Yale Psychiatry Grand Rounds: "Mania, Character and Genius"

Transcript

• 00:05Thank you. Okay.
• 00:07Well,
• 00:08by seeing
• 00:10that this is a packed
• 00:11house in person
• 00:12and that there are so
• 00:13many people also on Zoom,
• 00:16I know that doctor Kay
• 00:17Redfield Jamieson does really doesn't
• 00:20need an introduction,
• 00:21but, nevertheless, I'm gonna do
• 00:23one,
• 00:24especially as it's really,
• 00:27really feels
• 00:29an honor and and a
• 00:30privilege,
• 00:32that,
• 00:33such a treasure for our
• 00:35field is here, and I'm
• 00:36getting to introduce her.
• 00:38So,
• 00:39doctor Kay Redfield Jamieson
• 00:42is the Dalio professor in
• 00:44mood disorders
• 00:45and professor of psychiatry
• 00:47at the Johns Hopkins
• 00:49School of Medicine
• 00:50and co director of the
• 00:52Johns Hopkins Mood Disorder Center.
• 00:55She is also honorary professor
• 00:57of English at the University
• 00:59of Saint Andrews in Scotland.
• 01:03I cannot possibly do justice
• 01:05to the impact
• 01:07that she has had
• 01:09on the clinical
• 01:11and research fields
• 01:13and persons living with bipolar
• 01:16disorder.
• 01:17She's a psychologist
• 01:20and an eminent scholar
• 01:22in the field.
• 01:24She has written more than
• 01:25a hundred and twenty five
• 01:27articles
• 01:27about mood disorders,
• 01:29suicide,
• 01:31creativity,
• 01:32and lithium
• 01:33among other topics.
• 01:36And in nineteen ninety, she
• 01:37coauthored
• 01:39one of the most classic
• 01:40medical textbooks
• 01:42we have in bipolar disorder.
• 01:46So she is
• 01:47the best of academia,
• 01:50but then she also
• 01:53has been
• 01:55incredibly generous
• 01:57and has had tremendous
• 01:59impact
• 02:00by sharing
• 02:05her by share by sharing
• 02:08her own experiences
• 02:10with bipolar disorder.
• 02:12This began with her memoir,
• 02:15An Unquiet Mind,
• 02:17that was on the New
• 02:18York Times bestseller list for
• 02:19five months and translated into
• 02:22thirty languages.
• 02:24It was published in nineteen
• 02:25ninety five,
• 02:27so almost thirty
• 02:29years ago.
• 02:31So think about that for
• 02:33a moment.
• 02:36What a pioneer
• 02:38she was.
• 02:40Now we hear about the
• 02:42critical importance of including the
• 02:44voice of individuals with lived
• 02:46experience
• 02:47in all our work.
• 02:49But back then,
• 02:50it was revolutionary
• 02:52to write a memoir
• 02:54like she did,
• 02:56and it still stands as
• 02:57one of the best
• 02:59autobiographies
• 03:00of a person living with
• 03:01bipolar disorder
• 03:03and a treasure for the
• 03:04field.
• 03:06And if that was not
• 03:07enough,
• 03:08she followed it, authoring
• 03:10additional
• 03:11precious books, including
• 03:13touch with fire,
• 03:15manic depressive illness, and artistic
• 03:17temperament,
• 03:18an exploration of how bipolar
• 03:20disorder can run-in artistic,
• 03:22creative, and high achieving families.
• 03:26Also,
• 03:27nothing was the same,
• 03:28and night falls fast, understanding
• 03:31suicide,
• 03:32which provided
• 03:33historical,
• 03:34religious, and cultural responses to
• 03:37suicide
• 03:38and was a national
• 03:40bestseller
• 03:41and selected by The New
• 03:42York Times as a notable
• 03:43book of nineteen ninety nine.
• 03:45She wrote exuberance,
• 03:47the passion for life, which
• 03:49was
• 03:49selected by The Washington Post,
• 03:51The Seattle Times, and The
• 03:52San Francisco Chronicle
• 03:54as one of the best
• 03:55books of the year and
• 03:56by Discover Magazine
• 03:58as one of the best
• 03:59science books of the year.
• 04:01Her book about Robert Lowell,
• 04:04Robert Lowell, setting the river
• 04:06on fire, a study of
• 04:08genius,
• 04:09mania, and character
• 04:11was a two thousand and
• 04:12eighteen Pulitzer Prize finalist.
• 04:16I love this description that
• 04:18I saw online that it
• 04:19is a magisterial
• 04:21study
• 04:22of the relationship between between
• 04:24illness and art that brings
• 04:26an entirely fresh understanding
• 04:28to the work and life
• 04:29of Robert Lowell.
• 04:31And to me,
• 04:33it combines
• 04:35her astonishing
• 04:36depth
• 04:37as a scholar
• 04:39while it continues
• 04:41a theme on which she
• 04:42speaks so eloquently.
• 04:45Individuals with bipolar disorder who
• 04:47have some
• 04:48who have been some of
• 04:49the most creative
• 04:51individuals
• 04:52that the world has seen.
• 04:55Doctor Jamieson has been awarded
• 04:57numerous honorary degrees,
• 04:59including from the University of
• 05:00Saint Andrews in literature,
• 05:02from Brown University in medical
• 05:04sciences,
• 05:05and general theological
• 05:07seminary of the Episcopal Church
• 05:09and divinity.
• 05:10So you can see the
• 05:12breadth in addition to the
• 05:13depth of her scholarship.
• 05:17She is a MacArthur fellowship
• 05:19recipient
• 05:20and is a fellow of
• 05:21the American Academy of Arts
• 05:22and Sciences,
• 05:23as well as the Royal
• 05:24Society of Edinburgh
• 05:26and the recipient recipient of
• 05:28numerous lit literary and scientific
• 05:30awards,
• 05:31including the Lewis Thomas prize,
• 05:34the Sarnath prize, and the
• 05:36National Academy
• 05:37of Medicine
• 05:39in addition to the MacArthur
• 05:40Fellowship.
• 05:41She was aptly chosen
• 05:44by time
• 05:46as a hero of medicine.
• 05:49Definitely
• 05:50a hero of medicine
• 05:53and a hero of mine.
• 05:56I could go on and
• 05:57on, but you don't wanna
• 05:58hear from me. You wanna
• 06:00hear from her. So doctor
• 06:02Kay Jamieson Redfield.
• 06:14Thank you. How fabulous to
• 06:16be back at Yale. I
• 06:17love Yale. And I actually
• 06:19what what,
• 06:22doctor Bohmert didn't point out
• 06:24was that I actually invited
• 06:25myself up.
• 06:28So, thank you,
• 06:30very much indeed. And thank
• 06:31you for the wonderful work
• 06:33that's coming out of your
• 06:34lab and and your colleagues.
• 06:35It's just it's so
• 06:37imaginative
• 06:38and
• 06:39wonderful.
• 06:41This morning, I'm going to
• 06:43be talking about
• 06:44some of the things that
• 06:45we know clinically perhaps or
• 06:47personally, but don't talk about
• 06:49so much, which is some
• 06:50of the ethical aspects
• 06:52of having a psychotic illness,
• 06:54particularly some of the things
• 06:56that go on not infrequently
• 06:58in mania,
• 06:59which patients have to live
• 07:01with, families have to live
• 07:02with, society has to live
• 07:03with. And the question is,
• 07:05what do you do? What
• 07:06do you do
• 07:10okay. Great. Thank you.
• 07:14What do you do
• 07:15to try and understand,
• 07:19as were bad behaviors
• 07:21when nobody asks for this
• 07:23illness, nobody asks for mania,
• 07:24you don't sign up for
• 07:25it,
• 07:27and when it's so difficult
• 07:29to sort out seemingly
• 07:31character from disease.
• 07:33Mania often seems far more
• 07:35willful
• 07:36than it actually is,
• 07:38and people can't always control
• 07:40mania. It's not like you
• 07:41can just,
• 07:43always medicate it away because
• 07:45sometimes people obviously don't take
• 07:46their medications, and sometimes people
• 07:48just,
• 07:49get sick again.
• 07:51So some of the issues
• 07:53I wanna talk about in
• 07:54the life of the great
• 07:56American poet Robert Lowell
• 07:59is how much did the
• 08:01individual do to prevent recurrence?
• 08:03So that's one of the
• 08:04things that shows up in
• 08:05court, of course. If you're
• 08:06if you've done something that
• 08:08is against the law,
• 08:10a judge is going to
• 08:11ask you, what are you
• 08:12going to do
• 08:14to remain in treatment and
• 08:16and and to go along
• 08:17with treatment?
• 08:19Was the behavior during mania
• 08:21out of character, or was
• 08:23it perfectly consistent with somebody
• 08:24sort of sociopathic
• 08:26before they got sick and
• 08:28that just brought out that?
• 08:30Or was somebody actually just
• 08:32a perfectly fine person and
• 08:34all of a sudden is
• 08:35doing things completely out of
• 08:36character? What do you do
• 08:37with that? What does the
• 08:38individual do with that?
• 08:41And the response to behaviors
• 08:44done when when manic, of
• 08:46course, depend on the nature
• 08:47of
• 08:48the,
• 08:50nature of the mania, the
• 08:51nature of the symptoms. But
• 08:53what I'm gonna be talking
• 08:54about today
• 08:55are two of the symptoms
• 08:56that are very distressing to
• 08:57people indeed.
• 08:59One is,
• 09:00infidelity and sexual indiscretions,
• 09:03and one is violence.
• 09:05And what do you do
• 09:07about
• 09:08taking care of a patient,
• 09:10trying to look after a
• 09:11family, and so forth?
• 09:15And I think most importantly,
• 09:17again, something we probably don't
• 09:19talk about so much,
• 09:20what came up time and
• 09:21time again in the life
• 09:22of Robert Lowell, is what
• 09:24is the role of remorse?
• 09:27Robert Lowell was somebody who
• 09:28had twenty
• 09:29hospitalizations
• 09:30for mania.
• 09:32He got in a lot
• 09:33of trouble.
• 09:34Jail,
• 09:35straight jackets,
• 09:36hospitals over and over again.
• 09:39But he felt tremendous remorse.
• 09:41It was just these these
• 09:42behaviors were just not characteristic
• 09:43for him at all. So
• 09:45he had to spend a
• 09:45lot of time, and and
• 09:47his friends took him very
• 09:48seriously so that even though
• 09:49he had injured his friends,
• 09:51he still had
• 09:53very close friends to the
• 09:54end of, to the end
• 09:55of his life. And so
• 09:56what are some of the
• 09:57things that you can do?
• 09:58It's a hopelessly complicated
• 10:00situation.
• 10:02And there's a huge amount
• 10:03of suffering,
• 10:04not just obviously on the
• 10:05part of family members or
• 10:07society
• 10:08or friends,
• 10:09but for the individual,
• 10:11himself or herself. I mean,
• 10:13hospitalization,
• 10:14jail,
• 10:16divorce, repeated divorce,
• 10:18alienation of friends and colleagues,
• 10:20financial ruin,
• 10:22humiliation,
• 10:23damage to reputation and work.
• 10:26And these things are not
• 10:27easily rumbleed. So when we're
• 10:29talking about mania, we're talking
• 10:30about recurrence of mania. We're
• 10:31talking about, you know, bipolar
• 10:33illness. What we're also talking
• 10:34about is somebody who has
• 10:36to live with the consequences
• 10:38of the illness.
• 10:40So let me just
• 10:43I know this is easy.
• 10:49Thank you.
• 10:53He he pointed out I
• 10:54had to have a keyboard,
• 10:56okay, to get this started.
• 11:00So I wanna start with
• 11:02a great comment from Frank
• 11:04Sinatra
• 11:05who
• 11:07summed up the basic problem
• 11:08is, on the one hand,
• 11:10society and family members have
• 11:11their lives to live. On
• 11:13the other hand, the person
• 11:14with the illness
• 11:16has
• 11:17to get through the night.
• 11:19It's a very different set
• 11:20of moral
• 11:21issues.
• 11:23So
• 11:24Sinatra said, I'm for anything
• 11:26that gets you through the
• 11:27night, and I think that
• 11:28that is
• 11:29profound
• 11:30in an absolutely basic level.
• 11:31Whether it's
• 11:32alcohol or drugs
• 11:34or women or men, whatever
• 11:36it is,
• 11:38people have to survive, and
• 11:40it's not always a
• 11:41a a nice sort of
• 11:43thing.
• 11:45So today, I wanna talk
• 11:47about
• 11:47a little bit of an
• 11:48introduction to Robert Lowell, the
• 11:50poet,
• 11:51for those of you who
• 11:52aren't perhaps so familiar with
• 11:54his work or his life,
• 11:55extraordinary man,
• 11:58and then talk a bit
• 11:59about the issues of mania
• 12:01and violence and,
• 12:02sexual affairs
• 12:04and
• 12:05all the moral ambiguities that
• 12:06we know, and then end
• 12:08by talking a little bit
• 12:09about courage,
• 12:11which is
• 12:12something that is, I think,
• 12:15again, something we don't talk
• 12:16about perhaps as often as
• 12:18we could in the light
• 12:20of any kind of really
• 12:21serious chronic illness, not just
• 12:23mental illness. But certainly, in
• 12:24the case of a psychotic
• 12:26disorder, when you're terrified, it
• 12:28might come back again. You
• 12:29don't know what's gonna happen.
• 12:30You're surrounded complete
• 12:32uncertainty.
• 12:33Is how do you deal
• 12:35with that? And can you
• 12:36make a conscious,
• 12:38choice
• 12:40to live a courageous life?
• 12:41And I'll I'll talk about
• 12:43a little bit with Robert
• 12:44Lowell is he knew very
• 12:45early on. He was first
• 12:46sick when he was fifteen.
• 12:48He knew
• 12:49very early on that he
• 12:50was gonna have to contend
• 12:52with something beyond his control.
• 12:54And he studied courage, and
• 12:56he studied leadership, and he
• 12:57studied how people deal with
• 12:59ambiguity and uncertainty and suffered.
• 13:04So this Robert Lowell
• 13:05died in nineteen seventy seven.
• 13:10This is from one of
• 13:11his many, many hospitalizations at
• 13:13McLean.
• 13:14And on the admission form,
• 13:17many of his admissions were
• 13:18voluntary. Many of his admissions
• 13:20were involuntary, brought in by
• 13:22the police.
• 13:24But
• 13:25there's just this kind of
• 13:26note on his admission form.
• 13:28He had experienced attacks of
• 13:30mania in the past
• 13:31causing him great embarrassment.
• 13:34And this would be a
• 13:35theme throughout,
• 13:37Lowell's life with his illness.
• 13:43And I wanna acknowledge,
• 13:45Robert Lowell's daughter,
• 13:47Harriet Lowell, who
• 13:49was kind enough to allow
• 13:51me to find all of
• 13:53his psychiatric and medical records,
• 13:55of which there are many,
• 13:57and to be interviewed repeatedly
• 14:00and family photographs and so
• 14:02forth. And my husband, Tom
• 14:03Trail, who not only
• 14:05was the best editor one
• 14:07could wish, but he also
• 14:08he's cardiologist
• 14:09and,
• 14:11did a quite extensive
• 14:15appendix
• 14:16trying to sort out the
• 14:17role of heart disease,
• 14:19lithium, and mania.
• 14:27So Randall Gerrell, the great
• 14:29literary critic,
• 14:30poetry critic in particular,
• 14:33of his time, said that
• 14:34Robert Lowell's poetry
• 14:36will be read as long
• 14:37as men remember English.
• 14:40And,
• 14:42Lowell is hard to
• 14:44overstate
• 14:45how influential he was as
• 14:47a poet,
• 14:49how difficult he is. He's
• 14:50always said when people say
• 14:51Robert Lowell's poetry, they always
• 14:53say difficult poet. He was
• 14:55a difficult poet,
• 14:57but by no means, all
• 14:58of his poetry is is
• 14:59difficult.
• 15:01But brilliant, original,
• 15:05original,
• 15:07strong.
• 15:09So I wanna just read
• 15:11here.
• 15:12I'm I'm not gonna read
• 15:13it. Thank god.
• 15:15Rob Lowell's gonna read,
• 15:17just one poem to give
• 15:18you a sense of
• 15:23Oops. Yeah.
• 15:28Yeah.
• 15:33Thank you.
• 15:36Okay. So this is embedded
• 15:38sound.
• 15:39Alright. Let's see.
• 15:47You would think I'd have
• 15:48this.
• 15:49Shit.
• 15:51Hold on. Let's see. Back.
• 15:54You have to push it
• 15:55twice. I know that.
• 15:57Well, not that way. Hold
• 15:58on.
• 15:59Of course, he just left
• 16:01on us.
• 16:04Play it ten minutes ago.
• 16:05Yeah. I played ten minutes
• 16:06ago. So yeah. Say, hold
• 16:08on.
• 16:11Let's see if there's
• 16:13hold on.
• 16:21Wonder if I can play
• 16:22it from mine.
• 16:24Let me try that. Sound
• 16:25familiar. Let me try and
• 16:26play it from.
• 16:50They're into glitches.
• 16:54Well, so am I, but
• 16:55I don't want to.
• 17:10Sure.
• 17:13Reading myself. Yeah. Can you
• 17:15hear that? Like thousands,
• 17:18I took just pride
• 17:20and more than just,
• 17:22struck matches that brought my
• 17:24blood to a boil.
• 17:26I memorized the tricks to
• 17:28set the river on fire.
• 17:32Somehow
• 17:33never wrote something to go
• 17:35back to.
• 17:37And I suppose I'm finished
• 17:39with wax flowers
• 17:40and I burned my grass
• 17:42on the minor slopes of
• 17:43Parnassus.
• 17:45No honeycomb
• 17:47is built without a bee,
• 17:50adding circle to circle,
• 17:52cell to cell, the wax
• 17:55and honey of a mausoleum.
• 17:58This round dome
• 18:01proves its maker as a
• 18:02lion.
• 18:03The corpse of the insect
• 18:05lives embalmed in honey.
• 18:08Praise that it's perishable
• 18:10work live long enough for
• 18:12the sweet tooth bear to
• 18:14desecrate
• 18:15this open book,
• 18:17my open coffin.
• 18:20Thank you.
• 18:23So
• 18:25Lowell, as I say, was
• 18:26was acclaimed
• 18:28sort of took the mantle
• 18:29from TS Eliot,
• 18:32acclaimed,
• 18:34poet of time,
• 18:37multiple
• 18:38winner of the Pulitzer Prize.
• 18:39And,
• 18:41when he died,
• 18:43all of the major obituaries
• 18:45and all the major papers
• 18:46said he was the poet
• 18:47poet of his age.
• 18:49And his wife oh, I
• 18:51should say his he had
• 18:52three wives. His second wife,
• 18:55to whom he's married the
• 18:56longest, Elizabeth Hardwick herself, a
• 18:58great, great writer,
• 19:00said, you're a great American
• 19:01writer. You have told us
• 19:03who we are, like Melville,
• 19:05the most gifted in finding
• 19:06the symbolic meaning of this
• 19:08strange place.
• 19:10And I think that one
• 19:11of the things that Lowell,
• 19:13perhaps, particularly in this time,
• 19:14had a great capacity to
• 19:16love his country and be
• 19:18extremely critical of it,
• 19:20and to understand it and
• 19:21to understand it from,
• 19:23Mayflower's days to Vietnam War
• 19:26days.
• 19:29So
• 19:30Lowell had kinda classic bipolar
• 19:32illness for all of his
• 19:33twenty hospitalizations. He was diagnosed
• 19:35with bipo with manic depressive
• 19:37illness.
• 19:38He had positive family history
• 19:40for both mania and depression,
• 19:42onset in adolescence, twenty hospitalizations,
• 19:46a very a progressive course
• 19:49and lithium responsive.
• 19:53His clinical presentation was textbook,
• 19:56of of mania,
• 19:57rest, rapid escalation,
• 20:00enthusiasm,
• 20:01irritability,
• 20:03decreased sleep,
• 20:05increased speech, increased,
• 20:07aggression,
• 20:10impulsive purchases.
• 20:11At his place in England,
• 20:12when he went to live
• 20:13in England,
• 20:15he had
• 20:16written
• 20:18the
• 20:19about the dolphin, who he
• 20:21called his third wife the
• 20:23dolphin, and he had dolphins,
• 20:25stone dolphins all over his
• 20:27estate. I mean, he did
• 20:30get into things.
• 20:32He
• 20:32drank more
• 20:34and became more aggressive.
• 20:36But to say the two
• 20:37things I wanna focus on
• 20:38because there's some of the
• 20:40more difficult things that people
• 20:42have to deal with are
• 20:43verbal aggression and violence
• 20:45and extramural affairs.
• 20:49So Lowell
• 20:51said, perhaps one of the
• 20:53best descriptions I've ever read
• 20:56of bipolarous depression is an
• 20:57illness for oneself,
• 20:59and mania is an illness
• 21:00for one's friends.
• 21:02And so anybody who's been
• 21:04on the receiving end of
• 21:05the three o'clock in the
• 21:06morning phone call about some
• 21:08enthusiasm,
• 21:10you will appreciate that.
• 21:15So I wanna contrast Lowell
• 21:17when he was well with
• 21:18when he was sick.
• 21:20When he was well,
• 21:21Derek Walcott said he was
• 21:23extremely gentle,
• 21:25achingly well mannered. I mean,
• 21:26he was of old line
• 21:28washed who really was
• 21:30just unbelievably
• 21:32well mannered, soft spoken, gentle.
• 21:35Over and over again, gentle,
• 21:37kind.
• 21:38Everyone likes him, Isaiah Berlin
• 21:40said.
• 21:42His daughter and his stepdaughters
• 21:45said
• 21:46with great enthusiasm despite the
• 21:48things they'd been through with
• 21:49him,
• 21:50of how gentle and loving
• 21:52he was as a father.
• 21:54And his,
• 21:55Elizabeth Bishop, the the poet
• 21:57and his closest friend,
• 21:59the kindness was always the
• 22:00dominant note.
• 22:04And Norman Mailer, who wrote
• 22:06about him probably from a
• 22:07biographical
• 22:07descriptive point of view better
• 22:09than anyone, said that all
• 22:10flaws considered,
• 22:12Lowell was still a fine,
• 22:14good, and honorable man.
• 22:16So what happened? I mean,
• 22:18he got manic.
• 22:20And he was
• 22:24unbelievably sensitive and aware
• 22:26of what was going to
• 22:27happen to him. So he
• 22:28said, sometimes my mind is
• 22:30a rocked and dangerous bell.
• 22:33I climbed the spiral stairs
• 22:35to my own music,
• 22:36each step more poignantly oracular,
• 22:39something inhuman
• 22:41always rising in me. And
• 22:43this is all the kind
• 22:44of,
• 22:46aspects of Jekyll and Hyde,
• 22:48of what do you do
• 22:49when you are
• 22:51doctor Jekyll and you're inhabited
• 22:54by Hyde.
• 22:55You know, you haven't got
• 22:56many options, and you haven't
• 22:58got much control over it.
• 23:02So,
• 23:04Arterius
• 23:05of Cappadocia, put probably the
• 23:07the great original writer on
• 23:09mania, described the forms the
• 23:11two major forms of mania
• 23:12as we know them. We
• 23:13know a kind of,
• 23:15effervescent,
• 23:16ebullient form of mania.
• 23:20Cheerful, like to play.
• 23:22Some are passionate,
• 23:23of destructive type who seek
• 23:25to kill others
• 23:26as well as themselves.
• 23:28And sometimes these are go
• 23:30from the first form, the
• 23:32kind of euphoric form of
• 23:34mania, and then escalate into
• 23:36the very
• 23:37violent,
• 23:38paranoid, aggressive form.
• 23:42Tuuk in the late nine
• 23:44eighteen hundreds,
• 23:45said their sentiments and instincts
• 23:47are wholly transformed
• 23:48by the disease.
• 23:50Men formerly kind and benevolent
• 23:52become violent, passionate,
• 23:54vindictive.
• 23:55They acquire faults and vices
• 23:57foreign to their former nature
• 23:59and which render it impossible
• 24:01to live with them.
• 24:05In a review of studies
• 24:07of of violence,
• 24:11Fred Goodwin and I found
• 24:12that, you know, about almost
• 24:14half of people
• 24:15who are acutely manic
• 24:17had at least one episode
• 24:19of of violence. And, again,
• 24:20I think we talked not
• 24:22so much about it for
• 24:23a lot of reasons,
• 24:26But one reason is it's
• 24:27is it's stigmatizing. This is
• 24:29mental illness in general is
• 24:30stigmatized.
• 24:31We don't want, as clinicians,
• 24:33family members to further stigmatize
• 24:36it by saying it's violent,
• 24:37but it is potentially violent.
• 24:42And we know this from
• 24:43history by the ways that
• 24:44people have been treated,
• 24:46for mania.
• 24:49All kinds of restraining advice
• 24:50devices,
• 24:52people put in cribs, people
• 24:53hung from ceilings. If you
• 24:55look at the old literature
• 24:56on how to
• 24:58treat somebody with mania to
• 24:59control them, they're just every
• 25:01kind of,
• 25:03imaginable
• 25:04thing.
• 25:07This is Pennsylvania Hospital in
• 25:08mid eighteenth century.
• 25:10Again, these were,
• 25:12chains that were used and
• 25:14shackles for people with mania.
• 25:18So it's not like this
• 25:19is
• 25:20it's certainly not new, and
• 25:21it's not like you can
• 25:23overstate
• 25:24how violent mania can be.
• 25:27The question is, how do
• 25:28you understand it? What do
• 25:29you do about it?
• 25:31So I wanna talk a
• 25:32little bit about this kind
• 25:33of explosive
• 25:35irritability
• 25:37that underlies
• 25:38a lot of the violence
• 25:39in mania. This is,
• 25:41lord Byron who had a
• 25:42long, long family history,
• 25:44personal history, wrote as well
• 25:46as anybody in the English
• 25:47language
• 25:48about mania and depression.
• 25:51He said, as long as
• 25:52I can remember anything, I
• 25:53recollect being subject to violent
• 25:55proxisms of rage
• 25:57so disproportionate
• 25:58to the cause as to
• 25:59surprise me when they were
• 26:01over.
• 26:02Once the lurking devil in
• 26:03me is roused, I lose
• 26:05all command of myself.
• 26:06I do not recover a
• 26:08good fit of rage for
• 26:09days after.
• 26:10It shakes me terribly and
• 26:12leaves me no low
• 26:14and nervous after.
• 26:16And Sylvie Plath,
• 26:19wrote about her experience. This
• 26:21is an experience, mind you,
• 26:22in one of the London
• 26:23gardens,
• 26:25and she saw
• 26:27a young woman
• 26:29taking a, taking a flower
• 26:31from a stem in the
• 26:32in the gardens. So this
• 26:34is her reaction to that.
• 26:36I have violence in me
• 26:37that is hot as death,
• 26:39death blood. I can kill
• 26:40myself where I know it
• 26:41now,
• 26:42even kill another.
• 26:44I could kill a woman
• 26:45or wound a man, and
• 26:46I think I could. I
• 26:48gritted to control my hands,
• 26:49but had a flash of
• 26:50bloody stars in my head
• 26:52as I stared that sassy
• 26:53girl down and a blood
• 26:55longing to rush at her
• 26:57and tear her to bloody
• 26:59beating bits.
• 27:01These are, again, these violent
• 27:03states. This is something that
• 27:04was,
• 27:06not unfamiliar
• 27:08if you read the lives
• 27:09of writers and poets who
• 27:11who got these kind of
• 27:12mixed manias.
• 27:16Robert Lowell, getting mad to
• 27:17his life,
• 27:18some of the things he
• 27:19did when he was manic,
• 27:21he knocked his father to
• 27:22the ground
• 27:24and wrote about it for
• 27:26the rest of his life
• 27:27in remorse.
• 27:29Whoops. What did I do?
• 27:32No. Okay. He he broke
• 27:33his wife's nose.
• 27:36He tried to strangle her.
• 27:37He assaulted police officers.
• 27:39He was frequently put in
• 27:40straight jackets,
• 27:42put in jail,
• 27:43met
• 27:44them back into the hospital.
• 27:46Verbal cruelty, which is in
• 27:48some ways, verbal cruelty is
• 27:50not worse, but is a
• 27:51is a painful aspect of
• 27:53people say really truly awful
• 27:54things when they're manic.
• 27:56And it's very, very hard
• 27:58to to get that back
• 27:59again.
• 28:01Oops.
• 28:02The AB is on now.
• 28:03He's trying to fix it
• 28:04for you. So he might
• 28:06Oh. Just don't know.
• 28:08Let's see.
• 28:13That's him doing it.
• 28:17That's why it looks like
• 28:18there's a ghost down here.
• 28:24Is
• 28:32that okay?
• 28:34Share screen.
• 28:41Will he do this?
• 28:46So one of the things
• 28:47that I wanna
• 28:49emphasize is there are a
• 28:50lot of reasons for
• 28:52violence and mania, almost certainly
• 28:53the main one being this
• 28:55kind of mixed state
• 28:56of irritability,
• 28:58aggravation,
• 28:59paranoia,
• 29:01mixed in with,
• 29:03bad judgment, uncontrollable,
• 29:06impulsiveness.
• 29:07But another aspect of it
• 29:08is if you
• 29:10get manic delusions of grandeur,
• 29:14which is not uncommon, perhaps
• 29:15a little less common now
• 29:16than it used to be,
• 29:19And if, like, Lowell, you
• 29:20believe that you were the
• 29:21Holy Ghost
• 29:23or Christ
• 29:24or Achilles
• 29:25or Alexander the Great,
• 29:27the moral constraints of the
• 29:29world do not seem to
• 29:30apply.
• 29:31So when you're delusional,
• 29:32you know, it's not to
• 29:34give you free pass. It's
• 29:35just to say when people
• 29:36are delusional, obviously,
• 29:38they are
• 29:39give themselves
• 29:41certain attitudes.
• 29:42And in the case of
• 29:43Robert Lowell,
• 29:44partly, I think, because he
• 29:45was a very imaginative pope,
• 29:47but
• 29:48he
• 29:49had unbelievable,
• 29:52number of people that he
• 29:54identified with or thought he
• 29:55was. So he thought he
• 29:56was Achilles.
• 29:57He thought he was Julius
• 29:59Caesar. He thought he was
• 30:00Alexander the Great, TS Eliot,
• 30:02Homer,
• 30:03on and on. Napoleon.
• 30:05But a lot of these
• 30:06people, Hitler,
• 30:07Aeneas, I mean, a lot
• 30:08of these people are people
• 30:09who had enormous power
• 30:12as is thought that uncommonly
• 30:14the case in man delusions.
• 30:17Now, again, no control over
• 30:18this. You can't if if
• 30:20you think you're Julius Caesar,
• 30:22it's not because you're willing
• 30:23yourself to be Julius Caesar.
• 30:25You're that's what you're given.
• 30:27So, again, the question is,
• 30:29what do you do with
• 30:29that?
• 31:27She's depressed.
• 31:28She could just press the,
• 31:29the booty call button. Everything's
• 31:30fixed now. Okay. Fixed. Yeah.
• 31:32Yeah. The the The network
• 31:33and the
• 31:34the. Yeah. The network issue
• 31:37blocked everything out. Yeah.
• 31:41Okay. Thank you. If you
• 31:43switch.
• 31:43Oh,
• 31:44I'm from here.
• 31:58Huge problems in relationships.
• 32:00You can say to a
• 32:01spouse who's in your office
• 32:03with your patient,
• 32:05having affairs
• 32:07is
• 32:08not uncommon at all when
• 32:10people are are manic.
• 32:12That doesn't cut it. You
• 32:14know? I mean, as you
• 32:14can imagine, I mean, it
• 32:16it's true,
• 32:18but it doesn't pay the
• 32:19rent.
• 32:21So in the case of
• 32:22Robert Lowell,
• 32:24it's just a quote for
• 32:25one of his beautiful
• 32:27poems. Ode to break loose
• 32:29all life's grandeur is something
• 32:30with a girl in summer.
• 32:33Lowell was
• 32:35a very attractive man
• 32:37and
• 32:40was teaching at Harvard most
• 32:42of his adult life,
• 32:43and there were a lot
• 32:44of Harvard undergraduate
• 32:46students around.
• 32:47So every time he would
• 32:49get manic,
• 32:51he would tell his wife,
• 32:54we're getting divorced. He would
• 32:55buy an apartment
• 32:57for his,
• 33:01some student
• 33:02and say he was gonna
• 33:03marry her and so forth.
• 33:04Well, this was just no
• 33:06end of problems as you
• 33:07can imagine.
• 33:08In this day and age,
• 33:10he wouldn't last very long
• 33:11at Harvard, but, you know,
• 33:13at that time,
• 33:15he did.
• 33:17So
• 33:18Emil Krepelon said that sexual
• 33:20side ability has increased and
• 33:21leads to hasty engage engagements,
• 33:23marriages by newspaper,
• 33:25improper love adventures.
• 33:27It's a sort of a
• 33:28euphemistic way,
• 33:30putting what people do. But,
• 33:33and in the DSM five,
• 33:34of course, one of the
• 33:36criteria one of the inclusionary
• 33:38criteria
• 33:39for mania
• 33:41is sexual indiscretions.
• 33:46Again, when we reviewed the
• 33:47limited number of studies that
• 33:49there are, about, again, about
• 33:50fifty
• 33:51fifty plus,
• 33:53patients
• 33:54who went manic
• 33:55have,
• 33:56affairs, get hypersexual,
• 33:59but do something that's,
• 34:01along the line of hypersexuality.
• 34:04So it's complicated with with,
• 34:06affairs because
• 34:08love affairs in the absence
• 34:09of mania
• 34:11are scarcely uncommon.
• 34:12People have affairs a lot.
• 34:15Lowell was an attractive man
• 34:17as well as the most
• 34:18famous poet in America, if
• 34:20not the world.
• 34:22His affairs were destructive to
• 34:24his wife,
• 34:25to the women involved,
• 34:27to young girls involved,
• 34:29and to himself.
• 34:31And but most of his
• 34:33intense affairs were in the
• 34:34context of mania, and they
• 34:35were followed by very deep
• 34:37depressions for what he'd done
• 34:38to his wife and to
• 34:39the woman involved
• 34:41and by a deep remorse.
• 34:46And this is a letter
• 34:47he wrote to TS Eliot.
• 34:49The whole business has been
• 34:50very bruising,
• 34:52and it's it is fierce
• 34:54facing the pain I have
• 34:55caused
• 34:56and humiliating
• 34:58to think that it has
• 34:59all happened before and the
• 35:00control and self knowledge
• 35:02comes slowly,
• 35:03if at all.
• 35:06So this comes then down
• 35:08to the issue
• 35:09of moral ambiguity
• 35:11of just how complicated it
• 35:12is. And if there are
• 35:14easy answers, we would have
• 35:15found them. We don't have
• 35:16them, but I think thinking
• 35:18about them is
• 35:19interesting. So this again, Elizabeth
• 35:21Hardwick, the writer who is
• 35:23married to,
• 35:25Lowell and was terrific,
• 35:26you know,
• 35:27to her to his dying
• 35:29day, to her dying day,
• 35:31enormously
• 35:32loyal, understanding,
• 35:33deeply in love with him,
• 35:36and he's extremely close to
• 35:38her.
• 35:39If only these things of
• 35:40Cal
• 35:41Lowell, if only these things
• 35:43of Cal's were simply distressing,
• 35:46but they caused me and
• 35:47other people real suffering.
• 35:49And for what?
• 35:51I do not know the
• 35:52answer to the moral problems
• 35:54posed by the conduct of
• 35:55a deranged person.
• 35:57But the dreadful fact is
• 35:59that in purely human terms,
• 36:01this deranged person does a
• 36:02lot of harm.
• 36:06So if it it it
• 36:07so you get into the
• 36:09problem of an illness that
• 36:10once you've got once you're
• 36:11acutely manic, you have next
• 36:13to no control over what
• 36:15you do.
• 36:18And when you're well or
• 36:19recovered,
• 36:20you don't have any guarantee
• 36:22that you're not gonna get
• 36:23sick again.
• 36:25Hopefully, you won't in this
• 36:26day and age, but people
• 36:28again, people stop their medications.
• 36:30Medications are a lot of
• 36:32breakthroughs in medications.
• 36:33So
• 36:34what can be done?
• 36:36One thing is is remorse.
• 36:38And I think that it's
• 36:39one of those kind of
• 36:40biblical concepts,
• 36:42that priests and ancient doctors
• 36:45used a lot, which is,
• 36:46you know, genuine remorse. And,
• 36:48of course, in this day
• 36:48and age,
• 36:49AA and,
• 36:51the various self help groups
• 36:52put a tremendous
• 36:54emphasis on
• 36:56reach out to people whom
• 36:58you have hurt
• 36:59and try and make amends.
• 37:02Psychotherapy can certainly be helpful,
• 37:04and and Lowell found psychotherapy
• 37:06very helpful.
• 37:08And early warning about symptoms.
• 37:10I think in this day
• 37:11and age, you know, I'm
• 37:12trying to warn people that
• 37:13this is what happens
• 37:15at the beginning at the
• 37:16beginning symptoms of mania and
• 37:18so forth. Important to get
• 37:19Medicaid and so forth. That's
• 37:21easier said than done.
• 37:23But I want to turn
• 37:24at
• 37:25at at and end
• 37:27a little bit
• 37:29about the notion of courage,
• 37:30that we're all given things
• 37:32that are difficult
• 37:33to handle.
• 37:35And what is it that
• 37:37one can do
• 37:38reasonably
• 37:39about that and try?
• 37:41And I
• 37:43I like Lowell. I mean,
• 37:44I I've loved Lowell since
• 37:45I was seventeen, but I
• 37:47I like Lowell because his
• 37:48character is complicated
• 37:50by the things that he
• 37:51did. But his character is
• 37:53exemplary
• 37:54in
• 37:55the
• 37:57thinking
• 37:58and feeling
• 37:59that he tried to bring
• 38:01to bear to making a
• 38:02difference in his illness.
• 38:04And one of those things
• 38:06was from the time he
• 38:07was very young,
• 38:08he studied courage. And
• 38:12so he was an Episcopalian
• 38:17and,
• 38:18was well aware of the
• 38:20things that went you know,
• 38:22things left undone in depression
• 38:24and things done
• 38:26in mania. And we don't
• 38:27again, we I think we
• 38:28don't focus enough on those
• 38:29things not done in depression
• 38:30because that also riles,
• 38:33households.
• 38:35But
• 38:36mania is perhaps a little
• 38:37bit
• 38:38more
• 38:39obvious.
• 38:43So
• 38:44his his great friend and,
• 38:46initially, a student, Greg Gowrie
• 38:47at Harvard,
• 38:50said that you know, talked
• 38:52I had long conversations with
• 38:54with him about
• 38:56what it was that Lowell
• 38:58tried to do once he
• 38:59got over being manic and
• 39:01he had to go look
• 39:02at the ruins and pick
• 39:04up the pieces and feel
• 39:05humiliated and wanna die and
• 39:07so forth.
• 39:08And he said that he
• 39:09was consumed by guilt and
• 39:11remorse,
• 39:12by the awfulness of what
• 39:14he had done.
• 39:15He was a very gentle
• 39:16and sweet man.
• 39:18These things were quite out
• 39:19of character. He was shattered
• 39:21by his own cruelty.
• 39:26And to his third wife,
• 39:28after Elizabeth Hardwick,
• 39:31Lowell wrote, it's the most
• 39:33awful feeling.
• 39:34I never know when I
• 39:35when I'm going to hurt
• 39:36the people I love most.
• 39:38I simply can't stand it.
• 39:40And in a way, I
• 39:41would rather be dead.
• 39:47So as I say, when
• 39:48he was this is this
• 39:50this is excerpt from a
• 39:51poem that he wrote when
• 39:52he was a very young
• 39:53man,
• 39:54and,
• 39:55again,
• 39:56based on,
• 39:58biblical writings.
• 40:01But your lacerations
• 40:03tell the losing game you
• 40:04play against a sickness past
• 40:06your cure.
• 40:07How will the hands be
• 40:09strong?
• 40:10How will the heart endure?
• 40:12And he took these things
• 40:13and and thought about them.
• 40:14It's very hard to say
• 40:16how far he got with
• 40:17them, but he thought about
• 40:19them. And,
• 40:20perhaps that's all one can
• 40:22do,
• 40:23up to a point.
• 40:25So Lord Moran, who is
• 40:27Churchill's personal physician during the
• 40:30second World War, was somebody
• 40:31actually, had been a very
• 40:32highly decorated soldier himself during
• 40:35the first World War and
• 40:36wrote what kind of one
• 40:37of the classic books on
• 40:38courage.
• 40:40And one of the things
• 40:41he said, you know, is
• 40:42that we all think of
• 40:43courage as something that,
• 40:46you have it or you
• 40:46don't have it. It's innate
• 40:48or it's not.
• 40:50In fact, there's more of
• 40:51a conscious element to it
• 40:53that courage is a cold
• 40:54choice
• 40:55between two alternatives,
• 40:57the fixed resolved
• 40:59not to quit.
• 41:00It is the individual's exercise
• 41:02of mind over fear
• 41:04through self discipline.
• 41:06And these are all kind
• 41:07of old fashioned concepts, and
• 41:09they kinda go out in,
• 41:10you know, in a in
• 41:11a way in the day
• 41:12of wellness
• 41:13and so forth. But it's
• 41:15these are
• 41:16these were values that when
• 41:18people
• 41:19were trying to deal with,
• 41:21in the case of,
• 41:23soldiers coming off the battlefield,
• 41:26you know, there were only
• 41:27so many things they could
• 41:28do. They could adapt, not
• 41:30adapt, deal with it, not
• 41:31deal with it,
• 41:32have psychotherapists,
• 41:34which was one of the
• 41:35great guests of the first
• 41:36World War.
• 41:40So as I say,
• 41:41Lowell studied courage. He his
• 41:43letters,
• 41:44prose, poetry
• 41:46reflect a deep, deep study
• 41:49of what it means to
• 41:50be courageous in difficult circumstance.
• 41:53And in order to understand
• 41:55courage, he read deeply in
• 41:57biography, history, and religion,
• 42:00and he read all the
• 42:01time,
• 42:02about these things.
• 42:05He was also very clear
• 42:06eyed about the dangers of
• 42:07his illness and trying to
• 42:09protect other people from himself,
• 42:12which is not always
• 42:14possible.
• 42:17He said to his psychiatrist,
• 42:19I think therapy
• 42:20can help me not to
• 42:21give up
• 42:22or run away.
• 42:24I think I can learn
• 42:25to use my head and
• 42:26eyes together.
• 42:28I want to be able
• 42:29to see my faults,
• 42:30do something about them, be
• 42:32a good husband, a writer
• 42:33who can grow,
• 42:35and a steady, capable teacher.
• 42:41So I I want to
• 42:42end on
• 42:46what a difference, obviously,
• 42:49medication can make
• 42:50up to a point, but
• 42:51then also how contending
• 42:53with when the
• 42:55medication doesn't work,
• 42:57or
• 42:59or doesn't work as well
• 43:00as one might might like
• 43:01is,
• 43:02again,
• 43:04what are the things that
• 43:05go into people who have,
• 43:07I think, a very strong
• 43:08courageous core and wanna end
• 43:11on
• 43:11something that Lowell wrote,
• 43:13just a few months before
• 43:14he died.
• 43:17So this is hospitalizations
• 43:19for,
• 43:20Lowell over time,
• 43:22and you can see that
• 43:24he was actually given lithium
• 43:25reasonably early in the course
• 43:27of lithium treatment in this
• 43:28country.
• 43:29And he did
• 43:31really well on lithium.
• 43:35He had one kind of
• 43:36breakthrough,
• 43:37not a very bad one,
• 43:38but a breakthrough.
• 43:40And then he had he
• 43:41got lithium toxic.
• 43:43So in the
• 43:45about nineteen seventy five, he
• 43:47died in nineteen seventy seven,
• 43:49he
• 43:50got,
• 43:52very toxic.
• 43:53The doctors
• 43:54pulled him
• 43:55down
• 43:56on his lithium,
• 43:58and probably pulled him down
• 44:00too far, but there was
• 44:01no way of knowing that.
• 44:02I mean, not to blame
• 44:03the doctors. This is to
• 44:04say that looking back on
• 44:06it, they probably
• 44:08drew him down too far
• 44:09on his lithium.
• 44:10And then in the last
• 44:12two years of his life,
• 44:14he was backed in a
• 44:16way to a very recurrent
• 44:17pattern
• 44:18of of lithium.
• 44:20But he was a great
• 44:22advocate for lithium. And when
• 44:23people would talk about, oh,
• 44:24what's gonna happen to your
• 44:25poetry? What's gonna happen to
• 44:26this? He would say, basically,
• 44:27you know,
• 44:29I'm gonna take lithium. It
• 44:30works.
• 44:33So the question, I think,
• 44:35for anybody who has bipolar
• 44:37oils is the whole issue
• 44:39of, is it gonna come
• 44:40back again and how do
• 44:41you deal with it? And
• 44:41these are very famous lines
• 44:43that are are
• 44:45not attributed to Lowell, but
• 44:46they are from Lowell. If
• 44:47we see a light at
• 44:48the end of the tunnel,
• 44:50it's the light of an
• 44:51oncoming train.
• 44:52And so just when he
• 44:53thought he was out of
• 44:55the woods,
• 44:56he got very sick again.
• 45:01And so we're gonna end,
• 45:03by talking about the last
• 45:04few months of Lowell's life,
• 45:08and, actually, last year. And
• 45:11he had, again, had recurrence
• 45:13of his mania, a private
• 45:14nursing care, two hospitalizations.
• 45:16So completely demoralized. Right? Completely
• 45:19demoralized by that.
• 45:21And hospitalization
• 45:22at MGH
• 45:23for congestive heart failure.
• 45:26His,
• 45:27third marriage was
• 45:29a a wreck and a
• 45:30ruin and a nightmare.
• 45:33And he published,
• 45:36what I
• 45:38think
• 45:39is what kept him alive
• 45:41as well as it did,
• 45:42kept him through all these
• 45:44periods of needy remorse, of
• 45:46of terrible disease and so
• 45:48forth,
• 45:49of
• 45:50some spirit that
• 45:52great writers often have, great
• 45:54people often have, which is
• 45:57that belief that
• 45:59life is
• 46:01going on in one form
• 46:03or another's.
• 46:04So and he so in
• 46:07Day by Day,
• 46:08which was the last volume
• 46:09of poems that he wrote,
• 46:10which is a heartbreaking
• 46:12volume, on one might add,
• 46:14and quite beautiful,
• 46:17he
• 46:18wrote about that, and I'll
• 46:19I'll get to that in
• 46:20a second. And then he
• 46:21he died
• 46:22of cardiac death,
• 46:24in September of nineteen seventy
• 46:26seven.
• 46:27But
• 46:28he he wrote a
• 46:30a poem,
• 46:31and,
• 46:33my husband and I had
• 46:34been talking to
• 46:36a young singer songwriter
• 46:38in Massachusetts,
• 46:41Mick Hutchinson,
• 46:42who
• 46:44loved Robert Lowell and has
• 46:46spent far more than it's
• 46:47a fair
• 46:49amount to ask anybody to
• 46:50spend in a hot in
• 46:51McLean
• 46:52for mania herself.
• 46:55And we asked her to
• 46:57put to music
• 47:00five or six of Lowell's
• 47:01songs
• 47:02poems.
• 47:03And so this is from
• 47:05his last collection,
• 47:06as I say, just published
• 47:08just a few months before
• 47:09he died. And it, I
• 47:11think, personifies a certain amount
• 47:13of that that
• 47:14character on the other side.
• 47:17It's amazing
• 47:22that this
• 47:23still here,
• 47:30Like lightning
• 47:32on an open field.
• 47:59To affirm our
• 48:02and transient
• 48:14Swimming in variation.
• 48:23Fresh as old man first
• 48:25broke.
• 48:32Like the crocus.
• 48:53Here,
• 48:56swimming in variation.
• 49:04Fresh as in man
• 49:39Thank you.
• 49:56Are there any questions?
• 49:58Yes.