Kay Redifield Jamison. An unquiet mind: a memoir of moods and madness. Picador, 1996. £7.99, pp224. ISBN 0-330-34651-2

This remarkable book is a description of manic-depressive illness (the author prefers this name to ‘bipolar disorder’) related by a person who not only has the disease but is a professor of psychiatry at Johns Hopkins University. She is therefore able to look at her illness from both an objective and subjective point of view. Her remarkable writing abilities and clear scientific mind coupled with a wonderful sensitivity make this an engrossing book for any reader.

In the recent past, the plight of economically weak psychiatric patients in India was brought into public focus when, in Erwadi in Tamil Nadu, a number of patients who were being cared for in a makeshift private home died in a fire. The patients could not escape because they were chained.

Patients with major psychiatric disorders are often disruptive. They lack the usual inhibitions and therefore place a tremendous strain on their families. The author was relatively fortunate in having a family who could and did (and do) support her. She is also obviously extremely intelligent and motivated and was able to get control of her illness. She does not spare herself when she describes the effects of manic-depressive illness. In a more general way she describes what a major psychiatric illness can mean:

No amount of psychotherapy, education, persuasion, or coercion worked; …no tallying up of the hospitalizations, broken relationships, financial disasters, lost jobs, imprisonments, squanderings of a good, creative, and educated mind worked…He had a terrible disease and it eventually cost him his life.

She makes it clear that caring for a patient with major psychiatric illness is extremely difficult. In India, where public psychiatric institutions are few and far between, individual families often have to take care of the patients. Considering the tremendous effort involved, it is not surprising that they take recourse to private facilities such as those at Erwadi. The results are often tragic.

The author describes many dilemmas that a patient with psychiatric illness has to confront. For example, she had to debate whether to reveal her illness to potential employers. She also had to consider whether to reveal it to the men she was dating.

She candidly describes the reservations that some colleagues have on knowing about her illness. Psychiatric illness, more than physical ailments, seems to evoke certain emotions all over the world. Some people, including medical practitioners, believe that the patient can overcome the illness by willpower alone. They believe that an illness of the mind is just being ‘weak’. This, despite the clear evidence for the biochemical basis of many of the disorders, and the highly effective therapies that exist. This prejudice often means that the patients get less than effective care.

The drug lithium which she takes to control her illness, though highly effective, also has unfortunate side-effects. The side-effects are one of the main reasons that make patients ‘non-compliant’, i.e. stop taking the medication. The disastrous consequences of stopping medication are vividly described. It needs a lot of effort on the part of caregivers as well as the patient to keep taking the medication. It is a moot point how many families can, by themselves, devote the time and resources necessary.

It is obvious that a lot of cooperative social action is necessary to adequately care for people with major psychiatric illness. India is woefully short of such facilities. Tragedies such as those at Erwadi are always waiting to happen.