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The memoir written by Dr. Kay Jamison, An Unquiet Mind, provides an in-depth look at an individual’s personal experiences with bipolar disorder; something that I learned extensively about in the past 15 weeks in Dr. Robert’s PSY 423 class. The theoretical perspectives that we learned about in class are consistently touched upon in the entirety of Jamison’s memoir. Beck’s Cognitive Model of Depression, the Behavioral Activation System Dysregulation Model, the Integrative Model of Approach and Avoidance in Depression, and general interpersonal function are just a few that come to mind when speaking in terms of Jamison’s personal experiences. While not all are consistent with what we learned in class, it is still necessary to touch upon them in the sense that it shows how bipolar disorder develops over her life and how the implications can be further developed based on her experiences.
Reading through the memoir, it was shown that Jamison had lived in an environment that posed no immediate dangers to the state of her mental health. From the very beginning, she expresses an extensive amount of love and cares for her family and admiration for her siblings, specifically her older brother. She states that her relationship with her sister was “more complicated,” but she still poses that she cares for her and her father as well, when he was around. Right off the bat, I could see the complicated relationship with her sister and father as a vantage point for the decline in mental health, but overall, I can also see it not being the main cause for it. Another inference I had before diving deeper into the memoir was that Jamison states that her family was consistently moving, as her family was a military family. She states that, ‘…by the fifth grade my older brother, sister, and I had attended four different elementary schools, and we had lived in Florida, Puerto Rico, California, Tokyo, and Washing, twice,” (Jamison, 1996, p. 13). The stressor of constantly changing environments could also be another probable cause of the onset of Jamison’s bipolar disorder. While this is not the main topic of this paper, I felt as if I should provide my insights on what I believe may have led to Jamison’s decline in mental health. Aside from that, later on in life, Jamison would overcome the disorder with the combination of support from loved ones, medicine, and therapy, leaving almost a motivational story for those also struggling with the disorder.
Back to the main focus of this paper; starting with consistencies; I found the Behavioral Activation System Dysregulation Model to be consistent with Jamison’s experience with bipolar disorder and it allows us to understand the overall course of her mental health further. The Behavioral Activation System Dysregulation Model or BAS, is responsible for different aspects of approach behavior, as well as other behaviors such as hope and relief. According to the BAS dysregulation model, BAS activation in bipolar disorder is primarily associated with hypo(manic) symptoms including, but not limited to, incentive-reward motivation, inflated self-esteem, incentive-reward motivation, and increased goal-directed behavior and energy. Excessive BAS activation seems to be the cause of (hypo)manic symptoms (PSY 423 Lecture). Jamison, dealing with bipolar disorder, was a victim of experiencing manic episodes, which are typically reflective of the symptoms that I had just mentioned. Even though it is not explicitly stated in the memoir, this shows a consistency in the implications of BAS activation with Jamison’s personal experiences. She described her episodes in the exact same way as I described the symptoms associated with bipolar disorder. She experienced feelings of great pleasure, unrealistic creativity, and high amounts of energy which allowed her to be more productive than she normally would. I want to focus on the specifics of her goal-directed behavior, which is a key component of BAS activation. Being a doctor, she had a high interest in medical school early on in her school days. This led her to study and research many aspects of the medical field in her free time, such as observing surgeries, visiting hospitals, and asking medical-related questions to people who had extensive knowledge on the topic. While this ambition is relevant in BAS activation, those with bipolar disorder tend to experience grandiosity, to an extreme level. She found herself, “bubbling with plans and enthusiasms…making expansive, completely unrealistic plans,” (Jamison, 1996, p. 36), in addition to “racing about like a crazed weasel (Jamison, 1996, p. 36). It was almost like she had to get all of the ideas out as soon as they popped into her head. This is very common in those experiencing manic episodes, as the ideas and thoughts flow into their minds so quickly, that it seems as if they all need to be expressed for them to be relevant.
In contrast to the BAS, another theoretical perspective that encapsulates Jamison’s experiences is BIS, or the Behavioral Inhibition system. BIS has the ability to not only activate and deactivate itself, but it is able to suppress/activate the aforementioned BAS. The deactivation of the BAS is known to lead to depression. The DSM-5 associates depression with symptoms such as hopelessness, lowered energy levels, anhedonia, and less frequent approach behaviors. This makes sense, as the BAS is responsible for approach behavior, so the “shutting off” of it would lead to a decrease in those behaviors, as I mentioned earlier. The dark side of Jamison’s episodes came with the deactivation of the BAS. After her periods of energy and high stimulation of thought, she found herself feeling a completely opposite way. The manic episodes put her in a state where she felt “on top of the world,” but once these ended, she found herself lost and depleted of energy and all motivation. This is common with those with depression, as when the BAS state is lower in an individual, there is less reward sensitivity and responsiveness. Ultimately, this shows a feeling of indifference to overall rewards, thus reflecting a feeling of hopelessness even further. It also explains when she was super productive; as she was in a much higher BAS state, which normally results in less negative effects and more approach-based goals.
The second major perspective I will be touching upon in relation to Jamison’s experiences is Trew’s Integrative Model of Approach and Avoidance in Depression. This model emphasizes that both approach deficits and avoidance prevents the experience of positive things and also prevent reinforcement for non-depressed behaviors, thus, correlating with what I had spoken about before. These behaviors reflect a low BAS and a high BIS, resulting in more avoidance behaviors, as stated prior. While dealing with her depressed states, Jamison often kept to herself and would spend a lot of her time alone, studying or ruminating on her own negative thoughts. While at the time this may seem like a good idea to a depressed individual, the truth is that this is only a short-term solution. Avoidance is proven to be a highly ineffective coping mechanism for those with depression. As a matter of fact, it tends to make things worse, with one of the leading negative factors being rumination or dwelling on one’s own negative thoughts.
Together, the BAS dysregulation model and the Integrative Model of Approach and Avoidance provide excellent reflections on Jamison’s experience with bipolar disorder. The first part is; BAS activation tends to predict manic episodes, while BAS deactivation tends to predict depressive episodes. These were both evident in Jamison’s case, as during events where the BAS would be activated, she was in great spirits, excelled in many aspects of school and work, and on a less proper side of things, she would spend money as if it meant nothing to her. On the opposite end, she saw the downward spiral events; things like her divorce, financial burdens, and loss of friends.
For the final perspective, I will be talking about Beck’s Cognitive Model of Depression. This model states that extreme events activate dysfunctional beliefs which causes the development of negative automatic thoughts. The primary event, which was previously mentioned, was the number of times that Jamison had to move when she was younger. Specifically, after her family moved from Washington to California; it was a shock to her system. She was not ready for the move, especially at the age she was at. Moving to a new school is nerve-wracking and for her to adjust to a whole new lifestyle just adds stress to the situation. On top of all of that, the students at her new school had a different social dynamic than her previous one. The students at the school in California were much smarter, richer, and more competitive than the ones back in Washington. These stigmas surrounding her only accentuated the negative automatic thoughts that were already starting in her head. She started to believe that she was dumber than everyone else and that she wouldn’t be able to compete with them academically. With people who are prone to negative automatic thoughts, more often than not they have an underlying core belief of feeling subpar or lesser than everyone else. Her automatic thoughts were never negative back in Washington because she never had the feeling of being less than everyone else. This model can also be associated with environmental stimuli, as environmental stimuli often play a role in triggering dysfunctional beliefs in one’s self. Jamison was subconsciously coming up with strategies and techniques to deal with her beliefs, which had existed before, but she just never realized them. These strategies kept her negative automatic thoughts under wraps, which is why she had never had to deal with the realization of her negative underlying beliefs before her move to California. These reoccurring thoughts kept going through most of her life, which ultimately caused her to struggle academically, as avoidant behaviors started to become more frequent as she started to think less and less of herself.
Beck also has a cognitive triad, which states that depressed individuals tend to focus on the negatives in themselves, the world, and the future. To be more specific, they see themselves as unlovable, see the world as uncontrollable, and see their futures as hopeless and out of their power. Focus on Jamison specifically, she at one point felt hopelessness in her ability to save the dying world, which made her feel even more helpless than she did before. Also, she thought that if doctors and pharmacological solutions could not fix her condition, she would end up killing herself. On top of all of this, she believed that without medication, she would not be able to view the world in a positive light, which supports the triad that Beck speaks about.
Jamison’s experiences with bipolar disorder are essentially consistent with both the BAS dysregulation model and the Integrative Model of Approach and Avoidance. Her manic episodes, where she was positive, knowledgeable, and productive, support the model of the BAS and BIS in that they are opposite processes. The activation of one leads to the deactivation of another, which leads to an increase in approach behaviors or an increase in avoidance behaviors, with the other being an inverse of the first. The episodes were also predicted by environmental stimuli and BAS-related events, which also encompasses the main idea behind Beck’s Cognitive Depression. Jamison’s negative thoughts, automatic thoughts, and core beliefs also relate back to Beck’s model. Even when she would experience something positive, her negative automatic thoughts would ultimately warp her perspective, leading her to avoid all possible positive outcomes, thus, leading her further down the downward spiral that she had already been heading down since she had moved to California. Overall, this memoir was very interesting to read and it gave me further insight into the experiences and thoughts that an individual with a mental disorder has to go through on a daily basis. Even though Jamison ultimately fought her way through the disorder, not every individual has the joy of getting through something like this. Bipolar disorder is something that even when it is treated, the results of treatment aren’t always permanent. Treatment, in my mind, is unique to each individual. While one treatment may work for the majority of other people, you never know which person the treatment will have no effect on or even a negative effect on. I hope that this memoir can give those with bipolar disorder and depression some sort of motivation that they can get through a disorder like Jamison had and that they are not alone in the battle.
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