Friday 28 August 2020

Lithium, not too much

I was [not] writing about the capacity for boredom . . . because I'm not currently bored. As I thought about boredom, I was thrashing through An Unquiet Mind, Kay Jamison's [R talking about her 2017 biography of manic genius poet Robert Lowell] autobiographical dive into the stormy waters of manic-depression biopolar [affective] disorder whc is BAD. My mother thought that being bored was a character flaw if not exactly a clinical condition, so we soon learned not to use that word to define how we felt. Her response might have made us a bit more self-sufficient and resilient and more active in seeking things to edutain ourselves. Soldier on, I suppose?

You can't call it manic-depression anymore because both parts of the phrase are trigger words: threatening or making unhappy some of those affected by the condition. Those affected by the condition include not only the clinical case but a widening circle of family, friends, work-mates, dependents, employees, followers and line-managers. Before An Unquiet Mind came out, each year hundreds of doctors across the world were topping themselves out; leaving grief and devastation behind them. At issue was the fact that disclosing mental illness was likely to see the end of their licence to practice medicine and so they were in denial or struggling but certainly not seeking medical help for a condition which can respond really well to a combination of drugs and psychotherapy. It's not to say that other people don't suffer BADly, it is just to reflect on the irony of it being visited upon doctors who found that they were unable to cure themselves.  

The key to my Human Physiology course is homeostasis, the maintenance of everything - blood-pressure; core body temperature; sodium and potassium concentration; gut flora - in equilibrium. This is so important that many of the physiological systems are held to their set point by belts and braces involving nerves and hormones. Often, when things go wrong, you don't go completely off the rails or blow a cylinder-head gasket because of these redundant homeostatic mechanisms acting as a back-stop. The whole pharmaceutical industry is predicated on introducing alien substances to play the part of the original, now off-kilter, actors in the intricate dance of neurotransmitters, receptors, cytokines, hormones and enzymes. 

Lithium carbonate was revealed [chance favours the prepared mind] as a calmer of mania by John Cade, an Australian psychiatrist in 1948. At the doses given in the 50s, 60s & 70s Lithium was very blunt instrument. Sure it damped the awkward and time-consuming mania for psychiatric patients in locked wards, but also turned them into ataxic zombies unable to read or concentrate or feel any sense of joy. For a smart, widely-read, widely-reading, creative research scientist and driven author of books and papers Lithium was a disaster. The smart scientist, with a slightly puritan air-force brat upbringing, known as Prof Kay Jamison failed to embrace her meds for all sorts of conscious and unconscious reasons. It was, accordingly, many years before she was able to damp the wild swings between creative genius; cruel, [self-]destructive, shouty, talking-to-unicorns mania; and the black dog of darkest, suicidal ideation. Eventually, she got a great psychiatrist, a couple of really supportive blokes . . . and the Li dosage right for her system. With that sorted she went on to write a) the definitive text-book (with Fred Goodwin) on Manic Depressive Illness. b) An Unquiet Mind. c) The Robert Lowell biography and defg) four other books about madness and genius. Not to mention 3 pages of Honors and Fellowships; eight honorary degrees; 130 scientific papers; and hundreds of students, interns and colleagues who have been touched by her humanity, her restless curiosity and her extraordinary ability to see connexions. Sorry, this is reading like an obituary, she's not dead yet! Check one of her books out of the library: An Unquiet Mind reads real easy and the story is compelling and inspirational.

What do I take from this? That we should be really careful about stigmatizing The Other. That we are all going to need some help getting the full measure of our three-score-and-ten. Spectacles for me; a titanium hip for Sean and Margot [one each, even, they don't have to share]; ventolin for my asthmatic offspring; lithium for those over-active minds; Oxybutynin for over-active bladder. With these medical crutches we can live longer, fitter, independent lives and continue being useful to our families and our communities.  Still in Ireland, and doubtless wherever-the-heck you live, we privilege certain types of medical anomaly, notably HIV and Cancer [also: Top Ten -- Wallflower] -- Battens -- Orkambi <tsk!>] and all too often give the bum's rush to research into and financial support for mental illness. I've written a tiny bit to balance the books - Black dog -- Blackrock -- Bressie & Jeffrey -- Community care -- Drummer -- ECT -- Freedom.

Here's another, 23andMe, angle mentioned by Jamison. Many disorders of the mind run in families. Her own family tree, but only on her father's side, is beaded with black circles and squares indicating mania, depression, suicide. Bipolar for sure has a genetics angle: tree example from the Amish. This adds another dimension to the ethics and niceties of putting it all out there in your autobiography. By grassing yourself up to the Judgement of Publass, you are exposing your children, cousins, nieces and neffies to some undesired attention for which they get no royalties. Jamison is more sensitive about this than I am on The Blob as I chatter on about thinly disguised friends&relations.

More women in Science 

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