Living Crazy

What is behind the recent explosion in the diagnosis of bipolar disorder among American children? There is much to wonder about, as we know from Time magazine’s 2002 cover, “Young and Bipolar;” and from the recent 60 Minutes segment, “What killed Rebecca Riley?” Four year old Rebecca is said to have died from an overdose of psychiatric medications given to her for her bipolar disorder. The New York Times had already reported last month that the number of American children and adolescents treated for bipolar disorder increased 40-fold from 1994 to 2003. Behind these statistics lie powerful cultural changes in how Americans regard their moods.
One force behind the statistical increase is that bipolar disorder is in the process of redefinition from being simply a disability to being an asset. In many books and Internet sites there are lists of famous, creative, and influential people whose diaries, letters, and other writings indicate their bipolar disorder played a role in the enormously creative contributions they made to society. Larger than life figures like Robin Williams and Ted Turner are frequently described as “bipolar.” The other end of the spectrum of mood disorders, major depression, carries a different load of associations. If mania comes to seem more and more necessary for productivity in the competitive, sped-up global economy, depression signals the opposite: the person seems slow, quiet, inattentive, withdrawn, in short, unable to be productive. Some states have instituted depression screening for people still on the welfare rolls, assuming that these people are likely still on welfare because they are depressed. Of course, they may well be depressed! And medications the state provides may indeed help them become more productive. What interests me as an anthropologist is that cultural values very specific to our society are carried along with these diagnoses.
The notion is that as depression withers away altogether, the wild mania of the manic depressive can be tamed or optimized, the better to enable individuals to succeed and economies to grow. Key agents in this picture are the growing numbers of psychopharmaceutical drugs. They are what allow contemporary doctors to give a patient a diagnosis of mood disorder and treat it, rather than (as in earlier historical periods) lay the patient’s problems at the feet of her temperament or character. This transformation has certain benefits, not least that drugs can be effective and patients can feel less personally responsible for their condition. But as these conditions are rendered treatable, they are also become conditions that are greatly more susceptible to whatever cultural ideals are in play. It becomes thinkable to manage and adjust moods and motivations in directions that are apparently necessary for survival in the fierce economy of the present and that can be harnessed as an asset in the workplace. At a meeting of the American Psychiatric Association, I met a young doctor who practiced in a well-known hospital near Hollywood. When he heard about my research, he became quite interested and offered me this experience.
Where I work, we get a lot of Hollywood comedians coming in. They are manic depressives. There are two important things about this: first, they do not want their condition publicized, and second, their managers always get involved in the details of their treatment. The managers want the mania treated just so. They do not want it floridly out of control, but they also absolutely do not want it damped down too much.
He felt he was being called upon to optimize his patients’ moods (for particular professions and for the particular kinds of creativity each requires) through proper management of their drugs. His comment made me realize that drugs I was taking were being optimized for my profession, too: not so much lithium that my hands shook when I wrote on the blackboard; not so much Lexapro that my mind slowed down and stopped generating ideas during a class; not so little Focalin that my attention wandered constantly and I couldn’t write articles and books; not so little Lamictal that I got depressed and became unproductive altogether. A little like the Hollywood comedians, I was in the fortunate position of being able to afford expensive, expert advice about all this and working in a profession I valued. I began to feel uneasy about the prospect of extending the optimization of psychotropic drugs to suit other kinds of employment. What would happen if optimizing states of mind were extended, through health insurance, say, or perhaps as a condition of employment, to people who work in physically demanding jobs, for long hours, low pay, and little hope of advancement? To people who work in retail jobs demanding continuous emotional work (make the customer smile!), for long hours, low pay, and little hope of advancement? Or to soldiers on combat duty? What are the costs of extending the use of powerful psychotropic drugs to treat children whose behavior causes problems at home or school? It is essential to remember that the need for treatment (real as it may be in some cases) cannot be separated from a cultural environment in which some moods now seem to point to success and others to failure.