Book Review: A Hidden Madness by James T.R. Jones

It’s a question that appears on a number of state applications to obtain a license to practice law. Do you currently have any condition or impairment which, if left untreated, could affect the ability to practice law? While it seems simple, some of the questions it can raise are not. What are the chances someone who lists diabetes will undergo a hearing to determine if they have the “character and fitness” to be a lawyer? Now what do you think the odds are if the answer is bipolar disorder or depression?

From the outset, then, those in the legal profession are aware of the stigma that attaches to admitting to treatment for mental health conditions, even if that treatment is, like insulin, successful at controlling the potential effects of the condition. James T.R. Jones examines one aspect of that stigma in A Hidden Madness, a memoir of his work as a Wall Street lawyer, federal appellate court law clerk and law school professor while suffering from bipolar disorder.

Since 1986, Jones has been a professor at the Louis D. Brandeis School of Law at the University of Louisville. He has yet to hold a license to practice law in Kentucky. Why? Because, among other things, the application asks if the applicant has been diagnosed with or treated for a number of mental health conditions within the last five years, including bipolar disorder or major depression. Over the last 30 years, Jones treated continually for that condition and was hospitalized for it several times. Jones so feared the stigma of revealing his condition that he kept it a secret from virtually everyone. In fact, he didn’t disclose it to either of his wives until he was seriously considering asking them to marry him.

Jones now believes it is a condition that had its roots in childhood and that it was tied in with an inferiority complex he developed. Yet despite those struggles, Jones was a successful student and able to intentionally plot out and make the career moves he believed necessary to become a law professor. He tells his story chronologically and doesn’t hesitate to thank those who aided him along his way. Whether due to the academic setting or intentionally, A Hidden Madness at times takes what feels like more of an objective tone than a subjective one. This also means that while the effects are unquestionably difficult to convey, the book seems to be more detached than some other memoirs by individuals confronting mental health issues.

The fact Jones has succeeded doesn’t mean it is or has been easy. It’s unlikely any of us not afflicted with the condition can really understand its effects. Jones tells of periods, such as after a divorce, where even with lithium therapy he struggled to fulfill his job duties. He talks of stress pushing him toward the extremes of the condition, often being “constantly hopeless” and irritable, lacking energy and being “chronological suicidal.” He recognizes the lithium and other medication controlled the symptoms enough that he could work but still experienced peaks and “horrible valleys.” Although unlikely meant that way, Jones makes an serious observation inn which many of those who have attended law school may well find humor: “It is difficult to teach Decedents’ [Estates] at the best of times, let alone when severely depressed, sometimes suicidal.”

Jones’ occasional suicidal ideations may reflect the dichotomy of bipolar disorder. Jones has long had an interest in guns. Even though he and others recognized they pose a risk for someone who is suicidal, he had what he considered legitimate reasons for keeping them. “I wanted to to have them around both to show I would not use them and to have them available as the tools to end my life if I chose to do so,’ Jones writes.

Jones describes some of the effects of the disease in the private practice of law, noting there were days when he was an associate in a Jacksonville, Fla., firm where he was so depressed he couldn’t put in the necessary billable hours. Yet another aspect of that depression was to ruminate over that inability, creating a vicious cycle. Although A Hidden Madness touches on this, it has an inherent limitation in addressing mental health issues in the legal profession. For example, while it unquestionably has its own pressures, most law professors aren’t subject to the pressures and deadlines their job demands, many imposed by courts and clients. Moreover, academia affords the protections of tenure. In contrast, the practicing attorney faces a conundrum. If they don’t seek treatment, they may be harming their client or forced to quit practicing law. Even those who seek treatment fear disclosure because it may result in loss of clients or perhaps even opposing counsel seeking to take advantage of the condition.

Another area Jones occasionally touches on but does not explore in detail is the advantage professionals with mental conditions may have — resources. Jones points out that his insurance paid for his hospitalization. He observes that part of the reason he was able to maintain ongoing treatment is that insurance also paid for his it and his prescriptions. Likewise, he had the benefit of disability payments. In contrast, many people who face mental health issues in today’s America have none of those things. It is almost impossible to imagine a person staying on drugs like lithium or them remaining effective without ongoing visits with a health care provider. If they lose their job, the only income replacement may be unemployment.

What A Hidden Madness perhaps explores best is the fear of disclosure. The stigma of mental illness can be too much for even highly intelligent and rational people whose mental health issues are treated and under control. Even though Jones had episodes where he needed hospitalization, in part due to the fact physical side effects of lithium forced him to stop taking it, he has maintained a highly respected job for decades. Yet even he deeply feared going public with his story. He points out the fear an applicant for law school or admission to the bar may have in disclosing what is likely their most closely held secret and perhaps even disclosure of their most personal medical records. it is clearly a conundrum. The failure to disclose could result in denial of their application; disclosure might produce the same result.

Jones makes a strong argument against the stigma that attaches, encouraging others not to be held captive by it like he was for decades. recognizing it held him captive for decades and encouraging others. As such, he is one of many professionals lending their voices to what Jones considers to be “the most stigmatized group today,” those who have and treat for mental health conditions. It is only through efforts such as his that such people and their treatment may no longer need to stay hidden.

James T.R. Jones, A Hidden Madness