Jamison and Bipolar Disorder 1

Clinical Case Formulation: Kay Redfield Jamison and Bipolar Disorder

Emma Hans

90319302

Psychology 270

Paper 1

Dr. Ashley Gearhardt, Instructor

Heidi Westerman, GSI

Clinical Case Formulation: Kay Redfield Jamison and Bipolar Disorder

Kay Redfield Jamison is a 76-year old Caucasian woman, originally from Washington,

whose medical and personal history is detailed in the memoir An Unquiet Mind: A Memoir of

Moods and Madness. She has since lived in Baltimore, Maryland, and has traveled to Scotland

and England for her various academic pursuits (Jamison, 1995). From studying and researching

topics in psychology and zoology at UCLA and the University of St. Andrews, to then pursuing a

Ph.D. in psychology at UCLA, joining the UCLA psychology faculty as an assistant professor,

and having various other positions as a clinician in the adult inpatient service of a hospital,

researcher, director of a medical clinic, author of medical texts, and senior research fellow,

Jamison has had a long history in the field of psychology (Jamison, 1995).

Diagnostic Information

In her memoir, Jamison's symptoms best align with a diagnosis of Bipolar I Disorder.

According to the DSM-5, this diagnosis requires the presence of 1 lifetime manic episode

(defined as distinctly elevated and/or irritable mood and abnormally increased activity and/or

energy) along with 3 of the following symptoms noticeably changed from baseline (typical

behavior) (4 symptoms if irritable mood is present): an increase in goal-directed activity or

psychomotor agitation; unusual talkativeness or rapid speech; flight of ideas or the subjective

impression that thoughts are racing; a decreased need for sleep; increased self-esteem or a belief

that one has special talents, powers, or abilities; distractibility or attention being easily diverted;

and/or excessive involvement in pleasurable activities that are likely to have painful

consequences (e.g. reckless spending, sexual indiscretions, unwise business investments, etc.)

(Kring, Johnson, Davidson & Neal, 2014, p. 128). These symptoms must be present for most of

the day, nearly every day, for one week, require hospitalization, or include psychosis, and cause
Jamison and Bipolar Disorder 3

significant distress and/or functional impairment (Kring, et al., 2014, p. 128). In high school,

Jamison exhibits unusual talkativeness and/or fast speech, as illustrated by the conversations she

had with her friends, where they would tell her, "You're talking too fast, Kay" (Jamison, 1995, p.

37). She additionally exhibited a lack of sleep during this period, where she would "[stay] up all

night, night after night, out with friends, reading everything that wasn't nailed down, filling

manuscript books with poems and fragments of plays, and making expansive, completely

unrealistic, plans for [her] future" (Jamison, 1995, p. 36). Her attention was also easily diverted:

"I could not begin to follow the material presented in my classes, and I would find myself staring

out the window with no idea of what was going on around me" (Jamison, 1995, p. 37). Another

symptom experienced during adolescence was a belief that she had special abilities, that she was

unstoppable, as exemplified in her description of that time in her life: "I felt I could do anything,

that no task was too difficult" (Jamison, 1995, p. 36). Later on in her life, she exhibited the

symptom of an increase in goal-directed activity, while working as a part of the psychology

faculty at UCLA: "I worked very hard, and slept very little" (Jamison, 1995, p. 67). It was also

during this period that her thoughts were racing more than ever before, and she was incapable of

controlling them, thus exemplifying the symptom of a flight of ideas and racing thoughts: "my

mind was beginning to have to scramble to keep up with itself, as ideas were coming so fast that

they intersected one another at every conceivable angle" (Jamison, 1995, p. 72). She also

frequently experienced excessive involvement in pleasurable activities that are likely to have

painful consequences multiple times in her life, starting with an excess of books in college, to a

modern apartment and furniture, then a horse, and many more items (Jamison, 1995). Lastly, she

had experienced a manic episode more than once in her life, as exemplified in her time as a

clinician: "My enthusiasms were going into overdrive . . . I got into a frenzy of photocopying: I
Jamison and Bipolar Disorder 4

made thirty to forty copies of a poem by Edna St. Vincent Millay, an article about religion and

psychosis from the American Journal of Psychiatry, and another article . . . and passed them out

to everyone I could" (Jamison, 1995, p. 72). All of these symptoms were present throughout

Jamison's history with bipolar disorder, not just in these specified instances.

Her symptoms first presented themselves during her senior year of high school in her

"first attack of manic-depressive illness" (Jamison, 1995, p. 36): she "raced about like a crazed

weasel, bubbling with plans and enthusiasms," had periods where she didn't sleep, studied all

night, believed her world was "full of promise and pleasure", had a sense of euphoria, talked

extremely fast, along with other symptoms, and this "attack" was short-lived, according to

Jamison (Jamison, 1995, p. 37). This period persisted for an unspecified, but short duration, not

to where it was life-impairing. The more intense types of episodes, or as Jamison describes, "the

very severe manic episodes that came a few years later and escalated wildly and psychotically

out of control" (Jamison, 1995, p. 37) came later in her life in college and beyond, where social

and occupational impairment began to show itself, and the first signs of psychosis appeared as

well. Her, as Jamison puts it, "acceleration from quick thought to chaos was a slow, but seductive

[acceleration]" (Jamison, 1995, p. 68): over the span of a few weeks, from exhibiting symptoms

of dressing much more provocatively than usual, wearing much more makeup, being "frenetic

and far too talkative" (Jamison, 1995, p. 71), becoming "increasingly restless, irritable, craving

excitement,", separating from her husband, buying an uncharacteristically modern apartment,

going on multiple buying sprees, her thoughts "so fast that [she] couldn't remember the

beginning of a sentence halfway through," (Jamison, 1995, p. 82), and months later culminating

in Jamison engaging in self-harm, physically assaulting a friend, and attempting suicide

(Jamison, 1995, p. 114). This particular episode that culminated in Jamison's suicide attempt
Jamison and Bipolar Disorder 5

seemed to be the worst episode she experienced, in that she went from an extreme high, engaging

in promiscuous activity, to hurting herself and her companion, and attempting suicide via a drug

overdose: "I can't think, I can't calm this murderous cauldron, my grand ideas of an hour ago

seem absurd and pathetic . . ." (Jamison, 1995, p. 114). Evidence that all of these behaviors were

impairing is exemplified throughout multiple different episodes, from Jamison's episodes

preventing her from attending classes and thus receiving poor grades, to Jamison's impulsive

buying resulting in heaps of notices from the bank to where her brother had to take out a loan to

support her, to her lack of sleep and frenetic energy further provoking later episodes and

negatively affecting her physical health, her "restless energy and irritability" resulting in her

breaking up her marriage, thus affecting her personal relationships, etc. (Jamison, 1995). These

experiences evidently impaired her economically, physically, and socially. The one aspect of her

life not directly affected by her mania was her work, as her restless energy and drive allowed her

to work more and achieve more (Jamison, 1995).

Differential diagnosis

Another diagnosis that could be considered for Jamison that has similar symptoms, some

of which were presented by Jamison at one point in her life, is bipolar II disorder. The criteria for

bipolar I and bipolar II disorder are related to one another, with the differences being that bipolar

I requires at least one lifetime manic episode (with distinctly elevated and/or irritable mood and

abnormally increased activity and/or energy) with symptoms being noticeably changed from

baseline, being present most of the day, nearly every day, for at least 1 week (Kring, et al., 2014,

p. 128). Bipolar I disorder also may require hospitalization, which they considered for Jamison,

and/or include psychosis, which Jamison experienced, and causes significant distress and/or

functional impairment, which Jamison also experienced (Kring, et al., 2014, p. 128). Bipolar II
Jamison and Bipolar Disorder 6

requires the presence of at least one hypomanic episode and one major depressive episode, with

clear changes in functioning being observable but not impairing, no psychotic symptoms present,

and these symptoms must last for at least 4 days (Kring, et al., 2014, p. 128). Jamison should be

diagnosed with bipolar I disorder in lieu of bipolar II disorder because, even though Jamison did

experience less severe manic episodes earlier on in her life, as characterized by hypomania, and

experienced depression between all of her manic episodes, Jamison's manic episodes were

impairing and caused her significant emotional distress, and she experienced psychotic

symptoms later on in life. For a diagnosis of bipolar II, the presence of one major depressive

episode must be present because of the lack of severity of the manic symptoms (Westerman,

personal communication, February 14, 2022). In Jamison's case, her depressive episodes were

not as prevalent as her manic episodes. Another disorder that Jamison could be diagnosed with

based on her symptoms is major depressive disorder; however, though she had several major

depressive episodes throughout her lifetime, experienced them for the two weeks necessary to be

diagnosed, and experienced them episodically alongside her manic episodes, the primary

symptoms that appeared earliest in her life coincide with those of bipolar I disorder, and those

manic symptoms remained evident in their impact on her day-to-day life. Therefore, upon

looking at the whole of her experience, and not just the first presentation of mania in

adolescence, I would diagnose her with bipolar I disorder.

Treatment

In her memoir, Jamison mentioned two main forms of treatment: medication and

psychotherapy. As stated in the book Abnormal Psychology, "medication is a necessary part of

treatment for bipolar disorder, but psychological treatments can supplement medication to help

address many of its associated social and psychological problems" (Kring, et al., 2014, p. 147).
Jamison and Bipolar Disorder 7

The combination of both methods appeared to be helpful, as her psychotherapist helped her

reason through why certain symptoms were happening to her, and recommended that she

consider hospitalization, and further treatment beyond what she was receiving (Jamison, 1995).

Her mood-stabilizing medication (lithium), though relieving her of the majority of her manic

symptoms, initially distorted her reality, due to the higher dosage she was taking, but upon

decreasing the dosage, she was able to control her mania while also experiencing life fully: "A

few days after lowering my dose . . . my steps were literally bouncier than they had been and I

was taking in sights and sounds that previously had been filtered through thick layers of gauze"

(Jamison, 1995, p. 161). According to Abnormal Psychology, "drugs are the most commonly

used and best-researched treatments for [bipolar disorders]" (Kring, et al., 2014). Though

Jamison experienced side effects, its main purpose of relieving her manic symptoms was

fulfilled: "the extremes in my moods were not nearly as pronounced as they had been . . ."

(Jamison, 1995, p. 169). Other potential treatments that Jamison could have received were

anticonvulsants (divalproex sodium), or antipsychotics (olanzapine); "these are recommended for

people unable to tolerate lithium's side effects" (Kring, et al., 2014, p. 151).

Integration

Jamison's description of bipolar I disorder and treatment fit almost perfectly with material

from lecture and our textbook: the DSM-5 symptoms were all present in her memoir; the

treatment for the disorder was one typically used to treat patients with bipolar disorder, and the

progression of the disorder, beginning with its onset in adolescence, was illustrated in course

materials (Kring et al., 2014, p. 128). However, the presence of depression between each of

Jamison's manic episodes did not explicitly reflect knowledge from the textbook and lecture;

depression can be present with a diagnosis of bipolar I disorder, but it is not a requirement for
Jamison and Bipolar Disorder 8

diagnosis, and does not show itself in every patient with bipolar I disorder (Westerman, personal

communication, February 14, 2022).

References

Kring, A. M., Johnson, S. L., Davison, G. C., & Neale, J. M. (2014). Abnormal
Psychology (14th ed.). John Wiley & Sons, Inc.

Redfield Jamison, K. (1995). An Unquiet Mind: A Memoir of Moods and Madness.