Nothing Was the Same Read Online Free PDF

because they believed honesty to be intrinsically freeing. This was a far from universal view. Some were adamant that criticism was likely to be withering and the professional repercussions severe. Just as things had begun to settle in my life, they pointed out, I was risking additional instability. Those who were clinicians were even less sanguine about my being open about my illness. They, like I, had seen the prejudice and actions taken against colleagues in clinical fields; they had few illusions about tolerance within the profession.
    I discussed the decision at length with my psychiatrist, Daniel Auerbach, a first-rate clinician who has been my doctor since my first psychotic break as a young assistant professor at UCLA. Together we weighed the potential damage of disclosure against its possible benefits. I was wary of being labeled by my academic and medical colleagues as a manic-depressive psychologist, rather than being seen as a psychologist who happened to have manic-depressive illness. I knew that for many the question of professional impairment would be a critical issue. This would be a completely legitimate concern. Those who specialized in psychology or psychiatry would present a special set of problems: I risked newly vigilant eyes observing my actions and appraising my moods, newly honed ears listening for skips in reason, real or imagined anger. It was an unattractive prospect.
    My psychiatrist, who understood my desire to be direct about my illness, talked with me about the ramifications of openly discussing psychosis, suicide, and my initial reluctance to take medication. He, more than anyone, knew the cost to me of living in silence. But he also knew that once I had discussed my illness openly, my pride would take a sharp body blow. Pride had been a costly but sustaining force for me since childhood. Pride had kept me going when other things did not. I would be giving live ammunition to competitors, or to anyone I had irritated over the years.
    His counsel was thoughtful, circumspect, and protective. It was without condescension. If I thought I could do it and had reasoned it through, he said, I could do it. He made the indisputable point that it would be hard, and it was. He did not say it would be insurmountably hard, and it wasn’t.
    I knew that my account of my illness and my life would have to be explicit, or there would be no point in writing it. This meant reliving, describing, and making public a troubled and contradictory life. I had hallucinated and been delusional on more than one occasion, been paralytic with depression for months on end. My behavior at times had been bizarre and disturbing. By anyone’s standards, I had been severely ill. I had tried to kill myself and had nearly died from a massive overdose of lithium, the same medication I had written about in medical journals and strongly advocated that others take. In the early stages of my illness, I had taken it only fitfully and reluctantly. One could hope for understanding, but not assume it.
    I spoke with the then chairman of my department at Johns Hopkins, Paul McHugh, in part because I respected his judgment and in part because I had to. I told him I hoped it might be helpful to others to write about my oddly intersecting worlds—those of researcher, clinician, teacher, and patient—but that I did not want to put the Department of Psychiatry or the Johns Hopkins Hospital in an awkward position. We both knew the inevitability of the “Who’s in charge of the asylum?” quips. More substantively, there were very real legal, educational, and clinical issues. And no one could predict what the reaction of the public and the media would be.
    My chairman listened carefully as I laid out my concerns. When I had finished, he looked at me thoughtfully and said, “You know, Kay, you have it completely backward.” He mentioned the legendary surgeon William Halsted, who was the first chief of surgery at Hopkins. “It was known that