I reaped a bitter harvest from my own refusal to take lithium on a consistent basis. A floridly psychotic mania was followed, inevitably, by a long and lacerating, black, suicidal depression; it lasted more than a year and a half. From the time I woke up in the morning until the time I went to bed at night, I was unbearably miserable and seemingly incapable of any kind of joy or enthusiasm. Everything—every thought, word, movement—was an effort. Everything that once was sparkling now was flat. I seemed to myself to be dull, boring, inadequate, thick brained, unlit, unresponsive, chill skinned, bloodless, and sparrow drab. I doubted, completely, my ability to do anything well. It seemed as though my mind had slowed down and burned out to the point of being virtually useless. The wretched, convoluted, and pathetically confused mass of gray worked only well enough to torment me with a dreary litany of my inadequacies and shortcomings in character, and to taunt me with the total, the desperate, hopelessness of it all. What is the point in going on like this? I would ask myself. Others would say to me, “It is only temporary, it will pass, you will get over it,” but of course they had no idea how I felt, although they were certain that they did. Over and over and over I would say to myself, If I can’t feel, if I can’t move, if I can’t think, and I can’t care, then what conceivable point is there in living?
The morbidity of my mind was astonishing: Death and its kin were constant companions. I saw Death everywhere, and I saw winding sheets and toe tags and body bags in my mind’s eye. Everything was a reminder that everything ended at the charnel house. My memory always took the black line of the mind’s underground system; thoughts would go from one tormented moment of my past to the next. Each stop along the way was worse than the preceding one. And, always, everything was an effort. Washing my hair took hours to do, and it drained me for hours afterward; filling the ice-cube tray was beyond my capacity, and I occasionally slept in the same clothes I had worn during the day because I was too exhausted to undress.
During this time I was seeing my psychiatrist two or three times a week and, finally, again taking lithium on a regular basis. His notes, in addition to keeping track of the medications I was taking—I had briefly taken antidepressants, for example, but they had only made me more dangerously agitated—also recorded the unrelenting, day-in and day-out, week-in and week-out, despair, hopelessness, and shame that the depression was causing: “Patient intermittently suicidal. Wishes to jump from the top of hospital stairwell”; “Patient continues to be a significant suicide risk. Hospitalization is totally unacceptable to her and in my view she cannot be held under LPS [the California commitment law]”; “Despairs for the future; fears recurrence and fears having to deal with the fact that she has felt what she has felt”; “Patient feels very embarrassed about feelings she has and takes attitude that regardless of the course of her depression she ‘won’t put up with it’ ”; “Patient reluctant to be with people when depressed because she feels her depression is such an intolerable burden on others”; “Afraid to leave my office. Hasn’t slept in days. Desperate.” At this point there was a brief lull in my depression, only to be followed by its seemingly inevitable, dreadful return: “Patient feels as if she has cracked. Hopeless that depressed feelings have returned.”
At the time, nothing seemed to be working, despite excellent medical care, and I simply wanted to die and be done with it. I resolved to kill myself. I was cold-bloodedly determined not to give any indication of my plans or the state of my mind; I was successful. The only note made by my psychiatrist on the day before I attempted suicide was: “Severely depressed. Very quiet”.An Unquiet Mind, by Kay Redfield Jamison.