Bipolar Expeditions (9 page)

What competent and successful persons are expected to do has changed over time. These changing expectations might even stretch to include the emotions: could the value of emotional coolness characteristic of the early twentieth century be giving way, under conditions of greatly increased capitalist competition, to a focus on emotional
lability
? Coolness is by definition flat and restrained, and might be seen as suited to ordered and stable environments and institutions. Lability in emotional life means movement on the scale of feelings, and might be seen as suited to the ferment and turmoil of entrepreneurial activity. This possibility brings us directly into view of the changeable emotions thought to be characteristic of manic depression and hints at why fascination with manic depression may be increasing.
³¹
This hint, however, raises more questions than it answers. In psychiatric terms, manic depression is a “mood disorder.” Rather than taking this at face value, we need to ask: Are moods actually a form of emotions? Does manic depression only involve a disorder of moods or does it more centrally involve a diminution or exaggeration of
motivation?
How exactly could an entrepreneurial climate call forth a revaluation of manic depression, whether it involves moods, motivations, or both? To pursue these questions, I begin with the basics: the changing definitions of emotions, moods, and motivations in their cultural contexts.

What Are Moods?

The standard source for defining psychiatric diagnoses in the United States, the fourth edition of the
Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV), makes a strong link between mood and emotion. Bipolar disorder is a “mood disorder”: mood in turn is “A pervasive and sustained emotion that colors the perception of the world.”
³²
Given this, it is startling to realize that the DSM definitions of mania and depression do not include much obvious reference to emotions. A manic episode is the following: “A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).” During this period, three or more of the following symptoms should have been present:

1. inflated self-esteem or grandiosity

2. decreased need for sleep (e.g., feels rested after only three hours of sleep)

3. more talkative than usual or pressure to keep talking

4. flight of ideas or subjective experience that thoughts are racing

5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
³³

An episode of major depression involves five or more of the following symptoms during a two-week period:

1. depressed mood, nearly every day during most of the day

2. marked diminished interest or pleasure in all or almost all activities

3. significant weight loss (when not dieting), weight gain, or a change in appetite

4. insomnia or hypersomnia (excess sleep)

5. psychomotor agitation or psychomotor retardation

6. fatigue or loss of energy

7. feelings of worthlessness or inappropriate guilt

8. diminished ability to think or concentrate, or indecisiveness

9. recurrent thoughts of death or recurrent suicidal ideation, a suicide attempt, or a specific plan for committing suicide.
³⁴

Mania's “elevated mood” might translate into “elation,” and “depressed mood” might translate into “sadness”; some of the intense activities in mania might translate into “joy,” and the immobility of depression into “despair,” but the DSM symptoms do not fit squarely with an ordinary sense of what emotions are. Nor is it clear whether a “mood” is the same thing as an “emotion.” We need to understand better what the terms “mood” and “emotion” mean.
³⁵

In the 1990s, anthropologists turned their attention to the central features of “emotions” in Western languages.
³⁶
They determined that in Western societies people consider emotions to be physiological forces located within the individual. Further, in Western beliefs, a person's emotions constitute his or her sense of uniqueness because they represent a kind of inner truth about the self. Language that describes emotion gets its force from its “putative referentiality,” that is, from the assumption that when a person speaks the language of emotion, the emotion is really there.
³⁷
In other words, when I feel an emotion (anger, joy, or fear) and talk about it, what I say has rhetorical force because listeners assume the emotional state (anger, joy, or fear) is genuinely there inside me.

Are mania and depression emotions in this sense? Do they have a “putative referentiality” to an “inner truth about the self”? From the earliest history of the term, mania has taken its core meaning not from reference to an inner truth about the self but from a comparison with its opposite: depression. For the ancient Greeks, health involved equilibrium between opposite states and sickness involved the presence of one extreme or its opposite. The historian Roy Porter points out that in the Greeks' humoral system, “[M]ania implied—almost required—the presence of an equal but opposite pathological state: melancholy. The categories of mania and melancholy—representing hot and cold, wet and dry … became ingrained, intellectually, emotionally, and perhaps even aesthetically and subliminally.”
³⁸
The humoral conceptions of mania and melancholy that first developed in classical Greece and Rome continued to dominate medical writing through medieval times and the Renaissance, right up to the mid-nineteenth century. Although mania and melancholy were seen as opposites in the humoral system, they were also seen as connected: “Where mania and depression are considered in the historical medical literature, a link is almost always made.”
³⁹
Scholars thought mania and depression were linked together, and that they somehow brought forth each other. By the mid-nineteenth century, mania and depression came to be seen as aspects of a single disease, and accordingly this disease was given a new name by French “alienists”:
la folie circulaire
(circular insanity). Falret described this in 1854 as an illness in which “this succession of mania and melancholia manifests itself with continuity and in a manner almost regular.”
⁴⁰

Building on la folie circulaire at the turn of the century, the German psychiatrist Emil Kraepelin, as mentioned earlier, separated “manicdepressive insanity” from dementia praecox (later termed schizophrenia). Kraepelin made moods a key component of both mania and depression: mania involved rapture, “exalted” mood, “unrestrained merriment,” or “happiness.”
⁴¹
Depression involved a “gloomy hopelessness,” grief, or “sombre and sad melancholy.”
⁴²
But, much like the later DSM, Kraepelin's definition included far more than moods: among the common “psychic symptoms” of mania were disorders of attention (distracted), consciousness (clouded), memory (impaired), train of ideas (digressive), activity (pressured), speech and writing (increased), sexual excitability (heightened), and movements of expression (vivacious).
⁴³
Most interesting, Kraepelin emphasized that all these “morbid forms” were “impossible to keep apart.”
⁴⁴
Instead, one would find “gradual transitions” between states, as well as “mixed forms,” combining mania and melancholy in the same person.
⁴⁵
He asserted that the morbid forms “not
only pass over the one into the other without recognisable boundaries, but that they may even replace each other in one and the same case.”
⁴⁶

From Falret's la folie circulaire through Kraepelin's manic-depressive insanity to the DSM-IV's bipolar disorder, manic depression is an interrelated set of moods and behaviors whose hallmark is intensity. In the entire class of moods such a person experiences, the dial of intensity is turned up much too far. Wherever you look in the landscape of moods or behaviors, you find
too much or too little.
The same person, at different times, is too happy, too sad, too energized, or too immobilized. French, German, and Scottish psychiatric researchers from the mid-to late nineteenth century published photographs of their manicdepressive patients, often choosing pairs of photographs that would show the contrast between each patient's high and low extremes of emotion and behavior.
⁴⁷
Part of the meaning of mania is that it is the opposite of depression and part of the significance of this opposition is that the extreme states it embraces are sometimes found in the same person alternating with each other.

We can now see one reason why manic depression sits somewhat adjacent to the concept of emotion. Since opposite emotions, such as elation and sadness, or opposite behaviors, such as excitement and inhibition, are present too intensely in the same person, manic depression might be called a “meta” state. It is not a
member
of the class of emotions, but an emotional condition that
contains
classes of particularly intense emotions. The components of manic depression do not simply refer to something truly in the person, as emotions do; rather, they also gain meaning by their relationship to other parts of the person's system of emotions and behaviors. Within this meta-state, moods do not just coexist; they oscillate. The DSM formulates the definition of manic depression in a way that makes its meta-status clear. In the DSM-IV, both depression and mania are kinds of “mood episodes.” Mood episodes serve as the building blocks for the diagnosis of a mood disorder. But the DSM handles the building blocks of depression and mania quite differently. Whereas depressive episodes can combine into many types and subtypes of “depressive disorders,” mania by itself cannot be the only building block of a mood disorder. As far as the DSM-IV is concerned, mania only occurs as part of “bipolar disorder,” where it alternates with depressive episodes. In other words, mania always exists as a part of a system of moods, manic highs followed by depressed lows.

By definition, the manic-depressive person swings from the bright glow of mania to the ugly dark slough of depression. Many people living under the description of manic depression experience being in the grip of an oscillating force. When manic, one feels like one is kindled, blazing, incandescent to the point one fears burning out. When the descent into depression comes, it feels inevitable and without end. To anticipate an argument I make in part 2, the inevitable oscillation of moods in manic depression makes it resonate with the “mania” and “depression” in the markets of today. Both seem alive and regenerative in a sense, because for both the source of renewal seems to lie within: depression's “death” is brought on by mania's “life” and vice versa.

Although there is little consensus among psychologists about how to define and understand emotions, anthropologists have made clear from studies in a variety of cultures that, however defined, emotions are strongly linked to social interactions.
⁴⁸
To develop this point, I turn to Vincent Crapanzano's trenchant anthropological account of emotions. In Crapanzano's analysis, the grounding of emotions in the psychology of the individual should not be allowed to mask the important role that emotions also have in transactions. How do emotions function within social exchanges? Emotions “help call the context,” that is, their presence automatically changes the context in which they occur.
⁴⁹
This happens because emotions are conventionally taken to be a “manifestation, a symptom, of the condition—the emotion they are said to be describing.” Emotions refer so powerfully to the things they name, that to utter the words is to have the emotion: “Their truth and sincerity cannot be questioned, for they point to those perturbations as unquestionably, as nonarbitrarily, as smoke points to fire.”
⁵⁰
When a person expresses the “smoke” of anger or love, this conventionally means that the “fire” of anger or love must actually be there inside him. Those who witness the “smoke” of anger or love understand that the “fire” is there in much the same way they would understand any standard meanings in the English language. But because a person's expression of an emotion such as anger or love is taken to mean that his inner state has changed in an important way, the very expression of such an emotion changes
the context
in which he is interacting with others.
⁵¹
His witnesses are now dealing with an altered situation: they are dealing with a person on fire with anger or love.

Because they have to do with a set of moods, each of which is experienced intensely, mood disorders operate in social life in a different way than any one emotion does. When people witness the expression of emotions like anger or love, they are, as Crapanzano argues,
pulled into a changed definition of the context
because they are witnessing something that is genuine by definition. As we have seen, moods in a person with a mood disorder do not function exactly like emotions: participants in a social setting where a component of a mood disorder, such as mania, is expressed may be
pushed out of the context.
This is because the expressions of mania point not only like smoke to an ember glowing truly within—the “smoke” of the person's elation means elation is really inside them—but also like smoke to a burning house: in the context of a mood disorder, the elation may also be taken as a sign that something is awry with the person's entire system of emotional expressions. This is a way of saying that it is important not to oversimplify manic depression as merely the experience of one or another extreme emotion.