A Summer of Madness
The New York Review of Books, September 25, 2008
Edited by Andy Ross
Hurry Down Sunshine
By Michael Greenberg
Illness: Bipolar Disorders and Recurrent Depression
By Frederick K.
Goodwin and Kay Redfield Jamison
An Unquiet Mind: A Memoir of
Moods and Madness
By Kay Redfield Jamison
Touched with Fire:
Manic-Depressive Illness and the Artistic Temperament
By Kay Redfield
"On July 5, 1996," Michael Greenberg starts, "my daughter was struck
mad." No time is wasted on preliminaries. The onset of mania is sudden
and explosive: Sally, the fifteen-year-old daughter, has been in a
heightened state for some weeks.
Sally has also been writing
singular poems. Her father surreptitiously glances at these, finds them
strange, but it does not occur to him that her mood or activity is in
any way pathological. Such exaltation is normal in a highly gifted
fifteen-year-old. Or so it seems.
But, on that hot July day, she
breaks — haranguing strangers in the street, demanding their attention,
shaking them, and then suddenly running full tilt into a stream of
traffic, convinced she can bring it to a halt by sheer willpower. Such
sudden, dangerous exaltations and actions are not uncommon at the start
of a manic attack.
One may call it mania, madness, or psychosis —
a chemical imbalance in the brain — but it presents itself as energy of
a primordial sort. Greenberg likens it to "being in the presence of a
rare force of nature, such as a great blizzard or flood: destructive,
but in its way astounding too." Such unbridled energy can resemble that
of creativity or inspiration or genius.
For Sally there was no
precedent, no guide. Her parents were as bewildered as she was — more
so, because they did not have her mad assurance. Was it, they wondered,
something she had been taking? Blood tests and physical exams ruled out
any problems with thyroid levels, intoxicants, or tumors. Her psychosis,
though acute and dangerous, was "merely" manic.
Jamison, a brilliant and courageous psychiatrist who has
manic-depressive illness herself, has written both the definitive
medical monograph on this subject and a personal memoir. In the latter,
"I was a senior in high school when I had my first
attack of manic-depressive illness; once the siege began, I lost my mind
rather rapidly. At first, everything seemed so easy. ... I felt really
great. I felt I could do anything, that no task was too difficult. My
mind seemed clear, fabulously focused, and able to make intuitive
mathematical leaps that had up to that point entirely eluded me. Indeed,
they elude me still."
Jamison contrasts this experience with the
episodes that came later: "Unlike the very severe manic episodes that
came a few years later and escalated wildly and psychotically out of
control, this first sustained wave of mild mania was a light, lovely
tincture of true mania."
At first, Sally's parents struggle to
believe (as Sally herself believes) that her excited state is something
positive, something other than illness. But it becomes clear within
hours that Sally is indeed psychotic and out of control, and her parents
take her to a psychiatric hospital. There she is stupefied with
tranquilizers and put in a locked ward.
There is relatively
little attempt to understand Sally in the hospital — her mania is
treated first of all as a medical condition, a disturbance of brain
chemistry. Unfortunately, Sally does not respond to lithium, and so her
physicians have to resort to heavy tranquilizers. Seeing his teenage
daughter in this zombie-like state is almost as shocking for her father
as her mania has been.
After twenty-four days of this, Sally is
released — still somewhat delusional and still on strong tranquilizers —
to go home, under careful and at first continuous surveillance. Outside
the hospital, she establishes a crucial relationship with an exceptional
therapist, who is able to approach Sally as a human being, trying to
understand her thoughts and feelings.
Freud spoke of all
psychoses as narcissistic disorders: one becomes the most important
person in the world, chosen for a unique role, whether it is to be a
messiah, a redeemer of souls, or (as happens in depressive or paranoid
psychoses) to be the focus of universal persecution and accusation, or
derision and degradation.
Mania is by no means all pleasure, as
Greenberg continually observes. He speaks of Sally's "pitiless ball of
fire," her "terrified grandiosity," of how anxious and fragile she is
inside the "hollow exuberance" of her mania. When one ascends to the
exorbitant heights of mania, one becomes very isolated from ordinary
Although Jamison says there is nothing good
to be said for depression, she does feel that her manias and hypomanias,
when not too out of control, have played a crucial and sometimes
positive part in her life. Indeed, she has provided much evidence to
suggest a possible relationship between mania and creativity.
Sally's final return from the mad heights of her mania is almost as
sudden as her taking off into it seven weeks earlier. After her summer
of madness, Sally is able to return to school, and this, one might hope,
would be the end of the story.
There is no "cure" for
manic-depressive illness, but living with manic-depressive illness may
be greatly helped by medication, by insight and understanding (in
particular, by minimizing stressors like sleep loss, and being alert to
the earliest signs of mania or depression), and, not least, by
counseling and psychotherapy.
Hurry Down Sunshine will be
recognized as a classic of its kind. But what makes it unique is the
fact that so much here is seen through the eyes of a father who, while
never descending into sentimentality, has remarkable insight into his
daughter's thoughts and feelings.
This was not a quick or easy
decision for either Sally or her father. Manic-depressive illness occurs
in all cultures, and affects at least one person in a hundred. Hurry
Down Sunshine reminds us of what a narrow ridge of normality we all
inhabit, with the abysses of mania and depression yawning to either
AR Interesting manifestation of the physicality
of mind. My own bipolar tendencies have evolved into a chronic aspie
serenity — solipsistic consciousness and so on.
New York Magazine, November 2012
Edited by Andy Ross
Oliver Sacks gets
migraines with visual hallucinations. And "I'm an honorary Tourette's
because I tend to jerk. I am also an honorary Asperger. And I'm an honorary
bipolar. I suspect we all have a bit of everything." He is also shy: "I
never initiate contact. It's a little bit like some of my Parkinsonian
patients, who can't initiate movement but can respond to music or a thrown
ball." He has been in psychoanalysis for 46 years.
Sacks turns 80
next year. He is blind in one eye and has a cataract in the other. Last year
he broke a hip. He says he has two shattered legs, a replaced knee, and a
collapsed foot. But he is probably the most beloved brain doctor at work
today. He does not publish scientific papers, do research, or advance
arguments about theoretical questions. He has made his name as a teller of
other people's stories.
Sacks grew up in London just before the war.
His father was a general practitioner and read the Talmud at night. His
mother was a surgeon. But England was oppressive to Sacks. On a 1960 trip to
Canada at 27, he sent a one-word telegram back to England: staying. In 1962,
he took a residency at UCLA, where he hung out at Muscle Beach and set a
California state weightlifting record: "I was known as Dr. Squat."
Sacks has been celibate for decades: "I lived alone, I've always lived
alone." There have been appointments (Beth Abraham, Albert Einstein,
Columbia and, just this year, NYU) and honors (American Academies of Arts
and Sciences and Arts and Letters, a Guggenheim fellowship, Columbia
Artist), but to hear Sacks tell it, his most important work has been inside
But to many psychiatrists and neurologists, his
devotion isn't medicine and his storytelling isn't science. Many of his
friends agree that he has made, at most, a trivial contribution to brain
science. Sacks takes it in stride: "I think it's important that nature can
put a positive spin on so many awful-seeming situations."
very beginning, Sacks thought, most writing about the brain so missed the
point it might as well have been about the colon. Neuroscience and
evolutionary psychology offer insight, but often at the cost of identity. In
both his practice and his writing, he hoped to reverse that, to treat
neurological disorder not as an extractable affliction but a mesmerizing,
meaning-giving, and often benign peculiarity.
Sacks remains a hero to
his patients and those suffering from similar disorders. Recently he went to
a performance of Mozart's Requiem by a chorus of medical students: “They
were all young and dedicated, and I was carried away, thinking that I would
like a performance of it in front of me as I was dying."
AR Sacks has done more for science indirectly,
by encouraging new kinds of understanding, than he ever could have done