Bipolar Expeditions

Martin, Emily. Bipolar Expeditions: Mania and Depression in American Culture. Princeton: Princeton University Press, 2009.

Emily Martin seeks to answer the question of how popular notions of mania are related to psychiatric conceptions of bipolar disorder (also known as manic-depressive illness). The purpose of her research is to explore the experience of people living under the description of manic depression. Martin explores the concept of mania across a range of settings: support groups, clinical presentations, and media coverage. She proceeds in her ethnography as both a participant and an observer: “In my life, as in this book,” she writes, “I stand in a doubled position as a person who appreciates the benefits of psychopharmacology and other therapies and who is curious about their historical and cultural significance” (p. xviii). Like her informants, Martin herself has bipolar disorder. Her aim in this book is to explore bipolar disorder as the framework for understanding new conceptions of rationality, irrationality, mood, and motivation.

Martin presents a social history of irrationality and rationality and demonstrates that a diagnosis of manic depression blurs the dividing line between the two. She explores how concepts of rationality and irrationality are fitted into a framework of mania and wonders if individuals diagnosed as manic depressive can be considered rational beings. Martin critiques the dichotomies that exist to bifurcate the world into opposing spheres (self/other, rational/irrational, sane/insane) and suggests that individuals with bipolar disorder do not neatly cling to one side of the opposition but that people experience themselves at multiple points along the bipolar continuum. She explains that mania is, in the words of Maurice Merleau-Ponty, an “expressive space” defined by both the mediation of these poles and some element of control over movement between them. She describes performances of mania where individuals control the activation of their mania under the right conditions rather than have it overpower them completely. Those with manic depression are “incompletely rational” beings. The irrationality assumed in a diagnosis of manic depression does not define one’s personhood entirely.

Additionally, the diagnostic taxonomy and medical categories of mood disorders are not strictly defined, but have their own inherent fuzziness. This is especially the case when Martin sits in on medical rounds and listens as doctors diagnose patient’s illnesses with little regard for the patient’s own subjective experiences. In this context, medical authority reigns supreme and controls the terms of debate over one’s mental illness. “No matter what anyone wishes,” Martin writes, “if the doctors say you are manic depressive and write that down in your chart, then that is what you are, in contexts in which medical authority operates” (p. 133). Martin argues that the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) has created convenient scientific categories for people to use in describing their mental illness and as a result they fail to explore the phenomenology of their condition. This observation frustrates Martin’s “hope of finding a rich, individually and culturally nuanced language about interior states” (p. 134). She argues that individuals may impose a scientific framework on their mental illness as a way to control and protect themselves against potential harms that come with being outed as having a mood disorder.

In the new millennium, mania has become a way of making sense of individuals, making sense of economic markets, and demonstrating an individual’s worth. Individuals have begun assigning numerical values to their moods through use of mood charts. These charts are created to encourage individuals to rationally manage their psychological states and categorize their own subjectivity, keeping in line with the neoliberal ideas of self-responsibilization and self-governance. Once a person writes down their subjective information in some form, they can learn to manage it in new ways. Martin examines different perspectives on mania ranging from considering it as an asset to be valued and as a “thing” that makes it seem possible to identify, manipulate and optimize mania through medical taxonomy and psychopharmacology. Manic depression as a metaphor has been used in our current conceptions of economic markets. Manic behavior is increasingly linked with economic rationality and is idealized in the widespread images of successful and creative risk-taking entrepreneurs because it offers “continuous wakefulness, boundless energy, high motivation, and productivity” (p. 210). Motivation is the part of mania that our economic system places at a premium. But this positively valued aspect of mania does not exist in isolation from the total context of American life. American media have propagated the mood of the economic market reflects the mood of individual consumers and investors, but the media have not addressed the ways that the economy itself creates individuals with mood disorders.