Bipolar Expeditions (47 page)

64. T. Lutz,
American Nervousness, 1903,
4. In another evocative description, neurasthenia “embodied a new anxious sensibility of the excitable subject as symptom, mirror, and source of worldly forces; suddenly, both the self and the surrounding world seemed at once diffuse, weightless, floating, and unreal, weighted down with symptoms, haunted, immobilized, and excessively sensory and concrete” (Harding and Stewart, “Anxieties of Influence,” 258). The neurasthenic's “paralysis of will, his sense that he was no longer able to plunge into ‘the vital currents of life,' his feeling that life had become somehow unreal” amounted to a feeling of “inner emptiness” that was nonetheless harnessed to an imperative to produce. At its beginning, neurasthenia was a disease of the male subject, the one who was thought to suffer most from the pressures of urban society, the demands of competition in the business world, and the pressure to succeed. Showalter,
The Female Malady,
174.

65. Lears, “From Salvation to Self-Realization,” 7–9.

66. G. Lakoff,
Moral Politics,
65.

67. Goldstein, “Butching up for Victory,” 13.

68. An important area that needs research is the reaction to extreme states like mania in other parts of the world system. There is certainly no one thing that could be called mania in other cultures. But recent ethnographic studies of the disposition of authorities toward extreme experiences akin to mania make some tentative comparisons possible. On the periphery of the global system, under postcolonial conditions, manic-like states are anything but valued by the dominant sectors. For example, Nancy Chen describes how in China,
falungong,
a spiritual and physical practice that taps into vital energy, has been recently denounced by the state and by leading scientists as a cult that promoted superstition and disorder, the antithesis of rational knowledge
(Breathing Spaces,
177). Faced with tensions between its desire for centralized order and the forces of market liberalism, falungong's unregulated and unbridled energy was seen as a threat. State regulation tried to force it into either a sanctioned arena—statesponsored sport-like events—or a deviant area—mental illness (186). For another, in Good and Subandi's account of a Javanese woman's psychosis, we glean some hints about how extreme states are regarded in Indonesia. As we know from Benedict Anderson's work, the “idea of power” in Java is a mysterious, divine energy that permeates the universe. The “entire cosmos [is] suffused by a formless, constantly creative energy”
(Imagined Communities,
7). But the potency of the self is constituted by spiritual practices that enhance restraint and refinement in language, sentiment, and behavior, correlated with social status (Keeler, “Shame and Stage Fright in Java”). The break with decorum that can come with psychosis is experienced as profoundly embarrassing because it threatens the place of the self in the status hierarchy. The psychotic person may also be seen as in touch with the omnipresent divine energy of the universe but insufficiently potent to handle it without being harmed. See Good and Subandi, “Experiences of Psychosis in Javanese Culture.”

69. Comaroff and Comaroff, “Millennial Capitalism,” 10.

C
HAPTER
2

1. Sass,
The Paradoxes of Delusion,
21.

2. Kraepelin,
Manic-Depressive Insanity and Paranoia,
61, emphasis added. A manic-depressive's mistaken identities can “appear to be more an amusing game in which the patient takes pleasure, partially conscious of the arbitrariness of the designation. That occurs especially at the decline of excitement, when the wrong designations are still adhered to, while from the other conduct and occasional utterances of the patient it is evident that he is quite clear about his place of residence and the people round him” (Kraepelin,
Manic-Depressive Insanity and Paranoia,
7).

3. Rather than tape recording, I often took notes on the spot and then wrote a full account as soon as possible, although all of the interviews I did with pharmaceutical personnel and most of the interviews I did with heads of organizations were tape recorded. In quoted interviews, an ellipsis indicates a pause; in quoted written materials, an ellipsis indicates an omission. I have not constructed composite quotations out of statements made by more than one person. All personal names are pseudonyms, except for those of my academic colleagues and authors speaking about their published work.

4. William Burroughs describes the dress style of the Wild Boys in this way: “[T]here are Bowery suits that appear to be stained with urine and vomit which on closer inspection turn out to be intricate embroideries of fine gold thread … it is the double take and many carry it much further to as many as six takes.” Quoted in Hebdige,
Subculture,
24.

5. Bauman, “Verbal Art as Performance,” 305.

6. Judith Butler's work has been central in formulating the position that gender is not a role enacted by or expressing a preexisting interior self. Rather gender is an effect of performative acts: “Gender must be understood as the mundane way in which bodily gestures, movements, and enactments of various kinds constitute the illusion of an abiding gendered self” (“Performative Acts and Gender Constitution,” 519). Butler's theory of gender identity also has a performative aspect. In her theory, feminine and masculine dispositions are formed as the effect of the prohibition against same-sexed desire. The child's love for his or her same-sexed parent is forbidden on two grounds: first, homosexual desire is forbidden, and second, parent-child desire is forbidden through the incest taboo. Therefore, the child inevitably experiences the loss of his or her same-sexed parent as an object of desire. Following Freud's analysis of melancholia, Butler argues that an object of desire that is lost but cannot be mourned leads to identification with that object. The result is that the child identifies with the lost same-sex parent and incorporates that parent's gender identity—and becomes—a male or female person
(Gender Trouble,
63–64). Thus the child's gender identity arises performatively (as an effect of) a set of intimate relationships. There is a very rich literature in anthropology on performance (as opposed to performativity) as it plays a part in rituals. A useful collection of essays that focuses on the ways performance can be efficacious in rituals of healing is Laderman and Roseman,
The Performance of Healing.

7. Sally and Leslie Swartz analyze an interview with a woman in a psychiatric hospital for a manic breakdown. They find that the woman uses “metacommentary”—she refers to the ongoing talk in the interview—and they argue that this makes her apparently unintelligible discourse coherent (Swartz and Swartz, “Talk about Talk”).

8. Peggy Phelan, personal communication, March 15, 1999.

9. Fidler,
Affective Disorders.

10. I do not know how widely these simulations are used, but they are listed in a variety of catalogues of teaching materials on the Web. Charles Nuckolls describes how dramatic enactments were used for teaching in one medical school with such success that plans were made to produce and market them to other medical schools
(Culture,
209–10). Less formal versions of these scenes were enacted many times in the course of my observations of psychiatric training. In impromptu skits, more advanced students or residents would be designated the roles of patient and doctor to illustrate to less advanced students the salient behaviors and how they might be treated. One of these teaching sessions was recorded by the film crew of the television series
Hopkins 24/7,
aired by ABC. The segment did not make it into the ABC series, but was included by an HBO production made from the unused footage in a series called
Nurses.

11. Mischer, “An Evening with Robin Williams.”

12. Holtzman, Shenton, and Solovay, “Quality of Thought Disorder in Differential Diagnosis,” 379. This study differentiated thought disorders in manic-depressive and schizophrenic patients by analyzing their taperecorded verbal responses to the Rorschach Test.

13. Kraepelin,
Manic-Depressive Insanity and Paranoia,
27.

14. Cushman,
Constructing the Self,
92, 97. In a trenchant critique, Atwood Gaines argues that the prevalent U.S. “cultural ideal of a controlled, rational self” is embodied in the DSM's assumptions about what a mental disorder is (“From DSM-I to III-R,” 13).

15. Le Bon,
The Crowd,
12. Plotz provides many literary examples of how crowds were feared in England
(The Crowd).

16. Such associations between crowds and irrational behavior persist today, as in an assessment of the exemplary rational behavior of passengers and crew after an airplane crash in Toronto: “One survivor of the Air France crash in Toronto on Tuesday described the ‘panic' of his fellow passengers. Yet these people had just evacuated a burning plane in about two minutes. While they had had critical help from the plane's crew members, those trained professionals were busy assisting people with limited mobility, not providing psychotherapy. Thus what the passenger observed was clearly not ‘panic' in the sense of an unthinking crowd acting irrationally and abandoning the norms of civilized behavior. Indeed, it was the exact opposite. The Air France evacuation required an extraordinary degree of social coordination—which emerged among a group of strangers with virtually no time to prepare” (Fischhoff, “A Hero in Every Aisle Seat”).

17. Dr. Sagar Parikh of the Bipolar Clinic at Clarke Institute in Toronto used the phrase “riding the tiger” to describe this. Tillson, “The CEO's Disease,” 31.

18. Gay, “PBS' New Film about Theodore Roosevelt Chronicles the Many Sides of a Passionate, Energetic Man.”

19. Gaines, “From DSM-I to III-R,” 11.

20. Joel Robbins explores the pervasive attachment of anthropologists to “continuity thinking,” which leads us to emphasize continuity over discontinuity in the cultural forms we study. He suspects that we privilege continuity because it is so deeply rooted in our commonsense notions. See his “On the Paradoxes of Global Pentecostalism and the Perils of Continuity Thinking.”

21. Jamison,
An Unquiet Mind,
68.

22. An astute discussion of the role of having an interpretation in coming to conclusions about rationality is in Risjord,
Woodcutters and Witchcraft,
13–33.

23. I am indebted to Susan Harding for seeing this dimension of my material in relation to her ethnographic work on fundamentalist Christians. See Harding,
The Book of Jerry Falwell.

24. When I learned from my primatology colleagues at NYU that they call a similar “heads up” signal among nonhuman primates an “eye flash,” I adopted the term.

25. Some examples: what are three things wrong with the penis? It has ring around the collar, hangs out with nuts, and lives next to an asshole. Why is the blonde's belly button black and blue after sex? Because her boyfriend's a blonde, too.

26. In
Madness and Modernism,
Louis Sass describes the particular form “meta” communication takes in schizophrenia. Use of irony (a form of inner distance from the self) and even a subtly mocking ironic tone convey the schizophrenic's degree of “meta-awareness,” which, Sass argues, is not “congruent with standard conceptions of cognitive breakdown” (113). But Sass also asserts that meta-awareness alone is not sufficient to impart normality to the schizophrenic condition. The burden remains: a “disconcerting awkwardness and rigidity, a lack of free-flowing activity and syntonic social ease” (115). I am positing that the form of meta-awareness that I observed in bipolar support groups is somewhat different than in schizophrenia because it comes about through interpersonal interactions in a social setting. However, in common with Sass's argument, I would agree that meta-awareness alone does not relieve the bipolar condition of its burdens.

27. I am drawing on Mikhail Bakhtin's concept of double-voicing: “In … the double-voiced word, the sounding of a second voice is a part of the project of the utterance. In one way or another, for one reason or another, the author makes use ‘of someone else's discourse for his own purposes by inserting a new semantic intention into a discourse which already has and which retains, an intention of its own'” (Morson and Emerson,
Mikhail Bakhtin),
149.

28. This is like what Canetti called the “discharge,” “the moment when all who belong to the crowd get rid of their differences and feel equal”
(Crowds and Power,
17).

29. Bauman,
Verbal Art as Performance,
11.

30. Ramanujan quoted in Brenneis, “Dramatic Gestures,” 230.

31. Ibid., 230, 231.

32. Raymond Williams uses these terms to describe structures of feeling, which are “social experiences
in solution,
as distinct from other social semantic formations which have been
precipitated
and are more evidently and more immediately available”
(Marxism and Literature,
134; emphasis in original).

33. Ginzburg, “Style as Inclusion, Style as Exclusion,” 27.

34. Ibid.

35. Ibid., 34–35, 36.

36. “As the poet wrote with his style or pen, and the designer sketched with his style or pencil, the name of the instrument was familiarly used to express the genius and productions of the writer and the artist.” Hence the term “style” connoted a connection between “mind and hands.” Subsequently, Hegel and Heinrich Heine both used “style” in connection with a familiar Romantic theme—artistic freedom (Ginzburg, “Style as Inclusion, Style as Exclusion,” 35–36).

37. Ibid., 45.

38. Winter, “The Affective Properties of Styles,” 67.

39. Ibid., 71–72. In the case of Hebdige, his analysis of style by subcultures like punk points to its use to escape the bourgeois norm
(Subculture).
This subculture is interested in: how to refuse (3), detach from the taken for granted (19), disrupt (138), parody (139), and challenge hegemony obliquely in style (17). This subject position is dramatically different from that of my support group companions, who are already, and not necessarily by choice, relegated to the “abnormal.” Their problem is how to gain the dignity of membership in humankind without being stultified by the “normal.” Stuart Ewen outlines the historical changes by which U.S. consumer society has made style “a cardinal feature of economic life,” providing a “vast palette of symbolic meanings” that could be used to assemble a public self. See Ewen,
All Consuming Images,
248, 79.