Bipolar Expeditions (11 page)

In a typical example, Marge began by saying, “I am bipolar, I have anxiety and panic attacks, I am an alcoholic, an addict, I have posttraumatic stress disorder, and one more thing … oh yes, I have borderline personality.”
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Breaking the pattern, and jarringly out of sync with the rest of the group, Kevin introduced himself by describing some miscellaneous events at his job as a mechanic for an auto shop, providing no clue about any diagnosis of mental disorder. When he finished, Richard leaned over to me and said, “That is the guy who has a cyst on his brain.” When the meeting was over, Richard and I joined the others at a nearby restaurant.

After about an hour of eating, drinking coffee, and boisterous—sometimes outrageous, often highly exuberant—talk, Kevin suddenly asked me, “Do I look dead?” Hoping to fall into the spirit of the occasion, I said, “You produce a good illusion.” Richard joked, “He is actually an alien.” Kevin said to me, “I will never forget you. Are you married?” I nodded. Kevin's friend Paul persisted, “Well, do you fool around then?” At this point I was thoroughly embarrassed and nervous. Were they kidding? Would I offend them no matter what I said? Were they aware of how uncomfortable this conversation made me feel? If I went wrong here, would I be able to return to the group? Or were they simply taking a slightly mischievous delight in my unease? Confirming my dawning sense that Kevin was aiming for my ambiguous status as both a legitimate insider and a suspicious outsider who not only lived on the other side of the country but also intended to write down her own account of the group, he asked, to general hilarity, “Am I your science project?”

By definition the group occupies the space of the “mentally ill” wherever it gathers, and some of its members' behavior in public obviously made other customers wonder what was wrong with them: their raised eyebrows, quizzical looks, and stares indicated that our loud voices, dramatic gestures, and raucous laughter were outside of the norm in a family restaurant. But the sense in which there was double bookkeeping going on is this: Kevin knew that his behavior was outside of the norm, and he knew that I knew that. Having seen Richard speak to me, he may well have guessed I had heard about his brain cyst. He knew that I was studying him, and he knew that I knew he knew that. He could put these various descriptions of behavior into action in rapid succession, faster than I could anticipate what was coming next, shifting from one ledger to another, and from one perspective to another, with great facility and with the effect of keeping me off balance. Watching Kevin was like viewing the alternative “takes” in the raw footage of a movie scene, where Kevin was an improv actor. At first he appeared to be mentally compromised; on closer inspection he revealed himself to be a teasing observer; then he became a mischievous commentator.
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Another example of double awareness occurred during an event in the department of psychiatry where I attended classes and seminars as an ethnographer. During the department's weekly Affective Disorder Clinical Rounds, clinical rounds for short, doctors and residents (physicians in postgraduate training) would discuss a particularly interesting and instructive patient currently residing on the inpatient ward. The chosen patient would then be invited to join the group. Rounds were held in the ward's activity room, which was outfitted with upholstered armchairs, a stereo, and a wall of windows overlooking the city. Just before 11 a.m., medical students came in and arranged the armchairs: they set up two chairs at the front of the room, turned slightly toward >each other. The rest were arranged in a few rows facing the front and were quickly occupied by medical students, residents, and psychiatrists.

On this day, just before the event started, a large woman in a brightly colored knit dress came in, holding a bag of pretzels, a soda, and a few magazines. I took her to be a patient looking for a quiet spot. Apparently noticing the chairs in rows and the students in white coats, she said, “Oh, you want a lecture? [a short pause]
I'm
lecturing. What would you like? How about ‘Manic-Depression as It Manifests Itself in Schizophrenia'?” As she talked, she moved toward the door, and the soda and pretzels she was holding started to spill onto the floor. Pretzels flew out here and there, as she, balancing her soda and magazines, tried to get the door open. The door was heavy and tricky to unlatch, so more pretzels spilled. She made no particular effort to stop the flow of pretzels or pick any of them up and, as a result, every doctor and medical student who came into the room in the next few moments stepped onto the crunchy, slippery mess, looked down, disconcerted, perhaps taking a swipe at the crumbs with the toe of a shoe. It was as if the patient (by definition a person with a disordered mind) had left confounding traces of disorder in the room. She knew the mental disorder of patients like her was about to be studied in this room by doctors, but she reversed the direction of control:
she
announced the lecture and deftly made the entering doctors and students feel disconcerted. Marked as mentally disordered by her patient status, she could not only name psychiatric conditions and give a mocking announcement of a lecture about them, but she could enact a bit of disordered behavior in such a way that it looped back on the proceedings, in a small way perturbing those who came for the purpose of creating scientific order.

Because of the circumscribed role I occupied as a fieldworker, I couldn't ask the patient, but as far as I could tell, this little scene was not part of a planned and rehearsed series of performances by patients to disconcert those attending clinical rounds. In all likelihood, it was a one-off affair. But for this reason, it can serve as a hinge in this chapter between the notion of doubled awareness in those who are conventionally thought to be out of touch with reality and those who are not. People in both categories use performances of many kinds as they par ticipate in a broad cultural fascination with mania and manic depression. The linguistic anthropologist Richard Bauman once reflected that there is a kind of power “inherent in performance,” a power that could work either for enhancement of experience or for “subverting and transforming the status quo.” He argues that it is the “special emergent quality of performance” that can make a community's capacity for change become clear.
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Since I will use the concept of performance often in the remaining chapters of part 1, I want to be clear from the start about why the concept is pertinent to my argument. At the present time, notions of performance and performativity are playing an important role in critiques of conventional ideas about sex and gender.
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Introducing the idea that one's identity as a gendered person is not given in nature but produced by one's actions has led to a searching critique of taken-for-granted assumptions. In my account, performance matters in a different way: performance provides a way, in actions as well as words, for people cast into the category of the irrational to comment
on
their putative “irrationality.” In so doing, they demonstrate that they
are
rational. In this chapter I look at a wide variety of performances in which people hold the category of mania up to one community or another for thoughtful consideration. Although I use the term “performance” liberally in this chapter, these performances, with the exception of those with professional actors on a stage or in front of a camera, are barely formal enough to be worthy of the term. They are held without planning, they are unscripted, spontaneous, and ephemeral, but for all that they are no less able to provide sharp-witted commentary on living under the description of manic depression.
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Doctors' Rationality: A Closed Circle

When people who are designated “mentally ill” question and perturb medical categories, they use complex kinds of intentional action: mocking, reframing, or caricaturing. Hopefully even the small examples I have introduced so far make us reluctant to hold onto the overly simple notions that “mentally ill” people are unaware of what they are doing and that they are in wholly irrational states of mind. But we also need to look at how people learn and use categories at the center of what we often assume to be rational scientific knowledge. A good entrée into the logic of the system is the pedagogical material used to train aspiring psychiatrists and other mental health professionals. Doctors dramatize medical categories for particular purposes, and in the process they reveal some qualities of the rationality of their scientific mode of thought.

To see one way physicians dramatize the category “manic depression,” I turn to a section of a teaching video,
Simulated Psychiatric Profiles.
The psychiatrist who produced this set of VHS tapes, Donald Fidler, a professor at the University of West Virginia, told me that for reasons of patient confidentiality, the people depicted in the video are paid actors. (When I began to teach at New York University, I found out that some students at the Tisch School of the Arts, who are studying method acting, take jobs like these to help finance their education.
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) The actors prepare for their parts by watching videos of patients diagnosed with DSM conditions interacting with psychiatrists in therapy sessions. As an actor attempts to re-create what he sees in a patient, psychiatrists coach him until his performance captures the DSM definition of the condition closely enough. The set of videos is organized according to the major categories in DSM-III, which was current when this video was made, and each one is divided into sections illustrating the various subtypes in the DSM categories. The videotape of most interest to my research is labeled “Affective Disorders: Mania and Depression,” and the following transcript is from the section labeled “Mania I.”

[Patient and psychiatrist are sitting in an interview room.]

Psychiatrist:
Hello, I'm Dr. Grey.

Patient:
Yeah, well, I'm Dr. Brown today myself, you know, even though you've got green pants [patient touches the doctor's pants]. I got a thesis advisor, his name is Dr. Green, and last time I was in the hospital [while talking, patient is agitated; he begins taking his sweater off.] I had a Dr. Blue …

Psychiatrist:
Uh huh … well, why are you here?

Patient:
[continually crossing and uncrossing his legs] Why I am here—well, I'd kinda like to know that myself, you know [still taking his sweater off], you know, is that really the kind of question you want to ask me? I mean, don't you think you should sit up straight, you know, and have a tie, and I don't know about those shoes, Dr. Blues uh, you know, they're kind of bad news for me, at least.

Psychiatrist:
Okay, can you tell me why—how—you decided to come here?

Patient:
Come here? Well, you know I didn't decide to come here—what are you some kind of fag or what, you know, I mean that's something I usually do with my girlfriend at home alone in bed. [Patient has now taken the sweater off and tied it around his knees.]

Psychiatrist:
Uh huh.

Patient:
What else do you wanna know? [Patient crosses his legs and fidgets constantly. He continues, talking very rapidly.] … What I'd really like to talk about is the fact that I'm having trouble with my girlfriend, okay? I mean, you're a psychiatrist or something, right? So I'm having trouble with my—is that a camera? [Patient points at camera.] Because look, you know, my father's on the English faculty here, you know, and I just don't think that doctors should, should put people on cameras [patient is gesturing emphatically with both hands] and I don't want to be on the cover of
Newsweek
or something, anyway.

Psychiatrist:
The camera's not on.

Patient:
Okay, well good, that's better—that's a lot better [patient nervously takes his comb out of his shirt pocket and drops it into his lap and then picks it up and combs through his hair once] because if it were I'd comb my hair, okay?

Psychiatrist:
Uh huh.

Patient:
You know, so, what do you want to know? Don't you have any questions or anything?

Psychiatrist:
Yes, can you tell me who decided you should come here?

Patient:
Oh yeah, right okay, well I—I dunno, I—I—I could start like one day ago, three days ago, or two weeks. Maybe I better start two weeks ago, okay, ‘cause I'm a graduate student, right? And I've been working on my thesis project with my advisor, not that he has much advice to give—you know, much advice or consent—he looks like a senator, but he doesn't have much advice or consent to give me. [Patient is still nervously placing his sweater on his lap, turning it over, and putting his arm through it.] Anyway, so, okay, about two weeks ago I was really excited and I went in and talked to the guy—he's kind of an old guy and he's kind of conservative, but he's really pretty smart [patient is constantly folding and unfolding his sweater and he is agitated—constantly moving in his chair—he literally cannot sit still], so we were talking about my project, okay, and he was even getting excited, ‘cause you know he's really kind of a staid guy but even he was getting excited. Then yesterday, okay, so I went in and talked to him again, and he was not nearly as impressed—I don't know we kinda got into a big fight yesterday and I think that maybe what happened is he called up my girlfriend—‘cause they know each other and they've met at parties and everything, and we've been living together for a while—not my advisor, okay, just me and my girlfriend—so I think that maybe he talked to her, and—and I don't know I—maybe my roommate's part of it, too [patient is running his hands through his hair], ‘cause I think that—maybe—I think maybe my thesis advisor's kind of jealous of what I'm doing, ‘cause I've been doing really good work, okay.
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