November 2, 2009 — How can you tell the difference between grief and depression?
For Kay Redfield Jamison, the distinction is critical.
"It has been said that grief is a kind of madness. I disagree," Jamison told a nearly full house Thursday at the University of Virginia's Newcomb Hall Theater.
Jamison, a psychologist, knows firsthand: She detailed her own experience with manic depression, as well as research on the disorder, in her groundbreaking 1995 book, "An Unquiet Mind."
Then she lost her husband to cancer after almost 20 years together. Her most recent book, "Nothing Was the Same," not only pays tribute to Dr. Richard Wyatt, but also makes distinctions between grief, a human condition that eventually shows a way back to life, and depression, a disease that alienates one from life.
While learning to live with manic depressive, or bipolar, disorder, Jamison said she thought she had to trade love for sanity, to give up having a passionate love relationship for the sake of having a settled life. Wyatt both upended that cautious stance and supported her fully in dealing honestly with her mental illness, especially considering her profession. He encouraged her "to write from the heart," she said.
Reading from the prologue to "Nothing Was the Same," Jamison said, "There is a sanity to grief, in its just proportion of emotion to cause, that madness does not have."
Jamison said grief can trigger or reveal untreated depression, but they are not the same. Grief can become unhealthy if it keeps one from engaging in life after the initial feeling of being engulfed, she said.
People really shouldn't be medicated while grieving. As someone who has bipolar disease, however, she depends on medicine.
Grief will hit in waves, strike when one feels most alive. Depression is unrelenting, impenetrable. "One cannot access the beat of life," she said
Grief makes one distraught, but not deranged like bipolar illness does.
After a loved one dies, we may grieve over lost dreams, but we don't lose the ability to dream, which Jamison ascribed to manic-depressive disorder.
Grief will be restorative, whereas depression can be "lethal," she said.
Grief will yield memories and a new relationship with the dead loved one, a gift depression cannot give.
Jamison spoke with admiration about her husband, an expert on schizophrenia, when describing his struggle to overcome severe dyslexia. He had his patients read back the prescriptions he wrote for them to make sure he had written the dosage correctly.
She spoke of him fondly, describing him as "catnip for women" and said he was fun to be with. Life with him she described as "a blithe time, and it did not last."
She also found out he kept a syringe and antipsychotic drug hidden in case he ever needed to give it to her if she went out of control. He explained, "Medicine is imperfect ... love is imperfect."
Wyatt had beaten Hodgkin's disease when young, and he lived more than 35 years after that, but the price he paid for the earlier aggressive radiation and chemotherapy was getting cancer in middle age.
Both of them were concerned his illness and impending death would push her into a manic-depressive relapse. It did not happen, Jamison discovered.
"As it transpires, grief follows its own path," she said.
The night before he died, Wyatt encouraged Jamison to go home and get a good night's sleep, knowing she wouldn't sleep in the hospital. Sleep is essential for everyone; people with bipolar disease particularly benefit from its restorative and calming effects.
His gesture showed his understanding and concern for her, she said.
Hope can find a place in grief, but not in depression, she said. Remembering a trip to the natural history museum, Jamison said while walking through an exhibit of owls, she thought about how they were no more – dead and fixed. That state, however, enabled her to view their parts and proportions. She realized how death and grief instruct us.
"All die; much is lost, but not everything," Jamison said.
A professor of psychiatry, Jamison is co-director of the Mood Disorders Center at Johns Hopkins University. She has written several other books about manic-depressive disorder and suicide, and manic-depressive disorder and creativity.
U.Va. alumnus Chadrick Lane, a research fellow at the National Institute of Mental Health, began corresponding with Jamison following his own diagnosis of bipolar disorder. After a suicide attempt and hospitalization, Lane turned to Jamison's books as a way to understand what was happening to his mind.
Lane worked with U.Va.'s Counseling and Psychological Services and the Department of Psychiatry and Neurobehavioral Sciences to bring Jamison to Charlottesville.