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One of my psychotherapy teachers, Leston Havens, always says that when you open people up, you find the same suspects. His analogy is to surgery, where, after the abdominal incision, the surgeon finds the same organs in the same places in everyone – rich, poor, black, white, female, male. Similarly, when you open up the mind in psychotherapy, you find the same dirty little secrets: sex, rage, ambition, fear....mental illness. As the psychiatrist Harry Stack Sullivan put it, we are all much more human than otherwise. Or as Havens says: our secrets our very tiresome, because they are the same as everyone else's.
Paul Kamen learned these lessons when her friend, Iris Chang, a well-known author, the recorder of oral histories about the Chinese experience around World War II and the conflict with Japan (especially the rape of Nanking), killed herself. Chang's work had led to much debate with the Japanese government, against whom Chang passionately upheld her views. She seemed to relish the verbal combat and the attention, and was seen by her friends, like the author of this book, as a classic success story.
To Kamen, Chang's death made no sense. She had always been the epitome of energy, and persistence, and productivity, and commitment. A flaw might have been extreme ambition, yet she transformed her ambition into success, thus justifying it. Kamen had known her since college in Chicago, and they remained in contact over the years. Chang had married, and had children, and still maintained the active pace of a successful writer and journalist, with book tours and trips for interviews. For her, Chang had become a role model of sorts; she had even become a verb -- "Just Irischang it!" Kamen would tell others, when explain how they just needed to get to work and get things done.
Thus, her death was a challenge to her friend, and Kamen finally decided that her only recourse was to do what she did best: to conduct an investigative journalistic account of the life and death of Irish Chang. She talked to her husband, her family, her other acquaintances; she tracked down veterans she had interviewed; she even filed for her FBI files. By peeking into the dark corners of Chang's life, Kamen came up with an answer to the enigma, one she had never suspected: Chang suffered from bipolar disorder. Indeed, she had been hospitalized against her will with psychotic mania in the final years of her life, but she resisted the diagnosis and treatment. At the end, her manic periods likely were followed by a severe depression that took her life.
Her bipolar disorder seemed to explain a lot about her, even her successes. Was the extreme ambition a reflection of an underlying grandiosity? Was the extreme talkativeness characteristic of mania responsible for another flaw: she could never have a brief phone conversation, always needing to speak at length whenever she connected with Kamen (who, as a result, sometimes avoided Chang's calls). Was her combativeness about the China-Japan conflict driven by something within her, some reservoir of passion that came from mania?
That she had bipolar disorder can be little doubted: psychotic mania means nothing else. Some readers will debate how much can be explained by the illness however, both in her successes and in her suicide. Kamen comes out on the side of explaining much with the illness, and I tend to agree with her. Social constructionists will experience mini-strokes, perhaps, but their aversion to ascribing any behavior to disease is itself a disease, in my view, the disease of postmodern dogmatism. Chang's suicide almost certainly was preventable, as so many are. Her successful personality features are harder to relate to bipolar disorder, but they can be, and many of her characteristics likely are related to what is called hyperthymic personality.
Kamen is to be commended for honest and careful journalism, and for bringing to light the importance of these real diseases in the lives of even the most successful of us. She highlights the stigma within the Asian-American community about mental illness, and her book can serve perhaps that community in particular. She indeed reached the journalistic ideal of being "part scholar with the spirit of a poet thrown in." (p. 112) Postmodernist critics will take their shots, but their dogmatisms are not worth the life of a single human being, and certainly not that of Iris Chang.
© 2008 Nassir Ghaemi
S. Nassir Ghaemi, M.D., M.A., M.P.H., Director, Mood Disorders Program, Tufts Medical Center, Dept of Psychiatry. Dr. Ghaemi is author of The Concepts of Psychiatry: A Pluralistic Approach to the Mind and Mental Illness, Johns Hopkins University Press, 2003.