Bipolar Expeditions (31 page)

Evading Mood Charts

The sociologist Peter Miller has argued that accounting schemes like mood charts are virtually impossible to resist. If people refuse to use one scheme, they will be provided with a new, improved version. Con sultants and others will use their complaints to identify the shortcomings of the original calculating technology in order to develop a new one without those shortcomings: “The aspiration to render individuals and spaces calculable seems to engender a constant process of adjudication on the vices and virtues of this technique or that.”
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In small ways, however, people do try to modify calculating technologies themselves. For example, since the publishing capacities of the Web open the door to individual creativity, some individually designed mood charts have the potential to do more than reinscribe the same calculations in a more efficient or effective form.

A chart on a Web site published by Jinnah Mohammed includes large amounts of information about his particular life, undercutting the depersonalized and abstract qualities of most charts. The more specific his information is, the less readily it can be reduced to a number and compared to information from others. Jinnah's chart also separates measures of mood from measures of functionality, opening multiple axes on which he can compare different aspects of his condition. The additional axis has the potential to increase the surveillance of the chart over Jinnah's life, but at the same time it opens the possibility of challenging how standard DSM categories link moods and productivity. In the DSM, moods on either end of the manic depression scale are abnormal. By charting functionality as well as moods Jinnah discovers that he can be functional while his moods are abnormal, thus opening the possibility that he could reject the DSM's assumptions. However, he does not go this way. Instead, he concludes he is never normal: “I have used the charts to show my family that when they thought I was normal (i.e., functional), I wasn't emotionally stable. It came as quite a shock to them often because they couldn't detect anything wrong with me…. [The chart allowed me] to realize I had no periods of normality.”
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In the end, Jinnah Mohammed's charting bears out Peter Miller's general point: the more of his life the chart makes visible, the more he feels he does not fit the “norm.”

From another point of view, doing the accounting defined as self management might be considered a strike in favor of one's capacity to be a rational person. Charting one's moods could be seen as demonstrating one's rationality—and this in itself could constitute a form of resis tance to being categorized as irrational. From this point of view let us reconsider Amy's mood chart. What is being measured here? What is the something that goes up and down, or gets a numerical designation? Moods? Feelings? Energy? Will? Whatever it is, it comes from a private, individual, interior space. The chart converts specific experiences into abstractions through numeric measurement (Marx's “retort”), but it also makes these experiences social along the way.
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When one is categorized as “mentally ill” and hence outside the realm of the fully human, having one's private experience count as part of the social holds great significance. The individual uniqueness of experience might be lost in the homogenizing process of abstraction, but in return the private moods of an individual take the form of their opposite, moods that are widely shared. For people with pathological mood disorders, this is a move toward feeling human. This might be why people with mood disorders frequently say that charting their moods in and of itself makes them feel better. Even though, like Jinnah, charting might increase the range of their moods that appear abnormal, charting also makes them like everyone else, managing their moods through keeping records of diet, exercise, and medication.

From Temperate to Hot

I have made a case that compared to Kraepelin's charts, contemporary mood charts encourage self-monitoring because they are kept by patients, subdivided into many categories, liable to eliminate any space for the “normal,” and oriented to the relationship between drugs and moods. They, however, may have something in common with Rush's earlier version, the moral thermometer. Rush and his followers explicitly recommended that household members assiduously record information about themselves, though the matrix they provided was indeed less complex than today's charts. In the popular magazine that reprinted the chart, readers were exhorted to enter “in a journal every variation observed in their own tempers” and thus be able to look back over time “to see what measure of improvement has been gained in a given period.”
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Then as today, keeping a written record was a way of providing individuals with a path to self-improvement.

The inventor of the thermometer is persuaded that if ladies and gentlemen, young as well as old, were to use the instrument according to the directions which accompany it, they would find their own happiness increase, and their acquaintance more desirous at all times of their company; neither has he the least doubt, but husbands and wives, parents and children, masters and servants, would find their lives become gradually much more easy and happy by a proper attention to it. N.B. the scale had better be hung up out of reach.

A part of the early temperance movement in the United States, the intent of Rush's moral thermometer was to monitor the effects of consuming spirits and limit their consumption.
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Like the mood charts of today, the moral thermometer gave individuals a set of categories they could use to describe their states of mind, but it was not attached to broader kinds of summary measures. It had no numerical grid and therefore moods could not be graphed over time, nor could they be collected and compared statistically.

The main contrast between then and now is the ideal temperature on the moral thermometer. We might want to say that for Rush, the structure of feeling of his time was “temperate.”

An individual … was enabled to effect such a reformation in himself, that for many months on a stretch his temper and habits remained
temperate,
or rose only to the degree marked
warm but reasonable
. A gentleman … effected so complete a change in his disposition, by an alteration of his food, that he assured the writer a variation in the moral Thermometer higher than warm or lower than cool was to him an uncommon occurrence.
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In contrast, as we will see in the next two chapters, the ideal temperature, the structure of feeling for today, has come to be somewhere between “passionate” and “hot.” The small-scale technology of the mood chart allows individual acts of self-surveillance to be collected into large-scale statistics that watch for the rising or falling temperature of moods on a global scale.

CHAPTER EIGHT

 

Revaluing Mania

It is one of the great ironies of Western culture that we revere and socially applaud sustained creativity, drive, and infectious enthusiasm but fail to recognize these qualities as close cousins of the disorganization and suspicion that accompany them in mania and are stigmatized as maniacal madness.

—Peter Whybrow,
A Mood Apart

I
n contemporary Euro-American culture there is a pervasive imperative to experience emotion. Ubiquitous advertisements incite our desire and demand that we engage our strongest feelings. Managers of employees and creators of ad campaigns learn detailed, practical ways of arousing and harnessing emotion to increase productivity and increase market share. As we will see, no less an economist than John Maynard Keynes wrote that the market itself depended on the arousal of our “animal spirits.”
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Yet, as I mentioned in the introduction, people in the late twentieth and twenty-first centuries are also profoundly anxious and hence characteristically preoccupied with emotionally flat conditions—detachment and alienation. The flattening and deadening of the emotions is a pervasive theme in art, architecture, film, and daily life.
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In other words, at present, emotion is both flattened and incited at the same time. This chapter in the story of manic depression will take place on the terrain of this strange disjunction. If emotions seem necessary for the operation of strong markets, yet they seem frightening when experienced under a pall of intense anxiety, what cultural gloss will be given to a disorder understood as an excess of emotion? Will manic-depressive people seem like a scarce resource, a valuable terrain for exploration and colonization?
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Will they be less frightening to the extent their “good” emotions, their manias, can be isolated, fostered, and optimized? In beginning to answer these questions, my primary method is to trace changes in the ways in which intense emotionality has been valued or denigrated over time, and for whom. We will need to move back and forth over the line separating people living under the description of manic depression from people who may never have received such a diagnosis but who either think of themselves or appear to others to be “manic” in some sense.

Sociality and Conformity

We will find that the cultural logic of the category of manic depression and its media representation are different. We saw that “moods” are somewhat oblique to the category of “emotion,” and that although manic depression is called a “mood” disorder, it has as much to do with “motivation” as “mood.” We also saw that although manic depression shares the general characteristics of emotions, its peculiarity is that it is an interrelated, oscillating set of emotions. Most crucially for this chapter, we saw that mania and depression are strongly linked to sociality. This link is important because it opens a way to challenge the popular assumption that mania entails creativity.

To see this, I will look at the link between mania, depression, and sociality more closely, drawing on insights from psychiatrists who have paid close attention to the experiences of people living under the description of manic depression who are their patients. The early twentieth-century German psychiatrist Ernst Kretschmer referred to manic depressives' “harmonious sense of union both with the world and within themselves,” which makes them “sociable, immediate, and relatively undivided in their being.”
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Kretschmer found such a patient when in mild mania to be “the emotional man, the good mixer, who is outspoken, easily moved, and perpetually being influenced afresh. He likes meeting any new person and is at once his friend.” Even when melancholic, such an “emotional man” has a “non-moralising warm understanding of alien peculiarities” and a “good-natured unassumingness” that makes his company “so pleasant in personal relations.”
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Like his near contemporary, Emil Kraepelin, Kretschmer understood the manic-depressive person's sociability as the opposite of the schizo phrenic person's asociability: introverted and isolated, a schizophrenic person was seen as detached from other people and removed from social interaction. In broad strokes, a manic-depressive mode of being was closely attuned to social norms, while, in sharp contrast, a schizoid way of being did not conform to social expectations.
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Elizabeth Lunbeck has shown that in the early twentieth century, psychiatrists generally reacted favorably to the sociability of patients they diagnosed as manic depressive. As psychiatrists of the time told it,

the story of the manic depressive was lively, often raucously so, and entertaining. Such individuals engaged the world around them headon, often wreaking havoc at home and driving their relations mad … but they did so with a verve that drew admiration. Their signal characteristics—loquacity, excitability, intense sociability, and mordant wit—differed from those of normal individuals only by virtue of their excess.
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It is, of course, exactly
excess
that distinguishes mania from ordinary exuberance. The psychiatrist Alfred Kraus explains manic sociability as an “expansion” of identity. In order to expand her identity in every direction, to achieve a “harmonizing ‘oneness' of ego and world,” the manic person tends to disregard any limitation on her social roles from other people: her family members, her business associates, or other drivers on the road. The give and take that would be part of ordinary social interactions gets lost.
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Put another way, in a manic state, a person will hear and amplify the positive reactions from other people and ignore the rest; in a depressed state, she will do the opposite. These forms of sociability are exaggerated in different directions, but they need not seem bizarre to other people. In 1922, E. E. Southard (a psychiatrist at the Boston Psychopathic Hospital) supposed that “every one of us is of manic-depressive stripe.”
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He explained that most of the symptoms are easily understood “because they are exaggerations of the normal feelings rather than new or ‘different' or ‘peculiar' reactions.” As a result, Southard found that “one's ‘empathic index' is usually high toward such patients.”
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Seeing the contrast between manic depression and schizophrenia in this way leads to a startling realization: despite the contemporary belief that manic states can be a source of innovation and creativity, manic depression is actually a malady of social conformity. As Alfred Kraus puts it, the style of interaction of a manic depressive patient involves a “great willingness to fulfill the other person's expectations, in order to bring himself to a peaceful conformity with the other.” Their “great sociability” as well as their “high degree of conformity with the world around them” comes from an “attitude of unified human solidarity, avoiding at all cost any threat to this solidarity by anything like nonconformity.”
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In a depressive phase, the person is overly identified with the opinions of others and overly concerned to submit to whatever social norms will gain the approval of others.
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The person is so sensitive to the opinions of others that he is apt to plunge into despair in the face of others' rejection or disapproval.
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In the view of some psychoanalysts, depression is such an intolerable condition to sustain that manicdepressive people periodically escape into mania as a defense. On this view, mania serves as an attempt to escape the dependence on the approval of others characteristic of depression when that dependence becomes unbearable. As I mentioned in the introduction, early psychoanalysts such as Melanie Klein explicitly understood the psychodynamics of mania as a defense against the depressive position.