Bipolar Expeditions (43 page)

Race and Gender Revisited

The structural constraints entailed in cultural concepts of race, class, and gender are hard for Brooks to see, but they are also hard for even the most passionate advocates of mental health to see. An enlightened surgeon general, David Satcher, made improvements in mental health a priority of his administration, and appeared in my fieldwork, much to the delight of many of my interlocutors, by giving a speech at the 2000 meetings of the DMDA. His speech accompanied the publication of the supplement to his report, which dealt in its entirety with mental health in the United States.
¹⁷
The dominant model operating in the supplement is that there is something concrete and real in the world and (increasingly in the brain) that corresponds one to one with the major psychiatric diagnoses. Identifying this real thing, in the brains, say, of patients, is the proper first step to getting them the right treatment. Identifying “observer bias” and removing it will clear the way to more frequently correct diagnosis. But there are at least three troubling aspects of this view. First, what if the categories into which psychiatry divides disorders themselves already have cultural assumptions embedded in them, not fixed for all time but, as I have sketched for mood disorders, changing with the times? Second, what if our only route to the real is always through linguistic categories that are necessarily saturated with culturally constituted sets of meanings? Third, what if the interests of product-centered pharmaceutical corporations dovetail with seeing psychological states as physical states, extricable from social context? If so, can a pharmacogenomics specific to race or gender be far behind? If any of these conditions were to hold, the job of removing the effects of racialized or gendered perceptions becomes far more difficult. My object in saying this is not to create a cloud of pessimism over the endeavor of the supplement. It is to ask whether the problem of differential treatment for mental illness by race, class, or gender can be addressed without going much farther to eliminate the social factors the supplement identifies and then tries to correct for—poverty and racist or sexist attitudes? Will making medicines available to African Americans or to poor women who suffer more stress due to poverty and discrimination provide something we want to call a solution, let alone a cure?

Optimizing Moods

I have explored how the domain of interior psychic states is being made visible in particular ways and how it is being selectively harnessed for culturally specific purposes. Many people in the United States consider the domain of emotions to be essential for fueling innovation and creativity. But not just any form of emotion will do. Moods are important, but for this practical use, they need to be optimized. Optimizing moods means eliminating depression, and eliminating the extreme mania in mania, leaving only heightened motivation. The notion of optimizing moods means requiring them to go up and down as required by the economy. This kind of fantasy is not new. The goal of controlling a human being remotely was the hallmark of the very earliest development of psychotropic drugs. In the 1960s, the plan to control the administration of drugs to spacemen was explicit. As the sociologist Jackie Orr has shown, if the stress of space flight caused undesirable psychological states, “they suggested the possible administration of pharmaceutical drugs via remote control from earth.”
¹⁸
In the present, we are no longer dealing with men in space, but exhortations to control moods in relation to system stresses are still around. The neoliberal columnist William Safire said on December 3, 2003, that the recent good economic news was the “bursting out of animal spirits … the breath of life … made famous by John Maynard Keynes.” He cautioned: to avoid a repeat of the late 1990s, we should not “let invaluable animal spirits get the better of” our judgment.
¹⁹

The desire for remote control of emotional states cannot be confined to post—World War II paranoia. Advertisers and marketers invest major amounts of research in figuring out what mood the population is in and what tone their products should aim for. Roper, a major firm that writes expensive reports used by pharmaceutical marketers, published an immediate response to September 11 and the stress it caused the population. The Roper Report warned marketers to avoid “wigged-out characters” like the manic guy who appeared in a “longrunning campaign for an electronics chain that featured an ‘insane' hard-sell salesman.” They recommended that “stoic characters” should be used instead.

An even more explicit message once again came from David Brooks. In a 2003 article in the
New York Times Magazine,
he stressed the need for a new national mood. Because the “CEO superheroes of the 90s … will not supply the capitalist face of the age,” he called for a return to the “Lincolnian virtue of simplicity and humility,” “the staid but unexciting bourgeois virtues,” the “slow, steady, boring accumulation of accomplishments and money.”
²⁰
Brooks's argument was that the “creativity ethic” of the 1990s needed to give way to the work ethic, which makes wealth acceptable. The work ethic is based on a belief in social mobility, the idea that anyone who works hard can get rich. Social mobility, in turn, is “the very essence of justice, because each person's destiny is somehow related to the amount of talent and effort he or she pours into life.”
²¹
In Brooks's vision, belief in social mobility reduces class conflict because each person is building his or her own fortune without taking anything from the fortunes of others.

Brooks is trying to turn down the emotional temperature just a bit, but he is surely not trying to abolish emotion and moods altogether. Imagine what would happen to the markets if emotion vanished. Could a consumer society go on with consumers who felt neither happy nor sad, who neither desired anything nor felt the lack of anything? When our moods are disordered, we may have too much or too little sociality, but either would be preferable, from the point of view of markets, to socially disconnected emotional flatness. But if social conditions are such that the possibilities for emotions are reduced and conditions for disconnection are enhanced (in part because of the structural forces Brooks tries to ignore), then emotion itself, perceived as the vital spirit of the economy, might be seen as a valuable but endangered resource. Brooks is imagining identifying, measuring, moderating, in short managing this scarce resource, not eliminating it.

I am arguing that emotion is both selectively flattened (recall the Roper Report's stoic characters or David Brooks's work ethic) and incited (recall the Joule Company's manic hunt or Shackleton's mania) in these times. Capacities within a disorder understood as an excess of emotion have come to be a valuable terrain for product development. Our individual responsibility comes to involve monitoring our moods in detail with a watchful eye for the changing possibilities of pharmaceutical optimization. Within the cycle of bipolar disorder, the muchvaunted creativity of mania turns out to be a kind of intense motivation, conforming to the demand for great productivity. For all that mania has been associated with the creativity of great artists, inventors, and politicians of our times, the form of mania being extolled for entrepreneurs today is
conforming
rather than
creative.
As mentioned above, this mania is only innovative in ways the market can value. Echoing contemporary demands for relentless productivity, this sort of mania leads to conformity to the demands of the market, which in turn amplifies reigning neoliberal social norms, narrow and inhuman as they are.
²²

The End of Madness?

Michel Foucault referred to madness as the absence of the work of reason, the absence of work that endlessly shores up a historically specific definition of what reason is. Without the work it takes to achieve that definition of reason, “madness” arises. As Michel Serres explicates Foucault's point, “There is no madman but he in whom work sleeps, he who forgets to create it.”
²³
As long as Western culture imagines madness as the opposite of reason, it makes madness a fearful prospect. But Foucault also wondered whether there would come a time when Western culture would no longer define itself in distinction to the realm of the mad, the land of unreason.
²⁴
He thought this would mark the end of Western culture's passionate relationship to madness, because madness would no longer serve to represent the culture's deepest fears: of becoming like the “other” who lacks reason. What could cause madness as we know it to disappear? Foucault suggested two possibilities: first, precise pharmacological control of all mental symptoms and second, rigorous definition of behavioral deviations accompanied by methods of neutralization.
²⁵
With these methods in place, the formerly “mad” would be thoroughly brought into the “work” of reason, and “madness” as we formerly understood it would be gone. However, no matter how far technical means of control of mental illness were able to go, Foucault thought that “madness” in some form would continue. This would be true as long as humanity depended on the feared “other” to define who is fully human and who is not. The two possibilities that Foucault thought could cause the end of madness are already at play around us: precise pharmacological control of mood disorders is being offered through increasingly complex combinations of psychotropic drugs; rigorous definition of deviations is being accomplished by detailed mood charting and the compilation of statistics mood charts make possible. We have yet to see how far these methods will go. In this book, at a time when “madness” still exists as the feared “other” of reason, I have detailed how we cannot, however we may fear madness, escape it. We circle around it and into it. We are less
“at a distance
from madness than
within distance
of it.”
²⁶

Short of doing away with the category of “madness,” would such an enlarged role for pharmacological agents cure us?
²⁷
Would the suffering often attendant on living under the description of manic depression be eased? The many testimonials in this book, including my own, make it plain that these agents ease suffering. A cure, however, is another matter. A cure implies healing, and healing would have to address not just people's experience, crucial as that is. Healing would have to address the strong but not invincible barriers to our ability to flourish, as individuals and as part of collectivities. Those barriers are erected around race (think of Keith Burton's “I am not crazy” or Ms. Miller's “I ain't gonna mess with it backwards”), gender (think of Marie Cardinal's descent into madness or Martha Stewart's imprisonment in a double-bind), and class (think of welfare clients being screened for depression or the many people without access to health care), to name a few. The effect of all these barriers is intensified when “mental illness” comes into the picture. Unless these barriers are removed, no amount of psychotropic drugs, however soothing, will heal “mental illness.”
²⁸

At the same time, one goal of this book has been to show why the irrationality of those with emotional disorders, their ability to be emotionally extreme, is being treated as a resource, an economic resource for those in a position to take advantage of it in the right way. Those Americans who can are being encouraged to optimize extreme moods by filling out a chart or taking on board the managing presence of a drug. Paradoxically, participating in charting and medication means by definition that one needs management. A great many people are including themselves in such practices. Whose moods then are still in order? The line between the irrational and the rational is in motion. Whatever new ways of being social are emerging, they are emerging onto terrain where the line between the rational and irrational is shifting. We are all irrational (have disordered moods); we are all rational (even manic depressive people can chart their moods.)

In the early chapters of this book the inhabitants of the land of unreason were given a chance to speak: I described them as people whose words and acts were animated by a consciousness of their condition. Seeing them this way is particularly important, given that the domain of the irrational has so often been seen as a harrowing space that is inhabited by those who do not enjoy the full status of persons. As the poet C. E. Chaffin wrote in “Manic-Depression,” a poem that traces his movement from imprisonment in depression to release in mania,
²⁹

The sun rises, stone walls dissolve.

I clench a marigold in my teeth

and tango on the flaming grass.

The soil beneath is black with crematory ash.

I pray the lawn is thick enough

to hide the darkness I dance over.

The shadows cast across this country from time to time—the shadow of death or of profound loss—contain something Americans need to remember. In the specific social world we inhabit, a world harnessed to the harsh realities of increasingly unfettered capitalism and turning between the poles of emotion and anxiety, mania and depression, the dance contains darkness. People living under the description of manic depression have keen experience of this insight; indeed, they cannot avoid it. They cannot help wondering whether the dance will ever be incandescent enough, the lawn thick enough, to banish the darkness. This perspective, as much as the wild energy of mania, is the essential resource contained in manic depression..…

Appendix

 

Guide to Medical Terms

A
number of names of drugs and psychiatric conditions are used in this book. Tables 1 and 2 serve as a guide to the main types of diagnoses and drugs I mention.

T
ABLE
1
Psychiatric Diagnoses