Bipolar Expeditions

Bipolar Expeditions

 

Bipolar Expeditions

Mania and Depression in American Culture

E
MILY
M
ARTIN

 

 

 

 

 

 

 

 

 

 

 

 

 

Princeton University Press

Princeton and Oxford

Copyright © 2007 by Princeton University Press
Published by Princeton University Press, 41 William Street,
Princeton, New Jersey 08540
In the United Kingdom: Princeton University Press, 6 Oxford Street,
Woodstock, Oxfordshire OX20 1TW

All Rights Reserved

Third printing, and first paperback printing, 2009
Paperback ISBN: 978-0-691-14106-0

The Library of Congress has cataloged the cloth edition of this book as follows

Martin, Emily.
Bipolar expeditions : mania and depression in American culture / Emily Martin.
p.  cm.
Includes bibliographical references and index.
ISBN-13: 978-0-691-00423-5 (hardcover: alk. paper)
ISBN-10: 0-691-00423-4 (hardcover : alk. paper)
1. Manic-depressive illness—Social aspects — United States.
2. Medical anthropology—United States. I. Title.
[DNLM: 1. Bipolar Disorder—United States. 2. Anthropology,
Cultural—United States. WM 207 M379b 2007]
RC516.M382 2007
362.196'89500973 — dc22
2006036317

British Library Cataloging-in-Publication Data is available

This book has been composed in Electra

Printed on acid-free paper. ∞

press.princeton.edu

Printed in the United States of America

3  5  7  9  10  8  6  4

Does the sign-post leave no doubt open about the
way I have to go? Does it shew which direction I am to
take when I have passed it; whether along the road or the
footpath or cross-country? But where is it said which
way I am to follow it; whether in the direction of its finger
or (e.g.) in the opposite one?

—Ludwig Wittgenstein,
Philosophical Investigations

For my students

Contents

 

 

 

 

List of Illustrations

Preface: Ethnographic Ways and Means

Acknowledgments

I
NTRODUCTION
Manic Depression in America

Rational and Irrational

Brains and Genes

The Drug Factor

A Short History of Manic Depression

Manic Depression in Culture

Research Methods

 

PART ONE
Manic Depression as Experience

CHAPTER ONE
Personhood and Emotion

What Are Moods?

Mood and Motivation

Our Manic Affinity

CHAPTER TWO
Performing the “Rationality” of “Irrationality”

Patients' Rationality: Double Bookkeeping

Doctors' Rationality: A Closed Circle

The Bipolar Experience: Multiplicity

The Bipolar Experience: Interruption

Sounding a Second Voice

Style and Manic Performances

CHAPTER THREE
Managing Mania and Depression

CHAPTER FOUR
I Now Pronounce You Manic Depressive

1. I'm in a Hole

2. I Thought I Was Normal When I Was Speedy

3. What Is the Diagnosis?

4. Who Is Manic?

5. What Is Bipolar 2b?

6. I Ain't Gonna Mess with It Backwards

7. Maybe He Is a Normal Variant

8. I'm a Twenty-Year-Old College Student with a 3.75 GPA and I Am Not Crazy

Subjection and Rationality

CHAPTER FIVE
Inside the Diagnosis

DSM Categories as “Text-Atoms”

The Work of Support Groups

Performativity, Intention, and Diagnosis

CHAPTER SIX
Pharmaceutical Personalities

Marketing a Psychotropic Drug

The Rationality of Consumers

Living with Drugs

 

PART TWO
Mania as a Resource

CHAPTER SEVEN
Taking the Measure of Moods and Motivations

Mood Hygiene

Evading Mood Charts

From Temperate to Hot

CHAPTER EIGHT
Revaluing Mania

Sociality and Conformity

Manic Depression and Creativity Today

Gender and Manic Depression

Race and Manic Depression

Manic Depression as an “Asset”

A Mental State as a “Thing”

Understanding Mania and Manic Depression in Their Contexts

CHAPTER NINE
Manic Markets

Links between Individuals and Markets

Learning to Be Manic

Mania in the Market

Emotion in the Market

A Few Manic Heroes, Past and Present

Manic Affinity

A Few Fallen Heroes

The Edge

CONCLUSION
The Bipolar Condition

Race and Gender Revisited

Optimizing Moods

The End of Madness?

Appendix

Notes

References

Index

Illustrations

 

 

 

 

Figures

 

Intro.1. Robin Williams Depicted as a Crazy Comedian on the Cover of
Newsweek

Intro.2. Refrigerator Magnet Showing Antidepressant and Anti-Anxiety Drugs as Highway Signs

Intro.3. Icons of Artistic Creativity from
Scientific American

Intro.4. Poster from NIMH Showing the Ups and Downs of Mood Disorders

Intro.5.
New Yorker
Cartoon Associating “Bipolar” with Outstanding Art

6.1. A Plumber Installs Brand-Name Drugs Directly in the Brain

7.1. Benjamin Rush's 1833 “Moral Thermometer”

7.2. A 1921 Mood Chart from Emil Kraepelin

7.3. The Mood Tree

7.4. Cover of
The Judy Moody Mood Journal

8.1. Lladró Fashion Accessories Called “Talismania”

8.2. A Sand Sculpture of Benjamin Franklin at the 2002 American Psychiatric Association Meeting

8.3. Framed Photograph of Author in Phone Booth

8.4. Are You Bipolar?

9.1. Joule Company Trainees Find a Store Mannequin

9.2. Joule Company Trainees Singing to a Passerby in Cambridge

9.3. Money Grows on Trees on a
New Yorker
Cover

9.4. A Netscape Ad Juxtaposes the Trading Floor and the Dance Floor

9.5. “Dancing on the Edge,” from the 2000 American Psychiatric Association Meeting

Tables

 

1. Psychiatric Diagnoses

2. Drug Names, Types, and Uses

3. Twelve-Month Prevalence of Mood Disorders (International), 2001–2003 WHO Survey

4. Twelve-Month Prevalence of Mood Disorders and Schizophrenia (U.S.), 2001 NIMH Study

5. Comparison of Number of Uses of the Terms “Bipolar Disorder” and “Manic Depression,” 1960–2002

6. References to the Phrase “Survival of the Fittest,” Averages for Five-Year Intervals

Preface: Ethnographic Ways and Means

 

 

Studies are outcomes rather than realized objectives. They are intellectual footprints, not blueprints.

—Herbert Fingarette,
The Self in Transformation

I have done ethnographic projects before, but none has tapped into my personal experience as deeply as this one did.
¹
While I was writing my last book, I experienced a break with reality. Most writers are probably familiar with the self-doubt that plagues the mind while one is hammering out a draft of something new. That kind of self-doubt was a familiar feeling to me too. But this time something different happened: whenever I tried to write, I felt a sinister figure, a cold gray gargoyle, perched tenaciously on my shoulder, looking at what I was writing on the computer screen, and muttering a devastatingly negative commentary about what it read there. Obscene and inescapable, the creature knew me intimately and did not wish me well.
²
This might sound like a parody of academic anxiety, but the experience was anything but funny. I felt trapped, frightened, and out of control. I didn't know whether or not I was going mad, but I did suspect this was not just another episode in the periodic depressions for which I was taking antidepressants. In the weeks that followed, the psychiatrist I consulted concluded that the antidepressants I was taking (prescribed by another psychiatrist) had exacerbated my true underlying mental state—manic depression—which had darkly flowered to the point of psychosis.
³

A couple of years later, in 1996, I was spending a semester at the Humanities Research Institute in Irvine, California, when I saw an announcement in the local paper for weekly meetings of “manic depression support groups” held at several locations in Orange County. As I began to attend these groups, I realized I might be at the start of a new ethnography. I had already been surprised to find, during my last fieldwork project, that authors of books and magazines for businesspeople were discussing both manic depression (also known as bipolar disorder) and Attention Deficit Hyperactivity Disorder (ADHD), praising these conditions for the creative potential they offered corporations. Now I wondered if I were facing an opportunity for a broadly based ethnographic inquiry into how such a strange juxtaposition could be taking form. I explained to each support group I attended that I was thinking of doing an ethnographic study of manic depression and ADHD, although I had no idea yet what that would mean. The groups made it clear it was not a problem for me to wear two hats—a writer's and a patient's—because I had already met the criteria for admission to the group: I had received the diagnosis of a mood disorder and was on medication under psychiatric care. Their only request was that I not reveal any member's identity. But through looks and gestures the first time I took out pencil and paper, people also made it abundantly clear that they would not tolerate note taking of any kind.

So I faced a challenge. My own condition might provide a route for me to study aspects of mental illness that could not be witnessed in any other way. But fears around the stigma of mental illness would prevent me from using key tools in the craft of ethnography, which involve careful note taking or recording, preferably as events take place. After a long period of uncertainty, I decided to do this ethnography more the way I had done my work in Chinese villages in Taiwan years ago than the way I had done my more recent U.S. fieldwork. I would participate in events and observe them mostly without tape recording and I would consider carefully before requesting interviews. I would take notes on the fly, in the moment whenever possible, or immediately after events were over, if not. My reasons for this are important to clarify. Some were practical: the stigma against mental illness is so great that my knowing someone's phone number and address, which I would need to do a lengthy, confidential interview, could be threatening. People have lost jobs and relationships when such information has gotten into the wrong hands and for this reason participants rarely revealed their last names or addresses in support groups. To understand something like madness, defined as outside “rationality,” I would need to venture into unfamiliar territory.
⁴

I used the word “madness” in the last sentence intentionally, although the term “mental illness” has the benefit of grouping mental phenomena with physical phenomena, implying optimistically that both have biological causes and potential cures. Without denying the utility of this grouping, I would say that the term “mental illness” also robs the experience of being “mentally ill” of its complex darkness, and it is this darkness that I want to understand better. I knew from my own experience and that of my interlocutors that grappling with the category of madness would require me to find ways of pursuing the “darker forces in human life,” as James Baldwin puts it. He was concerned with the repression and denial of “human weight and complexity” to African Americans, but many of his arguments bear full weight against the ways those deemed “mentally ill” are denied the status of the fully human.
⁵
For Baldwin, the division between blacks and whites was maintained by relegating black men to the status of exotic rarities, thus erecting a separation between blacks and whites that could not be bridged.
⁶
The stigmas of race and mental illness are certainly not identical, but both draw on terrible reserves of repressed fears and angers.