Bipolar Expeditions (15 page)

The tension between conscious and unconscious thought and imagination is also involved in how style is thought to work in language. In anthropological linguistics, style is a concept valued for the way it confounds easy distinctions between unconscious patterns and conscious choice.
⁴⁰
Styles of language or dress can be by turns “extremely self-conscious,” designed for display of a particular identity, or simply part of timeworn habit.
⁴¹
In his early, classic work in linguistics, Roman Jakobson analyzed the structure of many forms of aphasia (speech defects caused by brain damage) and saw all forms of aphasic alteration in speech, including child language, as fully part of language. Even though different types of aphasia were structured at a deep, unconscious level, Jakobson thought that the differences among kinds of aphasia could also be called differences of style.
⁴²
Whatever type of aphasia a person displays, he “exhibits his personal style, his verbal predilections and preferences.”
⁴³
Of the variety of aphasic disturbances, in effect, Jakobson held that every aphasia has its own style.
⁴⁴
Jakobson saw the aphasic as losing particular aspects of language ability, but in the face of the immense variety of ways language can be spoken and written, he thought it would be a mistake to assume any particular loss would result in lack of competence: “The changes in an aphasic's speech are not mere losses, but also replacements.”
⁴⁵
By looking across the whole field of a person's language, a particular loss could be seen as compensated by an idiosyncratic but functional style.
⁴⁶

In sum, style contains both separation and incorporation, both enduring uniformity and individual variation, both conscious and unconscious thought. It is both patterned aesthetically and it escapes our efforts to describe its patterns fully.
⁴⁷
The work of the French phenomenologist Merleau-Ponty could be taken to argue that it is the visceral aspect of human experience that lends style its ineffability. Merleau-Ponty's everyday examples make the point most forcibly while serving as a bridge back to this chapter's earlier performances of mania.

The acquisition of a habit is indeed the grasping of a significance, but it is the motor grasping of a motor significance. Now what precisely does this mean? A woman may, without any calculation, keep a safe distance between the feather in her hat and things which might break it off. She feels where the feather is just as we feel where our hand is. If I am in the habit of driving a car, I enter a narrow opening and see that I can “get through” without comparing the width of the opening with that of the wings, just as I go through a doorway without checking the width of the doorway against that of my body…toget used to a hat, a car or a stick is to be transplanted into them, or conversely, to incorporate them into the bulk of our own body. Habit expresses our power of dilating our being-in-the-world, or changing our existence by appropriating fresh instruments.
⁴⁸

I want to borrow Merleau-Ponty's way of describing habitual patterns of action in relation to the body “as an expressive space.”
⁴⁹
A person's finger movements, hand gestures, and body bearing are united by a certain style: the style results from her performance of her body, and none other; it is marked by her style, and none other.
⁵⁰

There is this kind of
style
—both individual and social—in what I have been calling performances of mania.
⁵¹
For mania, style enters in each particular individual's way of expanding his or her body in the world, reaching out in broad gestures, standing tall, speaking loudly, moving vigorously. Manic gestures take their meaning by contrast to depressed gestures: shrinking the body, containing the body in a close space, becoming silent, immobile, still. The concept of performance allows us to see that these ways of being can be at least in part learned and enacted. The concept of style allows us to imagine that they may be less rote and wooden enactments of a script than vibrant and lively (or contained and downcast) interpretations done with unmistakable individual flair. Let me be clear: I am not saying being manic (or depressed) is simply a learned habit. Nor am I saying such an action is entirely consciously chosen behavior. I am saying that being manic does not fit easily at either end of opposites like conscious/unconscious, habitual/novel; compelled/chosen; or innate/learned. We need languages such as Merleau-Ponty's to describe the terrain between these poles.

I will now return to the manic performances I discussed earlier, this time with the notions of performance and style in hand. At first gloss, Robin Williams's comedy seems to be a paradigmatic case of performance that builds on a traditional comedic style. In the tradition of Jonathan Winters and Don Rickles, he would have worked for his particular way of making comedy through apprenticeship, discipline, and training. Looked at this way, it is conventional. But at the same time, most people would probably agree there is something inimitable about Robin Williams: could you mistake him for anyone else? Here we need the concept of style to capture the unique way Williams maintains a high level of energy, spinning out threads of connection among the objects he handles and the things he says and hears through a kind of slipping: a word leads to an association with another word, then an object; an object is put to one use, then another and another; everything is pushed and wrung to yield meaning after meaning.
⁵²

In the training video, the actor's depiction of manic behavior as defined by the DSM is certainly also a result of training for control of gesture, speech, expression, posture, and tone of voice, among other things. The actual words the actor spoke probably, in fact, followed a written script. But, to pass muster as an educational video, the actor would have had to master what psychiatrists call “the feel” of manic depression as he moved from depictions of anger, fear, and paranoia to grandiosity. If a viewer judged his performance to be a rather flat rendition of manic depression (many do), this might be because the actor had mastered his lines well enough to give a performance, but had not understood manic depression well enough to have performed it with style. If he had performed it with style, we would have seen the actor's particular personality refracted through the exaggerated exuberance of mania.
⁵³

When we look back at all the instances I have presented so far of mania performed by people with the diagnosis of manic depression—in the support group meeting, at the DMDA picnic, in conference lectures—we could say that they have been training for these performances during all the manic episodes they have witnessed in others or experienced themselves. But just as with Robin Williams, training for a performance is not the same as performing with style. Each of these occasions, whether collective or individual, provides a chance that fleeting, contingent circumstances and individual personalities could enliven the performance with style. We could say that, after Jakobson, “Every mania has its own style.”

Describing manic behavior in terms of performance and style helps mania escape the narrow confines of pathology. Seen as a style and materialized as performance, mania can join hands with many ordinary practices and some extraordinary ones. But inevitably in the contempo rary world, as this “style” materializes, it becomes more visible and ever more vulnerable to being captured and redescribed as a treatable condition. It comes to be seen as a pathology that is fixable or a brain condition that can be optimized. Of course, this may be a development that people desire because mania, like depression, can cause great suffering. No one would wish to deny healing for a condition that causes suffering. In due course I will be asking what kind of healing psychotropic medication offers. One thing is certain, as we will see in later chapters: pharmaceutical commodification, like the stylo, the knife of the Roman curia, separates and isolates mental conditions. Through this taxonomic process, they come to seem less like “styles” that are both socially patterned and individually inventive and more like fixed biological brain states. Where appropriate, isn't it more compelling to see mania as a performance “in solution” and manic performers as artisans of their experience?

CHAPTER THREE

 

Managing Mania and Depression

That is the secret delight and security of hell, that it is not to be informed on, that it is protected from speech, that it just is, but cannot be public in the newspaper, be brought by any word to critical knowledge, wherefore precisely the words “subterranean,” “cellar,” “thick walls,” “soundlessness,” “forgottenness,” “hopelessness,” are the poor weak symbols.

—Thomas Mann,
Doctor Faustus

T
he people I introduced in the previous chapter were neither helplessly mired in mania nor so medicated that they were incapable of displaying mania. Rather, they were able to perform mania in a situationally appropriate way, commenting through meta-action on the condition itself. As I sketched in the book's introduction, at the heart of the degradation often felt by those diagnosed with mental illness is the loss of one or more of the central components of personhood as it has been understood in Western societies since the seventeenth century. These components included being an autonomous individual who had control over his body, his capacities, and his property.
¹
The person was thought to exercise control through his
will,
a capacity that would enable him to choose his thoughts and actions.
²
Full and unqualified personhood was thought to be found only in adult men, namely, in “men of reason.” Their property-less dependents, such as women, children, servants, or slaves, did not possess the capacity to be full persons. From the seventeenth century, too, the “mad” were relegated to the ranks of the “irrational,” separated by an abyss from men of reason.

My goal, in close readings of daily events experienced by people deemed “mad,” is to examine the abyss that still conventionally divides the rational from the irrational. This is not to detract from the gains in recognition of their human worthiness the “mad” have made in the intervening centuries. Andrew Scull argues elegantly that in the eighteenth century, the “mad” were seen ontologically as little more than beasts. Because their reason, the faculty common to all humans, was deranged, they were regarded and treated as brutes.
³
This conception of madness changed dramatically in the nineteenth century with the introduction of moral treatments, such as orderly living arrangements, disciplined work, and exercise, which would lead, under the proper wholesome and edifying conditions, to a cure. The “mad,” their irreducible humanity still intact, could regain their reason. Any lunatic's rational qualities could be restored to him “so that he could once more function as a sober, rational citizen.”
⁴
Though Scull argues persuasively that this was a change in “the cultural meaning of madness,” there was still a long way to go before the mad were treated as equal to any other citizen.
⁵
This abyss remains today: a diagnosis of major mental illness, in practice, if not in law, often disqualifies a person from high-security clearance, from employment of various kinds, from political office, from insurance coverage, and from college enrollment. Some kind of terrible abyss is still thought to divide “normal people” from the “mentally ill.” This difference made necessary (and welcome) the principles that the Office of the United Nations High Commissioner for Human Rights issued in 1991 for the protection of people with mental illness and for the improvement of mental health care. Among the principles was this fundamental freedom and right: “All persons with a mental illness, or who are being treated as such persons, shall be treated with humanity and respect for the inherent dignity of the human person.”

I want to fill this abyss with complex social experiences that contain degrees of autonomous and deliberate action, so that the fearful darkness of this space will lighten. As we saw in
chapter 2
, the support groups' deliberate enactments of mania could be seen as demonstrations that being manic is something one could choose to do, and hence that people with manic depression possess volition—a key attribute of personhood. In this chapter I continue this inquiry, focusing in particular on whether people living under the description of manic depression are capable of self-management.

I begin by looking at what happens when a person living under the description of manic depression takes psychotropic drugs. Since autonomy is a key aspect of personhood, whether or not a person who takes a psychotropic drug retains his or her autonomy is an important question. Is the cost of relying on a drug for achieving rationality that the drug is seen as substituting for the autonomous action of the self by becoming the person's “manager”? If so, would this leave the medicated person “rational” in form but lacking self-generated action, one of the key substantive features of personhood in the Western cultural context? This is why it matters who is the “manager” of the manic depression. Is it the drug, acting autonomously inside the person, or is it the person who takes the drug? In support groups, facilitators discouraged detailed discussion of drugs because no doctors were present to provide qualified medical advice. Nonetheless members traded a good amount of information about side effects, combination effects, long-term effects, dosages, brands, and like matters before and after meetings. Brief though these conversations were, they were usually based on the assumption that (at least ideally) a person rather than a drug played the role of manager. People urged each other to notice signs of elevating or descending moods before they became severe, to keep doctors apprised of ongoing changes in life circumstances so that medications could be adjusted, to gather information about the comparative side effects and benefits of various drugs, and to assiduously develop structured life habits (diet, exercise, sleep, mood charting, or recreation) that help optimize moods.