A Summer of Madness

By Oliver Sacks
The New York Review of Books, September 25, 2008

Edited by Andy Ross

Hurry Down Sunshine
By Michael Greenberg

Manic-Depressive 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 Jamison

"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.

Kay Redfield 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, she writes:

"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 human relationships.

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 side.

AR Interesting manifestation of the physicality of mind. My own bipolar tendencies have evolved into a chronic aspie serenity — solipsistic consciousness and so on.

Oliver Sacks

By David Wallace-Wells
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 nursing homes.

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."

From the 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 directly.