Bipolar Expeditions (10 page)

Mood and Motivation

If manic depression does not sit easily with our everyday understandings of
emotion,
does it sit more easily with our everyday understandings of
motivation?
Certainly, the DSM hints as much by including “increase in goal-directed activity” in the traits characteristic of a manic episode. How exactly are moods different from emotion? Focusing on everyday language, Clifford Geertz analyzes the differences: moods are above all states we speak of as fleeting: they “go nowhere. They spring from certain circumstances but they are responsive to no ends. Like fogs, they just settle and lift; like scents, suffuse and evaporate.”
⁵²
While moods are fleeting, they can also settle down and become, briefly, all-encompassing.
⁵³
In contrast to moods, motives are neither acts nor feelings, but “liabilities to perform particular classes of act or have particular classes of feeling.”
⁵⁴
Unlike moods, which can be fleeting, motivations tend to be enduring. Unlike moods, which can monopolize, motivations tend to coexist. Motives “have a directional cast, they describe a certain overall course, gravitate toward certain, usually temporary, consummations.”
⁵⁵
Multiple motivations can coexist, sometimes in harmony and sometimes in conflict. A person can be motivated to both pursue a career and find a spouse, and find these goals compatible; or a person can be motivated to both pursue a career and nurture a family, and find these goals incompatible.

The DSM connects the characteristics of manic depression closely to everyday understandings of motivation—intensely present in mania and conspicuously absent in depression. For mania, DSM traits connected to motivation include “continuous wakefulness,” “excessive involvement in pleasurable activities,” or, as mentioned above, “increasingly goal directed activity.” For depression, DSM traits related to lack of motivation include “marked diminished interest or pleasure in almost all activities” and “fatigue or loss of energy.” These traits make manic depression seem as much like a bundle of “motivations” as a bundle of “moods.” In the end, the DSM links manic depression to
both
motivation (purposive and directional)
and
moods (fleeting and all-encompassing). Over time a person with this diagnosis is liable to experience both motivation and moods as too high and then too low: passionate pursuit of one's interests followed by lethargic immobility. I suspect it is the heightened
motivation
people in the United States associate with mania today that accounts for their bemused affection for the condition, at least among certain professionals who think of themselves as competing fiercely for rank and prestige. Whenever I have read the DSM definition of mania to audiences of students and faculty at universities and colleges, it has met with good-natured laughs and chuckles. When I asked why the definition was funny, people would tell me, “Because this manic level of activity sounds like me and a lot of the people I know.” Even though the DSM-IV category describes a major psychiatric disorder, people in this particular social setting enjoy recognizing themselves and their friends in mania's energy and passion.

“Motivation” is the part of mania that our economic system places at a premium. The historian Elizabeth Lunbeck believes that the link between mania and enhanced motivation may be a “survival” of a much older way of distinguishing psychological states, focused on the “will.”
⁵⁶
Evidence of this is a document from 1922, “Mood in Relation to Performance.” In this early psychological study of thirty-eight men and women, the author found
no
relationship between measures of mood and tests of performance. She hypothesized that her subjects experienced moods as “distractions,” but that they were able to overcome such distractions by exerting their will and “increasing the output of energy.”
⁵⁷
At this time people evidently thought the will led directly to performance: moods were minor annoyances that the will could overcome. Although in this study mood and motivation were unconnected, today they surely are. As we will see in part 2, mood and motivation are especially strongly linked when the term “mania” is applied to the market. The psychological category of manic depression now appears to contain one capacity—moods—that directly enhances both individual productivity and the energy of markets and another capacity—depression—that is a liability for the productivity of individuals and markets alike.

Our Manic Affinity

Psychiatrists have often assumed that schizophrenia is characterized by an absence of emotion, and, as we have seen, manic depression is characterized by an excess of emotions. Confounding this simple dichotomy, Louis Sass has argued that the link between schizophrenia and lack of emotionality is misleading. What psychiatrists call “flat affect”—lacking emotion—in schizophrenia actually turns out to be a complex state filled with strong feeling. Despite appearing outwardly emotionally flat, when asked, people with schizophrenia report strong inner feelings. Sass relates this disjunction between outer flatness and inner turmoil to various forms of fragmentation. In one form of fragmentation in schizophrenia, people, their actions, or their things may be perceived as stripped of their recognizable “affordances,” the qualities of persons and things that make them useful or significant in social life. For a schizophrenic person, people and things may retain their three-dimensional geometry but lose their everyday meaning: a chair becomes an object of a certain size and shape rather than a thing to sit on; a person becomes a body with certain dimensions rather than a being one might love, hate, or fear.
⁵⁸
This kind of fragmented state can be incompatible with emotion: if one perceives a three-dimensional shape instead of a person, one forfeits the possibility for “reacting with lust, loathing, or a yearning for peaceful repose.”
⁵⁹
The weakening of common emotional experiences may be behind the perception that people with schizophrenia have flat affect. Contrary to this common perception, accounts of patients attest that “flat affect” does not entail lack of feeling.
⁶⁰
Instead of emotion, their interior landscape is often filled with free-floating tension, fear, and vague anxiety. These anxious, fearful states can be highly intense, but they lack grounding in shared social experience. In her
Autobiography of a Schizophrenic Girl,
Renee writes that when she looked at her therapist, she saw “a statue, a figure of ice which smiled at me. And this smile, showing her white teeth, frightened me.”
⁶¹
Sass suggests that this “withdrawal from worldly emotional directedness” can provide a “haven from the frightening unpredictability of external circumstances.”
⁶²
This is the heart of the matter. “Withdrawal from worldly emotional directedness” is not simply a matter of suffering pain and becoming numb as a result. Rather, it is a matter of losing one's accustomed way of connecting objects to a context, people to collectivities, or features to a face, and all this produces a state in which emotions become problematic. Inner turmoil, anxious perturbation, and nameless agitation often result.

At this point we can see the historical significance of the timing of Kraepelin's bifurcation between manic depression and schizophrenia.
⁶³
Manic depression emerged as a condition characterized by intense emotion-like states in the context of an engaged (whether timid or exuberant) sociality; schizophrenia emerged as a condition characterized by fragmented, alienated consciousness, isolation from the social, and anxious agitation rather than emotion. This bifurcation allows us to understand how the two conditions relate to late modernity in opposite ways. On the one side, many of the activities that capitalism demands fragment, separate, flatten, and deaden feeling. The psychological hallmark of these experiences would be better called nameless agitation and anxiety, rather than emotion. In fact, as early as the turn of the twentieth century in the United States, “nerve weakness” or neurasthenia was a well-recognized set of symptoms for specifically modern anxieties. The symptoms of neurasthenia could include nervous dyspepsia, insomnia, hysteria, hypochondria, or asthma. Maladies like sick headache, skin rashes, hay fever, premature baldness, inebriety, hot and cold flashes, nervous exhaustion, brain collapse, and forms of “elementary insanity” were thought to be caused by “simple exposure to the hectic pace and excessive stimuli of modern life.”
⁶⁴
As a result, people felt “anxious busyness.”
⁶⁵
Still today, under the neoliberal administrations of the 1980s and 1990s, in tune with a style of government the linguist George Lakoff terms “the strict father,” many speeches and policies encourage a worldview that life is fundamentally dangerous.
⁶⁶
Since evil threatens the world (in the form of irrational terrorism) and the individual (in the form of immoral temptations), the strong leadership of a strict, moral leader is necessary. Some regard this as a bald effort to arouse anxiety and fear because “people kept in a state of constant stress will sacrifice their best instincts and even their real interests for the illusion of safety”—an illusion that a politician posing as a strict father can foster.
⁶⁷
These anxious states seem akin to the nervous perturbation of schizoid states.

Yet, on the other side of the bifurcation, we are in an era in the United States when markets command a preeminent place and where the economic has come to dominate the social. To flourish, these allimportant markets, operating with fierce ruthlessness in more domains than ever before, require emotions: not flattened but intense emotions. The “animal spirits” of entrepreneurs, their vital energies, are increasingly being called forth for the sake of stimulating markets.

In some settings, specialty firms are
teaching
people how to be manic for the sake of greater productivity; the mania they intend to tap flows from the mind and will go forth, so they hope, to unleash creative potential. Harnessing the mania of individuals to stoke the economy is happening in a country with a longstanding expectation that much of a person's worth—not to mention survival—is defined in terms of his or her productivity, where productivity means creating value in ways the market can acknowledge and reward. As the United States' sense of its own power has escalated, so has its sense that vitality flows primarily from its markets and the firms that participate in them. Increasingly, the financial order of things has a degree of autonomy and authority as never before. The United States is a country that sees itself as (and in some ways is) at the center of the global system of power and wealth.
⁶⁸
In this global system, markets are treated as a “life force,” and, paradoxically, people are treated as an ever more disposable source of inefficiency. As the anthropologists Jean and John Comaroff put it, “The spiraling virtuality of fiscal circulation, of the accumulation of wealth purely through exchange … enables the speculative side of capitalism to act as if it were entirely independent of human manufacture. The market and its masters, an ‘electronic herd' of nomadic deterritorialized investors, appear less and less constrained by the costs or moral econ omy of concrete labor.”
⁶⁹
In other words, markets are not human, but they are vital—“alive” with “animal spirits”—at the same time as this vital energy is being drained out of actual living people. Experiences of mania, once considered a sign of fearful and disordered irrationality, have come to epitomize the vital energy—found in the psyche rather than the laboring body—which the market needs to keep expanding. This is the heart of the affinity between contemporary American culture and the characteristics of manic depression.

CHAPTER TWO

 

Performing the “Rationality” of “Irrationality”

The mind is its own place, and in itself Can make a Heaven of Hell, a Hell of Heaven.

—John Milton,
Paradise Lost

I
n all its forms, “irrationality” is the enemy of “rationality,” the enemy of order, stability, and civilization. In this chapter I challenge the integrity of this battle line by showing how the rational and the irrational are not clearly separable. I begin with the point of view of patients diagnosed with a mood disorder.

Patients' Rationality: Double Bookkeeping

The psychologist Louis Sass has brought to light the term “double bookkeeping,” which psychiatrists use to refer to a schizophrenic patient's ability to “live in two parallel but separate worlds: consensual reality and the realm of their hallucinations and delusions.” For example, some schizophrenics who hold firmly to ideas others would call delusions nonetheless “treat these same beliefs with what seems a certain distance or irony.” A patient of Eugene Bleuler, an early psychoanalyst, “was well aware that the voices he heard originated in his own ears, for he compared these voices to the sound of the sea that can be heard by placing a shell to one's ear.”
¹
In his initial formulations of manic depression, Emil Kraepelin seemed to acknowledge a kindred kind of doubled awareness in manic-depressive people. He wrote, “It is just the
peculiar mixture of sense and maniacal activity
… which makes them extremely ingenious in finding out means to satisfy their numerous desires, to deceive their surroundings, to procure for themselves all kinds of advan tages, to secure the property of others for themselves. They usually soon domineer completely over their fellow-patients, use them for profit, report about them to the physician in technical terms, act as guardian to them, and hold them in check.”
²

The question raised by Sass, Bleuler, and Kraepelin is whether people designated as mentally ill are aware of living in a doubled reality through such “double bookkeeping.” If so, the question of whether they are rational becomes problematic, and I often faced this dilemma during my fieldwork. During a meeting of an evening bipolar disorder support group in northern Orange County, Richard, a physician with manic depression, now a writer living on a disability allowance, had briefed me about the regular members of the group and warned me that one member, Kevin, had a brain cyst in addition to his bipolar disorder. Richard thought Kevin's condition might cause him to behave in a bizarre manner. I noticed that this group began its meetings with brief introductions, but then, in contrast to all the other meetings I had attended, people went on to list all their coexisting conditions, sometimes in dizzying numbers.