Last week I attended a talk at the Wellcome Collection. For non-Londoners, the Collection houses the phenomenal range of medical objects gathered from around the world by Sir Henry Wellcome in the late 19th and early 20th century. It also plays host to relevant events including the series of free talks Exchanges at the Frontier, in which leading scientists speak to an audience made up of members of the public (the talks are later broadcast on the BBC World Service).
Kay is something of a heroine of mine. I know I wasn’t the only newly diagnosed bipolar to have left the psychiatrist’s office with a recommendation to read her memoir, An Unquiet Mind. I was grateful for the tip. It helped me to know it was possible to have bipolar and hold down a senior position – as a professor of psychiatry, no less. Kay is also well known for having written Touched by Fire, in which she examines the link between mental illness and creativity, and as coauthor of one of the best-known textbooks on the management of bipolar.
Kay answered a range of questions from philosopher and compere AC Grayling and from the audience, speaking on clinical issues as well as her own experience. She was particularly eloquent on the topic of lithium, which she clearly values over drugs such as antiepileptics (antipsychotics didn’t seem to get a look in) despite once having deliberately overdosed on it.
Many questions focused on genetic predisposition for bipolar and factors that might trigger onset. Kay feels that young people with a bipolar parent should be informed of the risks associated with disruption of circadian rhythms (by staying up late or all night) and experimentation with alcohol and/or illegal drugs. These are, in her view, the key reasons that bipolar most often makes its presence felt in a person’s teens or early twenties. If you had a family history of serious heart problems, said Kay, whose husband is a cardiologist, you would warn your young adult of the risks of certain behaviours. Bipolar should be no different.
If there was one thing about the talk that surprised me it was the complete lack of any psychological explanation for onset or symptoms. Kay seems very much in favour of people having therapy, especially when newly diagnosed, but mentioned this only in terms of educating people about how to stay as well as possible and get the most from their treatment regime. Psychological factors that occur around the usual time of onset – such the stress of moving away from home, adopting an adult role and forming first adult relationships – seem to me absolutely as pertinent as sleep and substance misuse but were not addressed. Kay accepted that bipolar can begin in earlier childhood, but possible triggers for this such were not discussed.
One audience member asked Kay how she would respond to those who challenge the psychiatric model and see the term “bipolar” as a doctor’s label rather than a well-defined disease. Kay seemed flummoxed for the first time since taking the stage, clearly reflecting on her personal suffering before finally answering, “I wouldn’t know what to say to someone who didn’t believe this was a real disease.”
An audience with Kay Redfield Jamison will be broadcast on the BBC World Service in early 2014