Bipolar Expeditions (6 page)

It had been the failure of just such business deals as the one I had plunged into last night that had precipitated my melancholia and brought me down. Worry. Worry. Anguish about failing business. Watching the market crash. Then, overwhelmed by a fear of falling seriously ill, of having my brain impaired, I had tried to forget by driving myself more fiercely into work.
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A more positive view surrounded the biography of John Ruskin by R. H. Wilenski (1933), which was hailed in the press for successfully correlating Ruskin's writing with the state of his mind at the time. He was a “mental invalid all his life,” “suffering continuously from the malady known in psychiatric circles as ‘manic depression.'”
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Ruskin was regarded as talented: “He learned as the imaginative genius learns, by suddenly piercing to the heart of a thing and understanding it.” But his talent stood somewhat to the side of his illness: “In his manic moods he boasted of his power. Even in his depressed moods he very seldom doubted it. And he really had it.”
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In a similar vein, the publication of the journals of André Gide in 1947 conveyed to the reviewer his “emotional intensity, his alternate ascent to peaks of joy and physical wellbeing and descent to an avernus [gateway to Hades] of acute depression, nervousness, insomnia and gloom. Amateur psychiatrists would have no trouble finding plenty of evidence of manic depression in these pages … [he] was hardly in normal control of his emotions.” As with Ruskin, Gide succeeds in spite of, not because of, his manic depression: “But, there can be no doubt, that [he] has one of the most acute minds and one of the most genuine literary talents of his generation.”
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Equally tellingly, when Virginia Woolf's husband, Leonard Woolf, died in 1969, there were some thoughtful articles about his role in her struggles with manic depression, and many references to her “genius.” But there was little mention of a link between these two aspects of her life.
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By 1970, an atmospheric change had taken hold. The efficacy of lithium carbonate in animal studies led to its use in humans for the treatment of manic depression, and this discovery received major press attention, even before it had received approval for therapeutic use in the United States.
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As if the existence of a treatment for manic depression in and of itself made the malady seem more approachable or possible to imagine as something more than maniacal insanity, a series of media developments ensued. Lithium as a remedy for manic depression made it into two episodes of a television show,
Maude,
in January 1976. The airing of these shows was controversial because people feared that the public, jumping to the conclusion that all forms of mental illness could be treated by lithium, would ignore lithium's potentially serious side effects.
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Autobiographies began to describe manic depres sion as a stimulus to creativity as well as a hurdle to be overcome. In
Josh: My Up and Down, In and Out Life,
Josh Logan, a theater director and producer who won a Pulitzer Prize for
South Pacific,
describes the triumphs of his career despite the two breakdowns he had as a result of his manic depression. In 1976, Ronald Fieve, who, not coincidently, was Josh Logan's psychiatrist, wrote the first widely popular book about manic depression, stressing that it could be treated with lithium. This book,
Moodswing,
also laid the groundwork for future elaborations of the links between the manic phase of manic depression and success in the marketplace. In a filmed interview, Fieve expounds on what he called the “Midas effect”: the ability of a manic person to take creative risks, work with enormous energy, and sweep others up along the way often leads to his economic success.
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Around this time manic depression came to be used as a general metaphor or framing device for the social conditions of the day. In a 1977 newspaper editorial, “Man's Despair, and Hope,” Eric Bentley mused on the “glum” faces of the people he saw across from him on the subway. Their facial expression ranged only from “resignation to rage, from moroseness to aggression.” He noted how differently people were depicted on the subway advertisements above their heads: “They picture the same people—ourselves—our fellow Americans, but in an exactly opposite mood. Gone is their manic depression. Come is their fixed elation. Their beautiful teeth proclaim their unmixed happiness. They laugh, they smile, or they show a gravity that is all poise and self assurance…. In short, the ads are populated by optimists, while the seats are occupied by pessimists.” Bentley went on to decry both exaggerated optimism and exaggerated depression among U.S. citizens in general, and to call on the moderating effects of an active intelligence to raise mindless (and overly emotional) hopelessness and to lower equally mindless optimism.
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By 1980, Kay Jamison had begun to publish her work on creativity and manic depression.
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In
Touched with Fire,
through careful examination of the content of personal diaries and letters, and patterns of productivity and fallowness, Jamison suggested that the diagnosis of manic depression (she prefers the term “manic-depressive illness”) could be retrospectively applied to writers and artists such as Walt Whitman, Vincent van Gogh, Virginia Woolf, Anne Sexton, and Edgar Allan Poe. Jamison listed over two hundred composers, artists, and writers who arguably had some version of manic depression, from T. S. Eliot and Edna St. Vincent Millay to Georgia O'Keeffe, Edvard Munch, and Jackson Pollock.
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Her effect on the public representation of mental illness was dramatic. By 1989, a mental illness advocacy group, Mental Illness Foundation, was soliciting contributions from the public in an advertisement featuring a photograph of Abraham Lincoln.
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The headline read, “You'd be surprised how many people have suffered from mental illness.” The text of the ad read, “It is not commonly known how many well-known figures in history suffered from mental illness. Depression. Manic depression. Schizophrenia. Suicide. Among them were Abraham Lincoln. Vincent van Gogh. Nijinski. To the world at large, they were powerful figures, but in the privacy of their own thoughts and feelings, they were at the mercy of mental illness, and suicidal tendencies.” The ad did assert the link between creative and powerful people and mental illness, but its main message was still that these great people had to overcome a serious handicap in order to succeed.

It would be hard to exaggerate the impact of Jamison's work, which has been featured in major newspapers, magazines, and documentary films. In 1995 she published an article in
Scientific American,
arguing that the “temperaments and cognitive styles associated with mood disorders can in fact enhance creativity in some individuals.”
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The article singles out a number of famous artists, musicians, and writers who could be considered manic depressive by the evidence in their letters and journals, or in descriptions given by physicians, family, and friends. No less than eighteen of these figures were illustrated with dramatic photographs or self-portraits, which surely enhanced the impact of the article for its readers. Among those pictured were poets Walt Whitman and Sylvia Plath, artists Vincent van Gogh and Paul Gauguin, writers Virginia Woolf and Edgar Allan Poe, and musicians Gustav Mahler and Cole Porter. Since Jamison was well known as the coauthor of a technical reference work on manic depression and as a frequent participant in national meetings of advocacy organizations, her publications on creativity added an additional layer to the esteem in which she was already held.
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Intro. 3. Icons of artistic creativity from
Scientific American
article by Kay Jamison.

Her revelation in 1995 that she had the diagnosis of manic-depressive illness added further to her popularity. At one meeting of a manic depression support group in Orange County, the facilitator, Sarah, started off by passing around an issue of the
Saturday Evening Post
containing an article on manic depression by Kay Jamison, together with a program from a concert Jamison organized in southern California to highlight the music of famous manic-depressive composers such as Handel, Schumann, Haydn, and others.
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Sarah commented that because these artists from the past did not have the benefit of today's medicine, they were so out of control that they made lots of suicide attempts. She also passed around a photo album that she had kept over the years with photographs she had taken of Kay Jamison giving talks at national meetings. This album was very worn from use and filled with Polaroid photos Sarah had taken herself.

The next developments in the revaluation of mania amount to a sea change in the understanding of mood: scientists began to understand the molecular mechanisms involving receptors in the brain as a system of interacting receptors and neurotransmitters. The pharmaceutical industry began to develop a new generation of drugs that could modify the way receptors worked and therefore the ways people experienced moods. For a brief glimpse of the public representation of these developments, we can look at two public health posters from 1984. The first commemorates Julius Axelrod's discovery of the cycle of interactions involving serotonin, a neurotransmitter: the abstract illustration depicts the space in between neurons, known as the synaptic cleft, and shows the newly understood variety of molecules in that space. The other commemorates a National Institutes of Health (NIH) conference held to develop a consensus about how mood disorders could best be treated. The poster portrays three men on the “merry-go-round” of mood disorder, one in the grip of mania, one in the grip of depression, and one somewhere in between. The title of the conference, “Mood Disorders: The Pharmacologic Prevention of Recurrences,” indicated that the components of mood disorders at both ends of the scale from depression to mania seemed amenable to a vastly greater degree of management.

In the 1990s, an important shift in popular terminology occurred, one that probably played a significant role in changing how people regard manic depression. Authors of popular books and articles began using the term “bipolar disorder,” following the shift from manic depression to bipolar disorder in the DSM-III in 1980.
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From the 1980s to the end of the 1990s, the use of the two terms was equally frequent in U.S. newspapers, but in the years since 1999, “bipolar disorder” has been used nearly three times as often. In August 2002 the major consumer advocacy organization for manic depression and depression, the National Depression and Manic Depression Association (NDMDA), changed its name to Depression and Bipolar Support Alliance (DBSA), specifically to avoid the term “manic depression.” They explained on their Web site:

Intro. 4. Poster from 1984 National Institute of Mental Health Consensus Development Conference showing the ups and downs of mood disorders. Courtesy of National Library of Medicine. Artwork by Robert F. Prien, Ph.D.

The decision to change our name came only after long and hard thought. There are many reasons the Board of Directors feels this is important. First, and foremost, our name was long and difficult for most people to remember correctly. Perhaps even more difficult was saying our tongue-tying acronym—National DMDA. In addition, bipolar disorder is no longer called manic depression. Many people are frightened by the term “manic depression” and this keeps them from contacting us for help.
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Over the last one hundred years or so, fright over the term “manic depression” has transformed into fascination with the term “bipolar.” Sometimes this fascination involves the extraordinary abilities bipolar people apparently have, as demonstrated in the
New Yorker
cartoon that depicts a couple viewing a painting in a museum. One says to the other, “It's good, but it doesn't say bipolar.” In other words, if the painter were “crazy,” his painting would have more value.