Maintenance on lithium and other drugs is a motif in the narrative. Like thousands of patients with manic depression, Jamison tries lithium and is repelled by its side effects, as well as its primary effects. In her book, she notes several times the irony of the fact she prescribes lithium for her patients with the same disease she has, but she can't stay on the medication even though she can see the devastating effects in her life when she won't take lithium. Jamison hints it is probably a combination of her intellectual and professional pride, combined with no small amount of denial, which prevents her from staying on the medication.