Jones, J TR --- "Walking the Tightrope of Bipolar Disorder: The Secret Life of a Law Professor" [2008] LegEdDig 24; (2008) 16(2) Legal Education Digest 34

• Walking the tightrope of bipolar disorder: the secret life of a law professor

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Walking the tightrope of bipolar disorder: the secret life of a law professor

J TR Jones

57 J Legal Educ 3, 2007, pp 349–374

Bipolar disorder is one of the most severe mental illnesses. It is a brain disorder that impairs a person’s mood, energy, and basic ability to function. Symptoms of mania include increased energy or restlessness; extreme irritability; racing thoughts and rapid speech; inability to concentrate; inability to/lack of need for sleep; poor judgement; spending sprees; and provocative, intrusive, or aggressive behaviour. Severe impatience and volatility can be real problems. Symptoms of depression include sadness and serious anxiety; feelings of hopelessness, pessimism, guilt, worthlessness or helplessness; lack of interest in activities one once enjoyed, including sex; fatigue; difficulty concentrating, remembering, or making decisions; irritability; sleep disturbance; fluctuations in weight; chronic pain not caused by physical illness or injury; and thoughts of death or suicide, or even suicide attempts (one study reports that bipolar disorder is the leading cause of suicide in the United States; 25 to 33 per cent of patients who have it attempt suicide, and 15 per cent complete suicide).

Those with bipolar disorder face a death rate 2.3 times greater than that of the general population. The disease, which is probably hereditary, is a chronic incurable problem; its symptoms can recur over a lifetime, typically due to environmental triggers. Hospitalisation, voluntary or not, is a con- stant risk, and the illness can be a major stressor for loved ones of those who have it. Episodes can be set off by the use of medications prescribed for other purposes.

Bipolar disorder can be managed with psychotherapy and medication such as some combination of the ‘gold standard’ first choice drug of lithium carbonate, mood stabilising anticonvulsant drugs, antidepressants, atypical antipsychotics, and sleeping prescriptions. Patients can have a good quality of life despite medication side effects like confusion and/or memory problems, weight gain, nausea, tremor, reduced sex drive or functioning, anxiety, movement problems, or dry mouth. People with bipolar disorder contribute to society, whether working quietly as a law professor or prominently in politics, science, arts, music, sports, and literature (indeed, high accomplishment and creativity are hallmarks of the disease).

I was born on December 28, 1953, in Richmond, Virginia, to a certified public accountant father and a homemaker mother. In the eighth grade I entered a prestigious private college preparatory school in Jacksonville, Florida (where my family then lived), where I excelled academically. I was selected for the National Honor Society, was a National Merit finalist, and graduated third in my class. Still, I had symptoms that were forerunners of bipolar disorder such as frequent irritability, undiagnosed bouts with depression, and poorly handled stress.

I very much wanted to attend the University of Virginia. In fall 1971 I applied under its early decision program and was overjoyed to be admitted. I did extremely well; thanks to my advanced placement credits, I received my degree (with highest distinction) in three years. Despite my seemingly successful college career, however, I had problems that presaged a diagnosis of bipolar disorder.

During my undergraduate years, I had periods of depression, which the disappointments of college life made worse. I was socially unsophisticated, did not pledge a fraternity or date, and spent most of my spare time playing historical simulation games and Dungeons and Dragons. My digestive health grew steadily worse, and in spring 1975 I was hospitalised for a week for gastrointestinal bleeding and nearly died. I dropped several courses and saw my grade point average fall.

I then attended Duke University School of Law. During my first year I had problems with anxiety and depression but functioned fairly well. I scored high in the class and was selected for the Editorial Board of the Duke Law Journal. I landed a summer job at a firm in Jacksonville.

I enjoyed my summer and returned to school ready to move ahead. I arranged to split my second summer between firms in Richmond and New York City. I applied for judicial clerkships to enhance my chances of becoming a legal academic and secured one with my life’s mentor, the Honourable Gerald Bard Tjoflat, then a Circuit Judge of the United States Court of Appeals for the Fifth Circuit. My clerkship would begin in January 1979, nine months after I graduated from Duke. I did grunt work as a Journal member, wrote a draft of a note, kept up my grades, won three academic awards, and readied for a busy summer.

The summer did not go as well as I had hoped. Although I loved the firm in Richmond, it did not like me. I was clingy, anxious, impatient, irritable under stress, depressed, and moody. The second half of my summer went better, as I enjoyed practice in New York City, but ultimately the news there was not good. Upon hearing of my clerkship, the law firm told me that firm policy on conflicts of interest precluded me from working there between graduation and the start of my clerkship. The curtain of my bipolar depression closed around me.

When I returned to school, I did my class work, finished my Journal note, and interviewed frantically. I ended up with a choice between two big firms that offered me jobs both before and after my clerkship. The atmosphere at Davis Polk & Wardwell impressed me, and so I took a job at a Wall Street firm, far from most family and my few friends.

The rest of law school went along routinely until early 1978, when I learned my father had lung cancer and needed immediate surgery. I drove home at once and spent a week in depressed shock before returning to school.

After a brief visit with my parents, I headed to New York. I decided not to take the New York bar until I knew I was going to settle there permanently, so I immediately reported to Davis Polk. I rotated through departments, but spent most of my time in the trusts and estates area. I learned a great deal about Wall Street practice, but was desperately lonely and unhappy. In December I returned to Jacksonville, unsure whether I would return to New York City and if I would survive if I did so. About this time, my deepening depression led me to believe that I was unlikely to live past thirty because the probability of suicide was high.

In January I began my clerkship with Judge Tjoflat. Over a ten-day break I studied for and passed the Florida Bar examination. I joined the bar of the Supreme Court of the United States in 1982 (as I recall, no mental status questions were asked on its application).

After the bar I worked on many cases, including a very stressful one involving what was, in effect, the first involuntary execution in the United States since the reinstitution of the death penalty. That case really bothered me, and I think Judge Tjoflat noticed my reaction to stress there in particular. He had become a close family friend and frequently visited my dying father on the way home from work.

Judge Tjoflat intervened with his former law firm in Jacksonville and helped convince it to hire me, thus letting me stay home. Perhaps more importantly, he convinced me to seek psychiatric treatment, and I took psychotropic medication for the first time. I also underwent counseling with Joseph H. Hartman, a Ph.D. in clinical psychology at a group Judge Tjoflat recommended to me. Dr. Hartman wrote an amazingly accurate evaluation of me that was a harbinger of difficulties with bipolar disorder.

After my clerkship ended I entered law practice, a realm for which I was ill-suited. Attorneys would enlist my aid on complex cases, but I did not get along well with them, and my services went underutilised. I had problems dealing with my secretaries due to the problems Dr. Hartman had noted. The stress of my father’s declining health and my own work difficulties made me so depressed that I was hospitalised (I kept the real nature of my illness secret from my employer, who thought I was being treated for digestive problems).

After my medical ‘vacation’ I worked at a low level (I dozed in my office with the door closed a great deal of the time), but got along until my father’s death on December 7, 1980. Finally, by the late spring of 1983, I attempted suicide and was voluntarily admitted to the locked psychiatric unit at a local hospital. I slept less and less (eventually sleeping no more than a few hours a night, which only exacerbated my manic state), fixated on suicide, mimed other patients’ self-mutilating behaviour, listened to symphonies and operas in my head, and fantasised I was Shakespeare’s Hamlet reincarnate. My psychiatrist was bewildered over my treatment and finally sent me by air ambulance (so I could not jump out of the plane) to Highland Hospital, a private psychiatric facility in Asheville, North Carolina.

I fit in well with the group, learned to play endless games of spades and hearts, underwent extensive counselling, and took various medications. Although my outstanding psychiatrist, Dr. Joanna Gaworowski, never called me ‘manic- depressive,’ she put me on lithium carbonate as well as an antidepressant. I gradually improved.

By November Dr. Gaworowski considered my discharge. She wanted me to stay in Asheville and arranged a semi-volunteer job with a local lawyer to try to retrain me as an attorney.

At this point Judge Tjoflat again intervened and helped me obtain a position as the Legal Assistant to a federal Magistrate Judge. While the Magistrate Judge and I often did not get along (he resented my working hours and frequent visits to the psychiatrist, and apparently interpreted my depression as laziness and a lack of motivation), he gave me a chance, and for that I shall forever be grateful. I now could work at a reasonably high level again, and it was time to move on. I applied for and won a position as a Bigelow Teaching Fellow and Lecturer in Law at the Law School of the University of Chicago and finally was ready to take my shot at legal academics.

I moved to Chicago in September 1985; one of my first acts was to arrange psychiatric care. The six Bigelow fellows taught the first-year legal research and writing course. I had a delightful year in Chicago; thanks to my lithium and a good counsellor (anyone with bipolar disorder needs someone to handle medications and a therapist) I stayed reasonably stable despite the stress of teaching and searching for a permanent academic position. Eventually, after several unsuccessful on-campus interviews, I was hired by the University of Louisville School of Law to teach legal writing and a doctrinal course.

Dr. Gaworowski referred me to a University of Louisville psychiatrist, Dr. John P. Bell, who treated me for about ten years until he retired. He was the first doctor to actually tell me I have bipolar disorder, although I long had suspected that due to the permanent lithium prescription. I did not disclose my psychiatric history to anyone at the Law School from fear of stigma.

My career at Louisville has gone well overall. I initially taught legal writing and a short-lived introduction to law course, and soon I added Torts to my repertoire. I was promoted to Associate Professor after I was turned down once because of what was deemed a lack of publications. At least some of the deficit was caused by the mood change/medication side effect problem, but I felt I dared not disclose my medical condition due to my stigma fear. I was granted tenure in 1992.

In my personal life, I finally overcame my fear of relationships after meeting a shy, sweet, smart (a Phi Beta Kappa and Alpha Omega Alpha member) and (to me) beautiful physician my age named Jane. We married in January 1988, and I was very happy over the next few years as I had a good job as a legal academic, a nice home, a wife I adored, twin miniature dachshunds, and daughters born in 1989 (Jennifer) and 1991 (Shirley). My mental condition was well-controlled; I never missed a class despite bouts of bipolar depression. I did have problems with student teaching evaluations in my writing class, some of which were attributable to the course (as is well known, legal writing ranks low on the average law student’s list of favourite subjects), but there were also the misperceptions of ‘arrogance or aloofness out of an attitude of superiority’ to which Dr. Hartman had referred.

All crashed down on me in spring 1993 when a combination of my issues and Jane’s sudden mental illness led her to move out with Jennifer and Shirley. We divorced in 1994. I grew severely depressed, was heavily medicated, had to take a summer off from work, and gave up a research grant to cope with the situation. I seriously contemplated suicide (I went so far as to buy a pistol — ostensibly for target shooting — but when I mentioned my purchase to my divorce attorney she insisted that I return it), but I joined a divorce support group, which was a tremendous help, and survived. During those dark days, the one constant loving presence in my life was my dachshund Nutmeg.

Gradually, thanks to Dr. Bell, the divorce support group, and the passage of time, I began to emerge from the fog of depression. While on sabbatical in spring 1995 I wrote a major domestic violence article. I also went on a teaching exchange to Leeds, England, where I had a delightful visit to Yorkshire that culminated in a tour of Scotland, Wales, and Ireland, which greatly raised my spirits.

In fall 1995 I was stable mentally, but I suffered from several physical maladies. I set the surgeries immediately after the December promotion vote. I was surprised and disappointed when the Dean told me I had been turned down due to insufficient publications since tenure. I had written two articles since 1992 because of the post-divorce depression and medication side effect problems. I was quite upset over what I considered unfair treatment, but I could do nothing without disclosing I have bipolar disorder, which of course I was unwilling to do.

The surgery was extremely painful and debilitating, but there was a bigger problem. Before it, I foolishly quit my lithium and antidepressant to reduce post-surgical complications. The anaesthesia and the Demerol for pain caused a bipolar psychosis, and then I lapsed into a severe depression. I had great difficulty timely grading my Torts examinations, but eventually did so after seeking aid via telephone from the Dean (to whom I never indicated the true nature of my predicament — the runaway bipolar disorder). I stayed depressed until I finally resumed my medications and they gradually kicked in over the winter of 1996. About this time, Dr. Bell retired and I went to his colleague Dr. Manishadi. I started seeing John Turner for therapy at the same time.

I resumed teaching in late January, but really was in no shape to do so. All spring I was depressed and irritable due to the pain, the Demerol reaction, and my short-term failure to take my medicine. The Dean believed I was pouting due to the promotion denial and gave me a substandard annual evaluation as a result. I argued to no avail that I was suffering from medical problems but was unwilling to disclose I have bipolar disorder.

My mood perked up because of my journey to the Republic of South Africa and Zimbabwe in July and August. I taught domestic violence law in South Africa following a tour of southern Africa, including Victoria Falls and the South African game reserves. It was the experience of a lifetime and greatly improved my view of the world. In fact, I almost reached a manic state, spending excessive amounts on gold jewellery and African souvenirs.

In fall 1996 I again sought promotion; it was approved and I became a Professor of Law. Despite my strong reluctance to speak in public, I gave a series of national and local lectures on domestic violence law; one talk was to the University of Louisville’s psychiatry department, including Drs. Bell and Manishadi. For at least a few years I was a nationally known expert on domestic violence.

Thanks to the promotion, post-surgical recovery, the change in my teaching load, and my generally positive mental health, life improved greatly. An important development was Kathleen Ann Murphy, an attorney six years my junior, with whom Jennifer, Shirley, Nutmeg, and I became quite enamoured and to whom I was married on August 2, 1997. Before our marriage, we met with John Turner so he could explain the nature of my disease. Kathi has not expressed any regret at marrying me (although she says if I quit taking my medication and then become uncontrollably manic, she cannot guarantee she will stay with me), something for which I am very grateful given the poor marital success rate of those with bipolar disorder.

Things went reasonably well over the next few years.

Disaster struck in late 2003. A glandular condition necessitated a difficult neck operation. The January 2004 surgery disclosed that three of my four parathyroid glands were bad because of long- term lithium ingestion. I could no longer take the old ‘gold standard’ friend that had handled my disease since 1983 lest I risk my remaining parathyroid gland and having a runaway calcium level. The surgeon insisted I get off lithium as soon as possible. Dr. Quinton was optimistic she still could manage my disease, but her hope was in vain.

Dr. Quinton immediately weaned me off lithium and onto an anticonvulsant used when lithium is not available. Before I could reach a therapeutic dose I had a full-blown manic episode in May that required my hospitalisation at Wellstone Regional Hospital, a private locked psychiatric facility, for over three weeks. I finally had to tell my daughters the truth about my illness (Kathi, Jennifer, Shirley, a Wellstone social worker, and I met, and I will never forget Shirley bursting into tears — I frequently became tearful during my hospital stay), had to miss the graduation of one of my favourite students, could not go over examinations and papers with my spring students, and was unable to teach summer school as scheduled.

I spent the summer in Wellstone’s outpatient therapy program. I went on various antipsychotic medications, both orally and by injection, to help regulate my manic symptoms, and these caused me to develop tardive dyskinesia, severe anxiety, and eventually painful symptoms of TMJ. I was hospitalised in June for a drug reaction that led to severe anxiety and involuntary muscle movements.

I could not work during the fall, and the Law School granted me a medical leave. I returned to Wellstone around Thanksgiving for suicidal ideation due to severe depression (this worsened Kathi’s concern that I would complete suicide). The most strenuous things I could do were audit a class at a community college and volunteer at a hospital. I joined the YMCA and started a daily exercise regimen that improved my mental status and helped me lose thirty pounds I gained due to my medications. I could read or concentrate for only a few minutes at a time; much as in 1983, I was utterly dysfunctional due to the breakdown. I slept either not at all or twelve to fourteen hours a day

— indeed sleep was the one real respite I had from the extreme mental anguish I felt due to my condition. The evenings were always the worst — I would weep inconsolably due to despair and the sheer pain of depression. To make matters worse, one horrible weekend in September, my non- smoking brother died from lung cancer and then the next day we had to euthanise my beloved dachshund Nutmeg at age sixteen. Perhaps worst of all, my secret was out because Kathi had had to explain my condition to the deans at the Law School. My concerns about stigma came to the fore. Thankfully, the deans kept my situation quiet — the party line was that I was suffering from the results of the parathyroid surgery, which was true in a sense. I finally told a few long-time friends on the faculty about my disease; one said he could not believe I had managed to keep it a secret for nearly eighteen years.

In the spring and summer of 2005 I taught one section of appellate advocacy. By fall I taught two classes, Torts and appellate advocacy, but gave up my usual service obligations and barely held on through the year. I suffered intense anxiety, for which I was heavily medicated, and had to pray and recite a mantra before each class. Although I had taught Torts over fifteen times, I repeatedly had to read the book to prepare for class because I could not remember what I had read. I was devastated in spring 2006 when I got mediocre reviews from the few students who filled out evaluations in appellate advocacy, but I survived due to good Torts assessments.

Gradually, my condition improved, and I taught appellate advocacy in the summer to good reviews. I joined a support group for people with bipolar disorder, and its biweekly meetings greatly comforted me.

By fall I was approaching my former ‘high-functioning’ state; things were far better than during the dark days of 2004. I had stress symptoms, but teaching Torts and appellate advocacy seemed more natural to me. I again advised the moot court competition I had supervised for years, and got through it despite severe stress I fear made it hard for my advisees. I even looked forward to teaching Decedents’ Estates in the spring for the first time since my spring 2004 breakdown.

I felt stress during our dean search and strategic planning processes, especially when the faculty tentatively voted to close the Law School’s fifty-six year old part-time evening program. The program was very important to both of us. I developed manic symptoms that interfered with my sleep, led to increased irritability and volatility, and caused Dr. Quinton to re-prescribe an antipsychotic from which she previously had weaned me. I had a limited ability to control obsession and ruminations over the part-time program, the moot court competition, the complicated reinstatement case, the dean search and strategic plan (at one point Dr. Quinton ordered me to skip a planning meeting just to reduce stress), the re-election campaign of Kathi’s employer (a local circuit judge), and even writing this article. All combined to create a perfect storm of stress and anxiety for me.

Finally, Dr. Quinton put me on a new antipsychotic that was supposed to deal with mania, depression, and severe anxiety. Thus fortified, I began the spring 2007 semester.

Torts and Decedents’ Estates seemed to go well, but things quickly unravelled. I worried about making inappropriate comments when manic and had episodes of theatricality, amusing irrelevancy, and even singing. The racing thoughts and tangential thinking that characterise mania bothered me, especially in my Decedents’ Estates class. This was evidenced by my fascination/fixation on the April 1912 voyage of the passenger liner Titanic. I appropriately used the story of John Jacob Astor IV to illustrate the rule that one can put conditions on an inheritance, such as one stating that if one’s spouse remarries after one’s death he or she will forfeit the amount left to him or her, because Astor put such a limitation on the USD$5 million trust he left for his wife upon his death on the Titanic, and she lost it when she remarried. I then launched into a long irrelevant saga over how Astor and his entourage ended up on the Titanic and their fate due to the disaster. I even went into great detail about the actor who played Astor in the movie ‘Titanic.’ This, I fear, caused me to waste many class minutes. Although my Decedents’ Estates evaluations overall were good, there were several complaints about me wandering off track.

Also in spring 2007, I worried the new Dean would make changes that might compromise my ability to continue my career, and the strategic planning process continued to upset me. Stress was a relentless enemy, as was my tendency to ruminate excessively about everything.

Finally, by spring vacation I was floridly manic and Dr. Quinton again redoubled my antipsychotic. My mental health had deteriorated enough that I, after consulting with John Turner, Dr. Quinton, Kathi, and a few others, decided to cancel the summer Decedents’ Estates class I had agreed to teach. Instead, I just would do some research over the summer, if anything Law School-related at all. Over spring vacation I worked manically on this article, but once I basically completed it, the increase in antipsychotic began to take effect and the mania started to ebb. Perhaps, at least for this particular episode, the worst was over.

As is by now apparent, my disease today is less manageable and far more dangerous than during the lithium years. The lack of sleep is a constant concern due to the fear it will trigger a manic or depressive episode. With either comes impatience, irritability, and a tendency to lash out at others. I worry whether my condition will allow me to publish on any sort of regular basis. On the plus side, because lithium no longer firmly holds my emotions in check my natural personality can come out more, with actual happiness a more attainable goal. I am back in the game and have proved to myself that a law professor who has a severe bipolar disorder can teach, write, and do service like anyone else in the profession.

Over my years at the Law School, I have seen students who either exhibited what I deemed to be symptoms of mental illness or even discussed such a condition with me, and I thought they could use my help. I have more empathy for those who have a mental disease than most, if not all, of my colleagues because of the bond I share with them. I am careful not to disclose I have a mental illness but still am an effective champion for students who otherwise might be denied a second chance. I sometimes encounter students who are not on probation but have a mental illness and often refer them to the University’s counselling centre. I particularly remember one student who openly discussed having bipolar illness and how it affected academic performance, and I intermittently worked with the student during the student’s Law School career (I always secretly questioned whether the student wondered why I knew so much about the student’s medications). Thus, I think my condition works to the direct benefit of students who have a mental illness.

Why am I ‘outing’ myself after nearly twenty-five years of secrecy? Should I risk stigma from the profession and others and generate the real fear that students will be prejudiced against me and fear to take my courses or give me bad teaching evaluations? I want to demonstrate that those with mental illness can have full and satisfying professional and personal lives, and they need and should not endure stigma or doubt as to their ability to perform their personal or employment duties. If that message gets across, and as a result someone is encouraged to reach for everything in life despite having a mental disease, this article was worth writing and my ‘secret’ was worth disclosing. The message is even worthwhile if it does no more than cause other legal academics with a mental illness to feel better about themselves and perhaps come forward, after due reflection, as I have done. It is time for the legal academy openly to welcome its members who have a psychiatric disorder and acknowledge that faculty who have a mental disease can function like any others and thus should not fear stigma or feel shame due to their condition. All faculty should deal compassionately with students who have mental or emotional issues and in particular work to change intrusive bar character and fitness application questionnaires in jurisdictions where they are still an issue. For now, here ends the saga of this law professor who gingerly walks the tightrope of bipolar disorder.