Bipolar Expeditions (7 page)

Sometimes whatever the manic end of bipolar represents has come to seem essential for survival, and certainly for success, as long as it is not overdone. As the novelist Tom Wolfe captures this sentiment in
A Man in Full,
the mayor of Atlanta discusses the city's midtown highrise towers and how they demonstrate that Atlanta wasn't a regional center, but a national one: “He gestured vaguely toward the towers that reached up far above them. ‘They did it! Atlanta favors people who are hypomanic—I think that's the term—people like Inman Armholster who are so manic they refuse to pay attention to the odds against them, but not so manic that they are irrational.'”
⁸⁹

Kay Jamison prefers the term “manic-depressive illness” to bipolar disorder because it “seems to capture both the nature and the seriousness of the disease,” while “bipolar” seems to her “strangely and powerfully offensive.”
⁹⁰
“Bipolar” “obscure[s] and minimize[s] the illness it is supposed to represent.”
⁹¹
Anticipating a theme that will emerge at the end of
chapter 8
, she also finds that the separation of moods implied by the term “bipolar” “perpetuates the notion that depression exists rather tidily segregated on its own pole, while mania clusters off neatly and discreetly on another.”
⁹²
In this book I prefer the more oldfashioned term “manic depression” because it leaves open the question whether the condition is to be understood only as an illness or also as a psychological style. But when I describe fieldwork contexts, I follow the usage of my interlocutors.

Intro. 5.
New Yorker
cartoon associating “bipolar” with outstanding art. Reprinted with permission.
The New Yorker
(2002): 74. © The New Yorker Collection 2002 Tom Cheney from
cartoonbank.com
. All rights reserved.

Manic Depression in Culture

This book follows the history I have just sketched, beginning with the experience of manic depression as a psychological state and then trac ing its emergence into a broader cultural field. Closely connected to ideas about the market, manic depression morphs into bipolar disorder and comes to serve as a focal point for collective disquiet about why exhilarating highs and frightful lows seem to be inescapably intertwined in contemporary life.

My primary goal is not to take sides in the debate over whether social causes of mood disorders are more important than biological ones. Rather, I am interested in issues that are simply left out of that debate. I want to offer different kinds of descriptions of the experiences and actions of people said to have manic depression, descriptions that allow such people to belong fully to the human condition rather than to an outer sphere of “irrationality.”
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I want to propose that “the human condition” might include both mania and depression within it. I have been guided by this analogy: consider manic depression to be a hand with a pointing finger. We might want to know about the physical properties of the hand, its muscles, tendons, bones, and how they enable the finger to point. Without those physical structures and relationships, no finger could point. But while the structures are necessary for pointing, they are not sufficient to understand what a pointing finger means. The pointing finger is a gesture that takes its cultural meaning from its use in a particular social context. By looking at mania and depression as “gestures,” my aim is to move toward a social theory of irrationality.

Will I be claiming that manic depression is not “real”? Not at all. I will claim that the reality of manic depression lies in more than whatever biological traits may accompany it. The “reality” of manic depression lies in the cultural contexts that give particular meanings to its oscillations and multiplicities. Will I be claiming that people living under the description of manic depression do not need treatment? Not at all. I will claim that whatever suffering attends the condition should be treated by any means possible. But I will also say that manic depression is culturally inflected: its “irrational” heights and depths are entwined in the present-day cultural imagination with economic success and economic failure. This is a central reason, as we will see, why manic depression's triumphs and failures hold very different kinds of promises and threats for those in powerful social positions compared to those in weak ones.

Research Methods

When I began the research for this project, I had only the sketch of a plan. I began with support groups in southern California and was led to psychiatry, neuroscience, the pharmaceutical industry, and the rest out of my interest in following up on what people living under the description of manic depression were experiencing. I thought of these excursions as “expeditions” into large-scale organizations whose activities I could only sample in the most modest way. The description that follows has the coherence of something written after the fact.

Beginning in 1996, I attended seven support groups for manic depression, some on the East Coast and some on the West Coast, as regularly as I could for the better part of five years. For the most part, I observed and participated in ongoing group meetings and social events, and had informal conversations with people I met. Toward the end of my research I interviewed some of the leaders of the groups' sponsoring organizations, in their official capacities.

My ethnography primarily focused on a pair of contrasting urban regions on each coast: the Baltimore metropolitan region in the Northeast (this area has been the base of my ethnographic work in the United States for the last twenty years) and Orange County in southern California. Both regions are suffering the effects of deindustrialization, poverty, and faltering town centers.
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Baltimore has attempted to recoup its losses by constructing an urban spectacle in a historic harbor to attract tourism and finance capital, but this has arguably increased the concentration of capital in the hands of a few multinational corporations and contributed to poverty in the city.
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Psychiatry in the region is located in both public and private institutions, including the University of Maryland, Sheppard Pratt Hospital, and The Johns Hopkins Hospital. Although I attended events at all of these institutions, the psychiatry department in one of them, here given the pseudonym Wellingtown Hospital, gave me permission to observe over a long term many of the ordinary contexts in which medical students and residents received training in how to treat patients for mood disorders. Since the department chair confined my activity to that of a medical student, I could attend classes and sit in on rounds (meetings in which doctors and students met with patients whose cases illustrated an important aspect of some psychiatric condition). However, I could not follow patients behind the scenes into the clinic or the community because this would have threatened the patients' confidentiality.

Orange County, in contrast to Baltimore, has become the site for many small and medium-sized firms supporting burgeoning information technologies and the entertainment industry, from Hollywood to Disneyland. Like these industries, psychiatry is also relatively decentralized, diverse, and entrepreneurial, and seeks to create opportunities for feedback from patients.
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Though Baltimore County and Orange County are roughly comparable in population and income distribution, and are largely “post-suburban,”
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Baltimore County has a concentrated urban settlement (Baltimore City), which it surrounds and which the state requires it to support financially. Whereas in Baltimore I concentrated on the psychiatric treatment of manic depression, in Orange County I worked with the neuroscientists in the region, who were some of the foremost national experts in brain imaging for manic depression and ADHD.

This geographic reach allowed me to pose comparative questions about personhood and mental illness. For example, in Orange County, on the low end of the social scale, I came upon cases of both ADHD and manic depression being used by recent Mexican immigrants as explanations for their own or their children's poor school performance, despite the high intelligence their family and friends perceived. Although people in support groups frequently stressed that each person was unique, they acted as though the group members' common diagnosis could override any social or ethnic differences. The diagnosis apparently provided a neutral way of explaining differences, as well as a path to success in school or work with the help of medication. An ADHD support group in Orange County (all of whom were white) embraced a new member who was Asian American as being “just like us”: all were thought to share a particular chemical makeup that made them unable to tolerate conventional nine-to-five desk jobs. In these cases, individuals were brought together across ethnic lines. On the high end of the social scale, my interlocutors in Orange County saw manic depression as tantamount to a requirement for a career in Hollywood, so common was it known to be in the entertainment industry and so necessary did its manic qualities seem for success in that field. Throughout the project, I was able to see how psychological categories were used in Orange County, as compared to the harsher, more rigidly divided economic environment of the Baltimore region, even though I did not organize the book along those lines. My research concerned manic depression and ADHD in about equal measure. Since the story that emerged turned out to be very complex, I have, for reasons of space, focused this book primarily on manic depression and its contexts. Because I will be able to mention ADHD here only rarely, the longer account of ADHD in its educational, media, work, and legal settings will have to wait for later publications.
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The third project location was central New Jersey (in particular the counties of Somerset, Middlesex, and Mercer), through which the Route 1 high-technology corridor passes. With its high concentration of finance, communications, and pharmaceutical companies (Bristol-Meyers Squibb, Johnson and Johnson, Roche, Merck, American Home Products, Warner Lambert, and Hoechst, among others), its highly educated workforce, and its increasing reliance on temporary workers and outsourcing, the area is an East Coast version of Orange County's business environment.
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In New Jersey, I concentrated my research on interviews with pharmaceutical company representatives and marketers, but it was also in New Jersey at Princeton University that I got basic training in the concepts and laboratory practices of contemporary neuroscience.

In addition to these geographically bounded sites, I traveled wherever I could to attend conferences and gatherings for professionals and patients related to manic depression and ADHD: the annual meetings of the American Psychiatric Association (APA); the meetings of the Neuropsychopharmacology Society; the Childhood and Adult Attention Deficit Disorder Association (CHADD); the Attention Deficit Disorder Association (ADDA); the Depression and Related Affective Disorders Association (DRADA); and the Depression and Manic Depression Association (DMDA). Over several years, I also attended a large variety of classes and seminars concerning work and the psychology of daily life: support groups for downsized workers, workshops and training sessions for management of the workplace, training sessions for workers, support groups for adults with ADHD, seminars in self esteem, classes for raising children to be productive adults, raising and schooling children with attention deficits, and so on. I collected and analyzed several hundred hours of tape recordings from these events. With people I met in these contexts, I carried out over eighty extensive, semi-structured interviews. To understand the contexts in which psychotropic drugs are produced, marketed, and advertised, I informally interviewed employees in the pharmaceutical industry in sales, marketing, and advertising. I also held a position as “visiting professor” in a major advertising agency.

PART
ONE

 

 

Manic Depression as Experience

The purpose of part 1 is to explore the experiences of people living under the description of manic depression. This task is difficult because I wish to raise perplexing questions about the terms in which manic depression, and mental illness more generally, are understood. However, people living under its description have themselves usually incorporated these terms into their self-understanding. My strategy is to begin by sorting out the meanings of common terms used to describe manic depression in psychiatric contexts and in daily life (mood, emotion, and motivation, for example). A contextual understanding of these terms is the best route to the counterintuitive perspectives I use in the remaining chapters. When I focus close-up on the daily experiences of the people I came to know during my fieldwork, I will be able to show what such terms capture and what they leave out.

CHAPTER ONE

 

Personhood and Emotion

Per-son