche, Jamison must get worse before she gets better.
According to Jamison, she was only able to accept her illness through her academic study of moods. But even after coming to understand the scientific basis of her illness, she was plagued with self-doubt. Her refusal to comply with a strict lithium regimen is an example of how this doubt worked to hurt her. Some part of her always believed that she might be able to face this illness "on her own," without the support of a medical professional or medication. It is only when Jamison faces the harsh reality of her sickness and all that it implies that she can begin to accept herself. This only happens when she reaches rock bottom and attempts to kill herself. In the aftermath of a suicide attempt, Jamison begins to take her illness seriously. She has to face her illness and accept all that it brings to her life in order to accept herself. Without this self-acceptance, Jamison would never have been able to submit to healing, and all of the arduous activity implicated in that process.
Role Reversal
The unique position Jamison holds, as someone who has both experienced mental illness and can treat it, gives her a particular insight into manic-depressive illness. She has argued that this insight allows her to understand the illness in an important and nuanced way. Writing An Unquiet Mind is in many ways Jamison's attempt to build a bridge of understanding between the two groups so that the culture's conception of the disease might evolve. Often throughout her journey with mental illness, Jamison is forced to face a role reversal. This role reversal leaves her feeling disconcerted and out of place, but also gives her a heightened appreciation for both roles.
This is shown in her recollection of her first meeting with her psychiatrist. As he goes through the motions of examining her, it takes her a while to recognize his technique and the motivations for each of the questions he asks her. Even though she is familiar with the process, she finds herself unnerved: "the questions were familiar, I had asked them of others a hundred times, but I found it unnerving not to know where it all was going" (86). She gains an appreciation for how confusing it must be to be a patient with no experience with psychology. This affects every single one of her future interactions with patients. Not only does Jamison gain compassion for patients, but she also finds herself "gaining a new respect for psychiatry and professionalism" (86). Her psychiatrist treats her with incredible compassion and patience.
Without this role reversal, Jamison would never have been able to dispell the damaging stigma that so often kept her from healing. Furthermore, she would not have been able to contribute so much to her field. One of the largest factors contributing to Jamison's importance to the study of moods is the unique knowledge she has gained. Without it, she could never be considered to be one of the leading experts of her discipline.
Professionalism
Jamison's identity as a professional is one that holds many implications for her struggle with manic-depressive illness. Not only does the study of psychology offer her access to the best possible care for her illness, but it also provides her with a detached and clinical lens through which she might understand her behavior. Her identity as a psychologist is inseparable from her madness - the two interact in ways that both help and hinder her professional career. For example, she describes periods of mania in which she would get more work done than three sane versions of herself might, and periods of depression in which it was extremely difficult to teach, write, or even read. Her studies also affect the ways that she understands her illness, and they influence her relationship to her medication and her ability to seek psychiatric help. They also provide her with a way to make sense of her life through the chaos.
Jamison describes an early instance of hypomania in which she arrives at a work party dressed provocatively and talks animatedly with many of her colleagues. Although at the time, she considered the party immensely successful and her behavior that of a social butterfly, it was at this party that her future psychiatrist first diagnosed her, plainly seeing that her behavior was influenced by mania. Although there were no clear consequences for her behavior at the party, despite perhaps providing her future psychiatrist with an early glimpse into her illness, she later recollects this moment in shame. To be sane means being able to interact fully with all aspects of one's professional career. It also means having complete control over one's self and actions, particularly in moments when that control is most important. Jamison was able to succeed in her professional spheres despite this lack of control, but it was not without moments that threatened all that she worked towards.
Gender
Jamison comes into conflict with gender norms constantly throughout her memoir, as exemplified in her memories of rebelling against curtsying in cotillion. She also commends the adults of her past who encouraged her intellectual pursuits despite her gender, as she grew up in a time that undervalued female participation in medicine. Jamison is never afforded the opportunity to shed her gender in her profession, as she is continually reminded that she works in a "boy's club." In her adulthood, Jamison enters many intellectual spheres dominated by men. This has a mixed array of implications in her career, and though, for the most part, she was able to find allies in her supervisors and coworkers, she never failed to encounter a sexist man eager to put her in her place.
But gender takes on an even larger role than this in An Unquiet Mind. The role of gender in how one understands their life becomes a major theme of Jamison's memoir. Gender is seen as inseparable from Jamison's experience with mental illness. Part of Jamison's original horror at going mad had to do with how little the person her illness made her into resembled the person she felt she should have been. She loses composure and self-restraint, which were "not only desirable characteristics in a woman, they were essential" (29). Instead of being like her mother—secure, caring, and stable—Jamison became a person much like her father, while having the extra burden of rejecting the masculine tendencies of her illness. Her gender caused her particular pain when she began to have violent episodes in her mixed states of depression and mania. Violence itself is a difficult topic to discuss but within the context of her gender, it became something more: "the discrepancies between what one is, what one is brought up to believe is the right way of behaving toward others, and what actually happens during these awful black manias, or mixed states, are absolute and disturbing beyond description" (121).
This inability to make sense of behavior in mania and one's gender is a larger issue in the medical world. People are often less willing to accept that manic states can be the provenance of women, and as a result inquiry into the relationship between women and mania has been stunted. Although manic-depressive illness occurs equally often in women and men, women facing mania aren't treated as well as they should be. According to Jamison, women are "often misdiagnosed, receive poor, if any, psychiatric treatment, and are at high risk of suicide, alcoholism, drug abuse, and violence" (123).
