Bipolar Expeditions (3 page)

Bipolar Expeditions

 

INTRODUCTION

 

Manic Depression in America

If I want to be beyond criticism, loved by everyone, flawless as a gem and incorruptible as platinum, having a holy hatred of evil and a desperate love of good—and if I plunge into suicidal melancholy when I realize how impossible this is, is it such a bad thing?

—C. E. Chaffin, “My Testament”

A
merican culture today has a strong affinity with manic behavior. Advertisements use the quality of mania to sell products from Macintosh computers to luxury linens, from perfumes by Armani to shoes by Adidas. Manic energy fuels the plots of detective novels, MTV shows, and television dramas such as ER; it rings through the lyrics of songs like Jimi Hendrix's “Manic Depression.” Serious academic tomes as well as patient advocacy Web sites and professional psychiatry meetings celebrate the creative mania of artists from Vincent van Gogh to Georgia O'Keeffe. During my ethnographic research in the years since 1996, I have found that people in many walks of life in the United States are fascinated by manic behavior and see it as a valuable resource in the everaccelerating spiral of “productivity.” Members of support groups for people with manic depression look to figures like Robin Williams or Jim Carrey as role models because of their manic performances; television regales the general public with the adventures of larger-than-life figures such as the polar explorer Sir Ernest Shackleton because of his manic and heroic feats. Television programs like Jim Cramer's
Mad Money
operate at “hurricane-force,” mirroring the manic pace of markets.
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The high energy associated with manic behavior seems to add to the creative potential of entrepreneurs, business leaders, and entertainers.

CEOs, Hollywood stars, and MTV
The Real World
youths embrace the diagnosis of manic depression, reveling in the creativity of its mania and regretting the immobility of its depression. Frequently, stories about manic depression involve life-and-death risks. One executive, a “manic CEO,” delivered his company “from the brink of death to complete dominance in an important technology market.” His kinetic energy and frenetic enthusiasm made him “the greatest salesman in the world,” and talking to him was “like being on an acid trip.”
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But while manic CEOs are carrying off feats like these in the business world, they are also facing their own brush with death: fearing the public revulsion toward mental illness and reluctant to admit they need treatment because it would be taken as a sign of weakness, they face their inner turmoil privately. Some, like Mark Helmke, first “spend a company into bankruptcy” and then commit suicide.
³
Popular media frequently assert the life-threatening nature of the condition. The
Washington
Post, in an article on the rise in diagnosis of bipolar disorder among children, puts it in a nutshell: “The illness, which is usually diagnosed in adolescence or early adulthood, is a serious and disabling mood disorder that, if untreated, carries an elevated risk of suicide. Sufferers typically cycle between manic highs, in which they can go for days without sleep in the grip of grandiose delusions, and depressive lows, marked by a preoccupation with death and feelings of worthlessness.”
⁴
Too often, the depressive lows swallow up a person's life.

Even in the face of life-and-death risk, popular books like
Emotional Contagion
or
Leading Change
report on the importance of high-energy moods.
⁵
Since a leader's mood is “literally contagious,” his primary task, indeed, his
primal task,
is “emotional leadership.” Mood is seen as all important for success: “A leader needs to make sure that not only is he regularly in an optimistic, authentic, high-energy mood, but also that, through his chosen actions, his followers feel and act that way, too.”
⁶
A wide variety of publications directed toward business managers claim that the emotional contagion of high moods can directly affect business success.
⁷

In this book, I will explore the cultural understandings and practices that surround mania and manic depression in the United States. How have these understandings and practices emerged from the recent past and how were they different in the past? With what American cultural assumptions about life, death, power, weakness, capacity and incapacity, the mind, and the body are they infused? How do these assumptions differ for people in diverse life circumstances and at different ages, for men and women, for people with different racial or ethnic identities? Most crucially, how can we understand contemporary psychiatric and neurological claims to knowledge about mental states in a historical and cultural way when they beg to be taken as new forms of scientific truth and when, for some of us (including me), our status as rational people may be deeply dependent on these claims?

Intro. 1. Robin Williams, depicted as a crazy comedian on the cover of
Newsweek. Newsweek,
January 26, 1998. © 1998
Newsweek,
Inc. All rights reserved. Reprinted by permission. Photo by
MosheBrakha.com
.

The affinity that contemporary American culture has for highly energetic, “manic” behavior is not simple.
⁸
On the one hand, in 1998
GQ
chose Ted Turner as “man of the year.” Because Turner launched several dramatic business successes with the help of his “manic” energy, the magazine described him as “the corporealized spirit of the age.”
⁹
On the other hand, just a few years later, Howard Dean's “manic” behavior wounded him fatally after the 2004 Iowa primary. Some journalists described Dean's behavior as outrageous: “Face plastered with a manic grin, Dean three times screamed out a litany of states he would win, and capped off his sound bite with a barbaric yawp.”
¹⁰
His behavior was even seen as animal-like: “Dean was as manic as a hamster on a wheel as he rambled on and let out a rebel yell.”
¹¹
Dean's fate makes it plain that mania is as much an object of horror as desire. Whatever affinity there is between mania and American culture, it is not harmonious or sympathetic: fear, disgust, and revulsion are the kinds of sentiments that roil the surface when a person flies out of control and “cracks up.” Extreme states like mania may fascinate and attract us, but they disquiet us as well.
¹²
Why was mania good for Ted Turner but bad for Howard Dean? In this book I will try to answer this question by considering how people in the United States understand manic behavior generally and how scientists, therapists, patients, and pharmaceutical employees understand the kind of mania that is part of the specific condition of manic depression.

Is the mania attributed to Ted Turner or Howard Dean the same thing as the mania that is part of manic depression? This question has no simple answer. In my ethnographic research, moving from setting to setting allowed me to observe and listen to patients diagnosed with manic depression, psychiatrists struggling to treat it, pharmaceutical marketers hoping to sell remedies for it, and researchers seeking to understand its causes. None of these different groups would agree on a single answer to the question. Apart from my research proper, my daily life had already shown me that no part of manic depression is seen simply as an asset. Ever since I began to write and speak about bipolar disorder, college students have been telling me how often administrators react with dismay and alarm when they hear a student has been diagnosed with manic depression. At Princeton, where I taught for a number of years, students who are diagnosed with manic depression must often take a lengthy leave and then apply for readmission. Fear—of a student committing suicide, failing academically, socializing excessively—is mixed with the attraction—for writing creatively, studying energetically, socializing exuberantly—that people imagine could come along with the condition. A colleague at a large state university called me for advice about what to do for a graduate student who confided that he had been diagnosed with manic depression. My colleague wondered whether she should inform other faculty, assuming the student gave his permission. Speaking out might cast suspicion on the student's rationality and his academic abilities, but it might also help protect him against undue stress. My colleague felt caught in a vise: the student's manic depression might signal his special creativity but at the same time it would also signal that he suffered from a frightening and dangerous emotional disorder.

Rational and Irrational

Being known as a manic-depressive person throws one's rationality into question. There are high stakes involved in losing one's status as a rational person because everything from one's ability to do one's job, teach one's students, obey the law of the land, or live with one's family can be thrown into doubt.
¹³
Exploring how rationality is understood today will be one of my main goals in the chapters to come.
¹⁴
From classical times to the nineteenth century, madness was defined as the loss of rational, intellectual functions. Plato and Aristotle considered “reason” the defining human characteristic, the means of achieving knowledge, and the prerequisite of ethical freedom. When reason was absent or obliterated, the result was error and evil: the unleashed “passions” would be the source of disorder. However, the passions, as the animal part of humans, served as their source of energy: hence it was important for emotions to be present, albeit reduced and subordinated.
¹⁵
The Greeks defined such things as dreams, passion, and poetic intuition, the voices of the insane or of the prophets as irrational. They were not regarded as sources of knowledge of a rational kind, but they were regarded with respect because they came from contact with the supernatural world.
¹⁶
There was an interest, in classical Greece, in making a sharp separation between the rational and the irrational: only the rational, male, adult Greek was a full person, a citizen who owned property and cast his vote in the city-state.

Today much of this has changed, but some institutions, like the law, reveal the outline of older dichotomies. Consider a case that appeared in the Florida courts in 1996. Alice Faye Redd was a prominent, well-off citizen who was president of the PTA, the Junior League, and the Garden Club. During Richard Nixon's presidency she was honored as one of ten outstanding young women of America. Her daughter, however, discovered that for nine years Redd had been running a pyramid scheme, involving 103 people (many of them elderly members of her church), who eventually lost $3.6 million. The family, assuming she “must have lost touch with reality,” sent her to a mental hospital. There she was diagnosed as “chronic hypomanic personality,” a condition, “known as Bipolar 2, in which she was almost always in an elevated mood, needed little sleep, was full of grandiose ideas and was likely to engage in foolish business investments.” Meanwhile, prosecutors charged her with racketeering and grand theft, charges she did not contest. Psychiatrists retained by both sides in the case agreed she was suffering from “a form of manic depression that made her seem vivacious and charming, while at the same time twisting her thinking.” The psychiatrists selected by the prosecution wrote the judge that she “was operating on a different reality” and that “her ability to appreciate the nature and quality of the acts was impaired.”
¹⁷

But the judge could find her insane only if she could not tell the difference between right and wrong.
¹⁸
Finding that she was not insane, the judge sentenced her to fifteen years in prison. He argued that her bipolar disorder merely slightly modified her perceptions, like wearing “rose-colored glasses.” Rather than making her fail to understand that what she did caused harm, her mania merely caused her to underestimate the harm she was doing to others. In the press coverage of the case, reporters said that people who knew her were fooled by appearance and blind to reality. “Appearance” was that “she seemed normal, a ‘superwoman.' … She always had a smile and her hair and makeup were as impeccable as her gracious Southern manners.”
¹⁹
The “reality” was that mental illness was common in the last six generations of her family, as shown by a genealogical chart included in the article.

If Redd were a rational person, then she would be held responsible for her actions and be subject to the law. Her actions would flow from the person she seemed to be, and where her actions were illegal, she would have to pay the price. But if Redd were an irrational person, an afflicted person with unmedicated manic depression who seemed rational but actually lived in a different reality, she would need to be hospitalized, not jailed.
²⁰

The Alice Faye Redd case shows how oddly in between manic depression is. Like Emil Kraepelin, an early twentieth-century psychiatrist who noted its “peculiar mixture of sense and maniacal activity,” the judge placed her in between having sense and being a maniac.
²¹
If he found her to be a wholly sensible person, he would be denying her hereditary manic depression; if he found her to be a wholly maniacal person, he could not sentence her to prison. The assumption that produces this dilemma is that the normal person is wholly rational. I suggest otherwise: in their everyday lives, most people have various degrees of awareness of reality and of the consequences of their actions, various degrees of “reason” in their decisions and opinions. I have an inkling of this from generations of undergraduates and graduate students in my classes who, given the chance to discuss the presence of the irrational in their daily lives, have a lot to say about their waking experiences of disassociation, free association, flight of ideas, emotional tempests or voids, and so on. These experiences are often fleeting, they do not usually interfere with daily life, and they would not be grounds for a diagnosis of serious psychological illness. But so frightful is the specter of such a diagnosis that most students say they have never admitted their small flights from the rule of reason before. It takes the strong grip of cultural assumptions to suppress evidence of the myriad ways people experience the “irrational”—awake or asleep. If such evidence did enter the picture, what would we do with Redd? Her case pointedly raises the question of whether the notion of an incompletely rational person—someone, I argue, who is like most of us—is compatible with the operation of one of our central institutions.
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