Search tips
Search criteria 


Logo of bmjThis ArticleThe BMJ
BMJ. 2007 May 12; 334(7601): 1009.
PMCID: PMC1867897
Medical Classics

A Mind That Found Itself

Robert Hierholzer, clinical professor, University of California, San Francisco (Fresno Medical Education Program)

Long before celebrities started going public about their struggles with mental disorders, Clifford Beers produced a vivid personal account of what it's like to live with bipolar disorder. A Mind That Found Itself, published almost 100 years ago, is widely regarded as having helped launch the mental hygiene movement, the precursor of today's mental health consumer movements. Apart from this historical significance, the work is also a primer on bipolar disorder while being a good, if not gripping, read. Indeed, William James thought that it read like fiction while also having interest for the scientist.

In a sense, the story is simple. A recent Yale graduate becomes depressed, attempts suicide, and is admitted to hospital. While still hospitalised, he becomes psychotically manic and accordingly spends several years in psychiatric institutions before recovering enough to be released. What makes the story compelling is Clifford Beers' deft and punchy writing; his arresting descriptions of his behaviour and thinking; his bitingly insightful observations of others, especially the medical professionals of the day; and his struggles to be treated with dignity. These features make this work a great resource for teaching about bipolar disorder and the treatment of mentally ill people in any age.

In an age of bland diagnostic schemes, Beers' descriptions of his symptoms are refreshing. When he rhapsodises about being an “embryonic Raphael” whose “Midas-like touch” could transform ordinary corncobs decorated with small thermometers into coveted objets d'art, the reader can feel his manic exhilaration. The experience is no less vivid when he recounts the exquisite anguish of his monumentally lethargic depressive states, in which his brain “felt as if pricked by a million needles at white heat.” Such depressive misery drove Beers to view death as potentially liberating, leading him, not surprisingly, to carefully conceal his suicidal plans. His deception of his family reminds us that simplistic notions about suicide prevention can easily fall short of the mark. Yet, he also reminds us that the ambivalence of the suicidal patient may be life saving. In a suicidal jump, he somehow altered his trajectory out the window of his second floor bedroom so that his fall resulted in mere injuries rather than death.

Beers has many provocative things to say about his interactions with doctors and attendants. He admits to enjoying at least one of his pranks more than any schoolboy could have. He elicited a range of reactions from his caregivers, from placement in straitjackets and outright physical assaults to compassionate understanding. Without the assistance of today's modern pharmacologic marvels, certain individuals could “control” him in the midst of his manic frenzies, but the mere presence of other practitioners threw him into a rage. Beers' descriptions of his interactions with staff always remind me of the therapeutic importance of my relationship with my patients and the dangers of unquestioningly accepting the prevailing therapeutic culture of the day, whether that includes reliance on straitjackets or on pills.

Clifford Beers felt that the value of his work was its authenticity. Most patients cannot articulate their thoughts or describe their experiences so well. By doing so, Beers gave a voice to mentally ill people and left a text for inquiring clinicians.

Articles from The BMJ are provided here courtesy of BMJ Group