Collaboration with a scientist

Cone and Martin work together as a team. Richard Cone (a practicing lab scientist) and Emily Martin (cultural anthropologist) work together as a team to pursue work on anthropology of science as it relates to health and medicine. 

 

Cone’s lab and collaboration were the basis for Martin’s widely known article:

 "The Egg and the Sperm: How Science Has Constructed a Romance Based on Stereotypical Male-Female Roles" Signs: Journal of Women in Culture and Society 16 (3):485-501. [translations: "Ei und Sperma — Eine wissenschaftliche Romanze aus dem Stoff, aus dem die Geschlechterstereotypein sind" In Metaphernanalyse. Michael B. Buchholz, ed. Göttingen: Vandenhoeck and Ruprecht, 1993;   in  Taiwan, 2004;  In Greek, Feminist Theory, Nisses Publications, 2005; In Polish, Gender and Anthropology: A Reader, Warsaw University Press, 2007 Vietnamese translation.]  

[reprinted in Fields of Writing: Readings Across the Disciplines, 4th Ed. Comley et al. eds. N.Y.: St. Martin’s Press, 1998; Looking Forward: A Women’s Health Agenda for the 21st Century, Kary Moss, ed., Duke University Press; Women’s Health, Nancy Worcester and Mafianne Whatley, eds., Kendall/Hunt; The Sociology of Gender, Sarah Franklin, ed., Edward Elgar; Gender and Scientific Authority, Barbara Laslett, Sally Gregory Kohlstedt, Helen Longino and Evelynn M. Hammonds, eds., University of Chicago Press, 1996; Counterbalance: Gendered Perspectives for Composition, Carolyn Fogan, ed., Broadview Press, Canada; Gender, Culture and Ethnographic Practice, Louise Lamphere, Helen Ragone, and Patricia Zavella, eds. Routledge; Writing Into Worlds, Buffington, Dogenese and Moneyhum, eds. Blair Press;  Issues in Feminism, 4th ed., Sheila Ruth, ed., Mayfield Publishing Co.; Frame Work: Cultural Story Frames and College Writing,, John Sullivan, ed., Bedford Books; Landmarks: A Process Reader for Canadian Writers, Julie Walchli, Roberta Birks, and Tomi Eng, eds, Prentice Hall; Feminist Approaches to Theory and Methodology: An Interdisciplinary Approach, Sharlene Hesse-Biber, ed., Oxford University Press, 1997; Feminist Theory and the Body: A Reader, Janet Price and Margrit Shildriek, eds, Edinburgh University Press, 1998; Effective Writing, Edna Troians and Julia Scott, eds, Prentice Hall, 1999; A Reader on Language, Culture and Society, Hy Van Luong, ed., 2003, College Reading for Writing, Wendy Bishop, ed.,  Construction of Sexualities, Prentice Hall, 2003, Language and Gender: Modern Themes in English Studies, Routledge, 2007]

[revised and updated in Gender and Health: An International Perspective. Carolyn Sargent and Caroline Brettell, eds. 1995, Prentice Hall.]

 

Cone collaborated with Martin in the research for three of her books:

 

1987.   

The Woman in the Body: A Cultural Analysis of Reproduction. Boston: Beacon Press.

Winner of Eileen Basker Memorial Prize, 1988

UK edition, 1989, Open University Press. 

German translation, 1989 Die Frau im Körper, Campus Verlag. 

Second Edition with a new introduction, 1996 

Third Edition with a new introduction, 2002.

Portuguese translation 2006 A Mulher No Corpo.  Garamond Ltd.

 

1994.

Flexible Bodies: Tracking Immunity in American Culture from the Days of Polio to the Age of AIDS, Beacon Press. 

Japanese translation, 1997

 

2007. Bipolar Expeditions: Mania and Depression in American Culture (Princeton University Press).

Chinese translation, simplified characters

Chinese translation, traditional characters

French translation

 

They have co-authored

“Corporeal Flows: The Immune System, Global Economies of Food and Implications for Health,” (with Richard A. Cone) The Ecologist 27(3) Translated into Danish in Global Økologi 4, 1997

which has been reprinted several times.

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guns and mentally ill

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The Lancet, Volume 377, Issue 9784, Pages 2172 - 2173, 25 June 2011

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“Why are the mentally ill still bearing arms?”

Jonathan M Metzl ajonathan [dot] metzl [at] vanderbilt [dot] edu

On Jan 8, 2011, a 22-year-old high-school dropout named Jared Lee Loughner allegedly opened fire at a “Congress On Your Corner” meeting outside a grocery store in Tucson, AZ, USA. Using a 9 mm Glock 19 semiautomatic pistol, Loughner shot US Congresswoman Gabrielle Giffords and then fired indiscriminately into the gathered crowd. Six people died and 19 were injured by the less-than-a-minute shooting spree, which ended when an injured bystander tackled Loughner as he attempted to reload.

Mainstream media outlets debated various theories in the aftermath of the horrific crime. Did a vitriolic political speech catalyse Loughner’s actions? Were readily available guns and ammunition magazines to blame? However, in fairly short order, the media focused on narratives that held mental illness responsible for the violence. Stories on CNN’s website focused on “Guns and Mental Illness” alongside pictures of Loughner looking shaved, glassy-eyed, and crazed. David Brooks, from The New York Times, suggested that Loughner suffered from schizophrenia while asking “How can we more aggressively treat mentally ill people who are becoming increasingly disruptive?” And TIME magazine asked, “Why Are the Mentally Ill Still Bearing Arms?”

Such rhetoric probably sounded familiar to many Americans. Similar stories appeared in the aftermath of other recent high-profile gun crimes, from Columbine to Northern Illinois University to Virginia Tech. In each case, media connected the psychological instability of shooters to broader calls to limit gun rights for the mentally ill. It is undoubtedly the case that some people with mental illness commit crimes. Indeed, last month a federal judge ruled that Loughner was not mentally competent to stand trial due to his “delusions, bizarre thoughts, and hallucinations”. However, the contention that mental illness caused any particular shooting is more complicated than it might seem.

While debates about “mental competence” and guns have played out in American psychiatric journals for decades, surprisingly little evidence supports the notion that individuals with mental illnesses are more likely than anyone else to commit gun crimes. Many scholars hold the association to be overstated. According to Columbia University psychiatrist Paul Appelbaum, less than 3—5% of American crimes involve people with mental illness, and the percentages of these crimes that involve guns are actually lower than the national average—particularly when alcohol and drugs are taken out of the mix. For Appelbaum, the focus on so-called mentally ill crime obfuscates awareness of a far more important set of risk predictors of gun violence: substance use and past history of violence.

Links between mental illness and other types of violence are similarly contentious among researchers who study such trends. For example, research by John Brekke and Cathy Prindle, professors of social work at the University of Southern California, shows that individuals with schizophrenia are more likely to be assaulted by others than to commit violent crime themselves. Such research suggests that people with mental illness might well have more to fear from “us” than we do from “them”. By blaming people who have mental disorders for violent crime, the threats posed to society by a much larger population—the sane—are overlooked.

Further complicating matters, associations between violence and mental illness vacillate over time. Most people in the USA considered schizophrenia, to use David Brooks’s example, as an illness marked by genteel docility for much of the first half of the 20th century. From the 1920s to the 1950s, psychiatrists described it as a “mild” form of insanity that had an influence on people’s abilities to “think and feel”. New York Times articles told of “schizophrenic poets” who produced brilliant rhymes. Features in general magazines such as Ladies’ Home Journal described white middle-class “schizophrenic housewives” whose mood swings were suggestive of “Doctor Jekyll and Mrs. Hyde”, a theme that also appeared in Olivia de Havilland’s depiction of Virginia Stuart Cunningham in the 1948 Anatole Litvak film, The Snake Pit.

Only in the 1960s and 1970s did American society link schizophrenia with violence. Case studies in leading psychiatric journals described patients whose illness was marked by criminality and aggression. FBI Most-Wanted lists in leading newspapers described crazed “schizophrenic killers” on the loose, while Hollywood films, like Samuel Fuller’s 1963 Shock Corridor, showed angry schizophrenics who rioted and attacked. Research done at the University of Michigan has recently shown that the emergence of “schizophrenic violence” in the 1960s and 1970s resulted, not from the increasingly violent actions of people with mental illness, but instead from changes in the diagnostic categories by which mental illness was defined. As but one example, the second edition of the Diagnostic and Statistical Manual of Mental Disorders, published in 1968, redefined paranoid schizophrenia as a condition of “hostility” and “aggression” and projected anger in ways that encouraged psychiatrists to conceptualise violent acts as symptoms of mental illness.

From a historical perspective, shifting connections between violence and mental illness also connect uncomfortably with shifting anxieties about race. In the 1960s and 1970s, many of the men depicted as being armed, violent, and mentally ill were, it turned out, African American. A 1966 Chicago Tribune headline read “FBI Adds Negro Mental Patient To ‘10 Most Wanted’ List” above an article that advised readers to remain clear of “Leroy Ambrosia Frazier, an extremely dangerous and mentally unbalanced schizophrenic…who has a lengthy criminal record and history of violent assaults.” Similar themes are found in case studies in medical and psychiatric journals, as well as in 1960s-era pharmaceutical advertisements. Also around this time, the US Federal Bureau of Investigation (FBI) trumpeted links between African American men, violence, and mental illness in ways that intensified fears about black activist groups. FBI profilers famously diagnosed Malcolm X with “pre-psychotic paranoid schizophrenia” and with membership in the “Muslim Cult of Islam” while highlighting his militancy and his “plots” to overthrow the government. The FBI hung Armed and Dangerous posters throughout the southern states warning citizens about Robert F Williams, the controversial head of the Monroe, North Carolina chapter of the National Association for the Advancement of Colored People and author of a manifesto, Negroes With Guns, that advocated gun rights for African Americans. According to the posters, “Williams allegedly has possession of a large quantity of firearms, including a .45 caliber pistol…He has previously been diagnosed as schizophrenic and has advocated and threatened violence.”

It turned out that Malcolm X, Robert Williams, and other leaders were far from schizophrenic. But fears about their anti-government sentiments, guns, and sanity helped mobilise significant public response. The government cracked down on protest groups. Articles in the American Journal of Psychiatry, such as a 1968 piece titled “Who Should Have a Gun?”, urged psychiatrists to address “the urgent social issue” of firearms in response to “the threat of civil disorder”. And Congress began serious debate about gun-control legislation leading to the Gun Control Act of 1968. One cannot help but notice how different the terrain is in the present day. White shooters with mental illness beget reaffirmations of gun rights by leading politicians and by the National Rifle Association. Meanwhile, groups that advocate anti-government platforms and support broadening of gun rights, such as the Tea Party, take seats in Congress rather than being subjected to police scrutiny.

Questioning the links between guns and mental illness should not detract from the horrifying nature of events that transpired in Arizona. That shooting, like many others, is so far beyond the boundaries of acceptable behaviour that insanity understandably seems the most apt descriptor. And, of course, society needs to do everything it possibly can to take violent weapons out of the hands of potentially dangerous assailants. Yet the certainty of diagnosis—who else but a crazy person would commit such a crime?—is belied by the shifting nature of the discourse surrounding guns and mental illness. Beneath seemingly absolute questions of whether particular assailants meet criteria for particular mental illnesses lie ever-changing categories of race, violence, and indeed of diagnosis itself. As history reveals, decisions about which crimes American culture diagnoses as “crazy”, and which crimes it deems as “sane”, are driven as much by the politics and anxieties of particular cultural moments as by the innate neurobiologies of particular assailants. Perhaps more importantly, the focus on mentally ill crime effaces narratives that, by default or by design, fall out of collective purview. Again, understanding a person’s mental state is vital to understanding their violent actions. But focusing so centrally on individualised psychology isolates the problem onto lone “deviants” while making it ever-harder to address how mass shootings might reflect cultural as well as individual states of mind. We in the USA live in an era that has seen an unprecedented proliferation of gun crimes, and indeed of guns. Yet this proliferation has gone hand-in-hand with a narrowing of the lexicon through which American culture can, or is allowed to, talk about the problem. Ironically, the question of whether “the insane” should be allowed to “bear arms” becomes the only publically permissible way to talk about questions of gun control. Meanwhile a host of other narratives, such as the mass psychology of needing so many guns in the first place or the anxieties created by being surrounded by them, remain oft-unspoken.

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This emphasis on insanity risks taking the USA farther away from real conversations about guns at the very moment when more cultural debate seems badly needed, whether or not these guns are allowed, regulated, or banned. As reckoning with tragedies such as Tucson progresses, it seems imperative to recognise that connections between violence and mental illness, like connections between violence and political discourse, are nuanced and complex. Ultimately, the ways a society frames these connections reveal as much about its particular cultural biases and blind spots as it does about the acts of lone, and obviously troubled, individuals.

 

Further reading

Appelbaum and Swanson, 2010 Appelbaum PS, Swanson JW. Gun laws and mental illness: how sensible are the current restrictions?. Psychiatric Services 2010; 61: 652-654. PubMed

Metzl, 2010 Metzl JM. The protest psychosis: how schizophrenia became a black disease. Boston: Beacon Press, 2010.

Muth et al., 1999 In: Muth RM, Dizzard JE, Andrews SP, eds. Guns in America: a historical reader. New York: New York University Press, 1999.

Williams, 1962 Williams RF. Negroes with guns. New York: Marzani and Munsell, 1962.

a Vanderbilt University, Center for Medicine, Health, and Society, Nashville, TN 37235, USA

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Cheiron conference

Calgary and Banff

http://www.ucalgary.ca/ISHN_Cheiron/ 

 

The International Society for the History of the Neurosciences (ISHN) and The International Society for the History of Behavioral and Social Sciences (Cheiron) are pleased to announce their first ever joint meeting from June16-19, 2011 on the campus of the University of Calgary.  A workshop following the meeting will be held in the spectacular setting of Banff, Alberta from June 19 to June 23.

 

FEATURED LECTURE II

 

Chair: Henderikus J. Stam (University of Calgary, Canada) EMILY MARTIN (New York University, USA)

Anthropology and the History of Experimental Psychology 

 

 

 

Historians, neuroscientists, psychologists, psychiatrists and other professionals with an interest in the history of the neurosciences and the behavioral sciences will gather in Calgary, Alberta in June of 2011

 

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Financial Times and bipolar expeditions

http://www.ft.com/cms/s/2/5ff67be2-b636-11df-a784-00144feabdc0,dwp_uuid=a712eb94-dc2b-11da-890d-0000779e2340.html

 

Financial Times FT.com

When narcissism becomes pathological

By Adrian Tempany

Published: September 4 2010 00:23 | Last updated: September 4 2010 00:23

Sam Vaknin
Sam Vaknin is a victim of – and expert on – NPD: ‘Narcissists are likely to work in politics, finance or medicine’

Amy and Rob had been married for four years the day he turned a gun on her. Their relationship had been turbulent from the outset, but by 2005 their farm was failing, and, Amy says, “We were in so much debt it was unbelievable.” There were other, more serious problems: Rob would frequently tell the children they were lazy, stupid and ignorant, and he had threatened to kill his father. One night, Rob flew into a rage, screaming and cursing his wife. Amy told the kids to get their things together, because they were leaving. While the eldest two went to their room, Amy picked up her youngest, and went to the bedroom to gather some of his things.

“Then the door flew open,” she recalls, “and Rob was standing there with the shotgun. He closed the bedroom door and told me that he would kill me if I tried to leave with the kids. I told him that I would not be going alone; that if he wanted to shoot me he would get shot himself.”

No one shot anyone. Amy calmly reached for her mobile and called her father. “He said he was coming over, and Rob backed out of the bedroom.” Rob denied threatening to kill his wife, and the charges were eventually dropped. But as the divorce wound its way through the courts, a social services report diagnosed Rob with narcissistic personality disorder. In preparing to leave the farm with their children, Amy had threatened to take from her husband the one thing he couldn’t live without. It wasn’t love, or sex, or his family. Rob couldn’t accept a life in which he wasn’t the centre of attention.

. . .

Narcissistic personality disorder (NPD) is a form of pathological narcissism, first diagnosed by the psychoanalyst Heinz Kohut, in 1968. A rigid pattern of behaviour that drives a lifelong quest for self-gratification, NPD is characterised by a grandiose sense of self-importance, an insatiable need for attention and a chronic lack of empathy. (See the box on page 30 for a full list of symptoms.)

NPD is classified as a cluster B (or “dramatic”) disorder, alongside antisocial and histrionic disorders. (Cluster As, or “odd” disorders, include paranoid and schizoid disorders; cluster Cs, or “anxious”, include dependent and obsessive-compulsive disorders.) Today, experts believe disproportionate numbers of pathological narcissists are at work in the most influential reaches of society. As Sam Vaknin, author ofMalignant Self-Love, a bestselling study of narcissism, says: “Narcissists gravitate towards professions where they can control people and elicit adulation. They are more likely to work in politics, finance or medicine than in shoemaking.”

The disorder, formerly known as megalomania, affects 1 per cent of the population and up to 16 per cent of the clinical population. It is not easily discernible to the untrained eye, partly because a degree of self-love is essentially healthy: it protects us from self-harm; it enables us to form support networks, to find a mate and procreate. NPD, however, is not simply a healthy self-regard gone astray.

Jose Romero-Urcelay is a forensic psychiatrist and the director of therapies at the Dangerous and Severe Personality Disorders unit at Broadmoor, West London Mental Health Trust. He confirms Vaknin’s theory that pathological narcissists are drawn to careers in finance, law and politics. He also treats numerous patients with narcissistic personality disorder. “It is crucial,” he says, “to distinguish between narcissistic traits, which may be advantageous – such as confidence, a need to get to the top, the need for praise – and NPD. Those with personality disorders are exploitative, and likely to cause significant distress to others.”

Typically, this takes the form of emotional abuse. The narcissist’s insatiable quest for attention (what Vaknin was the first to describe as “narcissistic supply”), leads him or her to seek out a steady source of admiration. Where that is in short supply, the narcissist prefers to inspire fear or hatred than suffer the nightmare of being ignored. And unable to empathise, they are indifferent to the consequences of hurting people.

NPD alone is seldom the trigger for violence; this tends to arise when it is co-morbid – ie, it co-exists with another personality disorder, often histrionic or paranoid disorders. But the case of Rob and Amy is far from isolated.

In 2005, Brian Blackwell, a promising student from Merseyside, was sentenced to life for killing his parents. Blackwell, then 19, had bludgeoned his mother and father to death with a claw hammer, and stabbed them repeatedly with a kitchen knife. He then left them to decompose in their living room while he took off on holiday to America with his girlfriend and his parents’ credit cards.

Blackwell pleaded guilty to manslaughter on the grounds of diminished responsibility. His lawyers argued that he had NPD, pointing to his fantasy lifestyle (Blackwell claimed to be a professional tennis player) and the swaggering sense of power that persuaded him to return from the US to collect his A-level results (four As) even as the smell from his parents’ rotting bodies was drawing worried neighbours to their door.

The police were at a loss to understand Blackwell’s motive for killing his loving parents. But experts believe that NPD patients are dysfunctional and immature, and that to compensate for this inner, sick child the narcissist invents a fiction – that they are omniscient, or omnipotent.

This delusional sense of power appears to have afflicted Raoul Moat, who earlier this summer shot his ex-girlfriend and killed her new partner, before going on the run – later shooting a policeman and killing himself. Moat was never diagnosed with NPD, but David Wilson, professor of criminology at Birmingham City University, has labelled him “one of the best examples of a narcissist we will ever encounter”. Indeed, Northumbria police, suspecting they were on the trail of a narcissist, admitted appealing to Moat’s vanity by paying tribute to his outdoor survival skills and his ability to evade their dragnet, as well as reassuring him that he had a future.

Moat had a record of steroid abuse, and had appealed for psychiatric help. His ability to function to the extent he did, and, in his own mind, thrive – possibly triumph – in his confrontation with the police may have been sustained by pathological narcissism. For, according to Sam Vaknin, it is the narcissism that allows a person with NPD to function, “because it is adaptive: it’s a set of defence mechanisms that compensates for the narcissist’s deficiencies”.

. . .

Vaknin ought to know. The former owner of Israel’s largest stock exchange brokerage house is, in his own words, a “pure-bred narcissist”, and has twice been diagnosed with NPD. In 1985, while working in the City of London, he submitted himself for diagnosis, because “I wanted to understand why I was destroying my relationship with my fiancée.”

Vaknin was in his mid-twenties and a self-made millionaire. He was also heavily into group sex and voyeurism. His moods swung between attacks of rage and obsequiousness. And, he says, “I was haughty, fake and nouveau riche.” When his psychiatrist concluded that Vaknin had NPD “I had no idea what he was talking about,” he says. “I tried to corrupt him, I offered him money, and having felt that I succeeded, I lost all interest in him.”

Vaknin’s relationship with his fiancée petered out, but his appetite for high-risk rewards did not. In 1995, he was arrested for securities fraud in his native Israel, and sent to prison near Tel Aviv. The following year, Vaknin agreed to be assessed by a mental health expert, as a condition of his parole. He was diagnosed with various personality disorders. “I was borderline schizoid, but the most dominant was NPD,” he says. “It was a relief to know what I had.”

In the mid-1990s, public awareness of NPD was virtually non-existent. Nonetheless, Vaknin says his diagnosis “explained fully, without exception: everything from my style of speech to my relationships. This time I knew: this is it.”

Since his release from prison 14 years ago, Vaknin has communicated over the internet with tens of thousands of narcissists and their victims. Few people can claim to have increased the public awareness of NPD to such a degree. Today, his website receives five million users a year. “Not bad, huh?” he says. “You see, I have leveraged my narcissism: I have lived on the proceeds of my book for 15 years. What would I have been without my illness? Another businessman?”

Nonetheless, Vaknin is on controversial ground with some of his theories. The most contentious is that narcissists are akin to a form of artificial intelligence: “Intelligent,” he says, “because most narcissists are. And artificial, because they lack empathy, the ability to relate to other human beings. Academics will tell you that I am wrong; they will say ‘No, narcissists are people.’ This is bull.”

. . .

NPD is the bastard child of personality disorders. “No one knows where it comes from,” says Jose Romero-Urcelay, “but it tends to present in the patient’s early twenties.” There is no genetic predisposition to the disorder, nor are specific types of people more susceptible than others. It isn’t triggered by illness, injury or substance abuse. Some suspect it may be caused by an excess of love in infancy; others by childhood abuse or emotional trauma. Some point to a breakdown in the infant’s relationship with his or her mother.

One thing is clear, though: NPD is more common among men than women. According to Romero-Urcelay, this may be because the traditional male instincts – power, aggression, a hunger for adulation – are more amenable to narcissism. But with gender models changing, there is no known reason why women won’t succumb to the disorder in greater numbers.

Dr Martyn Pickersgill
These days, says Dr Martyn Pickersgill, many more people see each other in psychiatric terms

Certainly NPD is thriving in western societies. Increased materialism, the decline of community life and a fascination with image afford perfect conditions for its growth. Similarly, our culture increasingly celebrates attention-seeking behaviours. (In July, David Cameron used Prime Minister’s Questions toappeal to Facebook users to take down their “Raoul Moat is a legend” page. “I cannot understand any wave, however small, of public sympathy for this man,” he said.)

But while those on the left might seek to explain the increase in NPD by looking to Margaret Thatcher’s infamous claim that “there is no such thing as society” – and then to Emile Durkheim’s theory that sick or failing societies breed pathologies – sociologists are by no means unanimous that western culture is a greenhouse for pathological narcissism.

“It’s not clear-cut that society as a whole is more individualistic than, say, 20 years ago,” says Dr Martyn Pickersgill, a sociologist at the University of Edinburgh. “You can see all these new mechanisms of community, from Facebook to more overt activism. In mental healthcare you have a number of grass-roots groups. This is a reaction against individualism.”

Sociologists are also sensitive to the pressure from drug companies to medicalise different categories of people. “In general, we can see more of a ‘psychiatrisation’ of society,” says Pickersgill. “Many people more broadly see themselves and each other in terms of psychiatric categories.”

It’s a trend mapped out in alarming detail by Emily Martin in her recent book Bipolar Expeditions. Martin, an American anthropologist, describes how mania has come to be regarded as the new American frontier – one that attracts clinical pioneers with the promise of fame and fortune.

“Sometimes, as clinicians, we project our diagnoses on to patients,” says Romero-Urcelay. “NPD can be misdiagnosed.”

It is widely anticipated that the next edition of the influential Diagnostic and Statistical Manual of Mental Disorders, due out in 2014/15, will reclassify NPD from a standalone disorder to one that presents only alongside other personality disorders. How will narcissists feel about this?

“Pathological narcissism is not a pure diagnostic category,” says Vaknin. “It is like taking temperature: you have a temperature present in so many diseases and illnesses, but you can’t diagnose someone with ‘temperature’.”

. . .

It is, perhaps, not surprising that clinicians are still grappling with NPD. Even the people who live with narcissists can take years to spot the symptoms. “Victims don’t see a pattern of abuse in their narcissistic partner,” Alice says, “because there’s nothing wrong with them. It’s your fault.”

A victim herself, Alice is in her thirties and works in the City of London. She grew up in New England and suffered at the hands of her narcissist mother for much of her adolescence. From the time Alice was two years old, her mother was largely absent from her life. “She was chasing her boyfriend all over the world,” she remembers, at her home in Surrey. “Mum had me, and my brothers and sisters, and my Dad. But the boyfriend was her narcissistic supply.”

In the absence of her mother, Alice was raised in a loving, patriarchal family. Crucially, she says: “My mum didn’t have much chance to abuse me during the first nine years of my life, because she didn’t have to – she wasn’t there.”

But when she returned home to New England, Alice’s mother began to seek a supplementary supply: her discarded family. The problem was Alice. She was maturing into a bright and pretty nine-year-old, and her popularity infuriated her mother. “I had a high IQ, morals, values,” Alice says. “I was the adult in our relationship, and that looked bad in front of her friends.”

While the narcissist’s need for “supply” is inexhaustible, their sources are not. Devoid of empathy, narcissists will escalate the drama of a situation – regardless of whether the attention is positive or negative, it is simply more attention. As Alice realised as a child, “Nothing says to a narcissist mother ‘You are really important to me’ like the sight of their own child in a heap, crying, because of what mother has done.”

Overshadowed by her youngest daughter, Alice’s mother began to turn her siblings against their sister. “A narcissist can be covert in their abuse,” Alice says, “and my Mum used my siblings as her ‘enablers’. Children will compete for love, and there was no love coming from my mother, so they began to pick on me.” She shrugs. “They were only trying to survive.”

By 14, Alice had had enough. Her mother was ready to drag her overseas. “I said, ‘Mum, there’s a really good boarding school down the road. You know what… you go and I’ll stay here’. She came back and threw me out at 18.”

Did you ever sit down and explain that she was damaging your life? “No,” Alice laughs, “there was no point. There was nothing wrong with her!”

. . .

Alice regained her self-esteem in her mid-twenties – initially at university, and then by moving to London and working her way up through the City. She claims to have spotted a high level of pathological narcissists in the financial sector (“in hedge funds, more than anywhere else”) and mentions a friend who I should talk to.

She is a recruitment consultant for City companies and actively profiles for narcissists. Unsurprisingly, she was reluctant to talk to the FT. But as Alice explains, “Narcissists are prime candidates in finance, because they are able to make quick, bold decisions without any thought for the consequences these might have on other people.”

Despite her abusive childhood, Alice was unable to spot similar traits in her husband. It is not uncommon for the victims of narcissists to be drawn to successive abusers – experts label these repeat victims Co-Ns. So what attracted Alice to a narcissist partner? After a lengthy pause she smiles. “Me,” she says, ruefully. “Narcissists are empty vessels; they reflect back your personality so as to attract you. They try to make you think you’re their soul mate.”

Alice’s marriage hobbled along for 12 years. Her husband’s abuse was unrelenting. He spent much of a fortnight’s family holiday texting his mistresses. He flew into a rage when, two weeks after giving birth, she had still not returned to work to support his business venture. He would humiliate her in front of friends and strangers.

Eventually, Alice realised that she had to leave, “otherwise I would be conditioning my daughter to accept a narcissist as a partner, and my son to emulate his father. I couldn’t do that.”

Alice was unable to persuade either her mother or husband to seek proper diagnosis. But while Romero-Urcelay and Vaknin caution against self-diagnosis, Alice is extremely intelligent, and has spent many years researching her ordeal. “It’s a huge comfort to know it’s NPD,” she says. “You realise it’s not you that’s the problem. It’s like being reborn.”

There is no cure for narcissistic personality disorder, and while projections of its growth would be purely speculative, Jose Romero-Urcelay fears that an increase in diagnoses will not be matched by treatment: the healthcare sector currently lacks the experience and resources.

At present, the preferred treatment for NPD is psychological therapies, from individual psychodynamic and cognitive behavioural treatments to group, family and marital therapy. Sam Vaknin believes the emphasis in therapy is more on accommodating the needs of the narcissist’s spouse, children, colleagues and friends than on treating the narcissist. “If the narcissist’s behaviours are modified, those around him benefit most,” Vaknin argues. “This is a form of social engineering.”

So what of the patient? Is he or she not a victim too?

. . .

Wayne sits on a doorstep
Abused as a child, the adult Wayne can’t stop himself humiliating people. ‘Only through my narcissism am I able to feel somewhat alive’

One night, an e-mail drops into my inbox from Wayne – a motorbike courier in Utah, and a self-diagnosed pathological narcissist. His e-mail makes plaintive reading. “I am more scared than at any other time in my life because of the way I am with people,” he tells me. “When I’m making deliveries on my bike, people look me in the eye to try to make a connection, but with me, there is none. I am proud and mean, and most of them find me very rude and disappointing. I can’t help it, but I have just ruined their day by visiting them.”

At 23, Wayne is coming to terms with an abusive childhood, but he can’t stop humiliating people: he relishes the power he gets from intimidating friends and colleagues. He says he wants help, but in America help costs money. Wayne feels trapped: “Parts of me want to have love, friendships, or relationships, but the other parts will not let me,” he says. “So it seems that only through my narcissism am I able to feel somewhat alive, or to have these things.”

Wayne says he frequently contemplates suicide. “It’s just self-pity, though – a thought that takes away from the pain I feel when there is an absence of supply.”

Both Wayne and Sam Vaknin are disarmingly candid, and, in their different ways, reveal a hint of vulnerability. Is there hope for people such as Wayne – narcissists with a critical self-awareness, and a longing for love? Not according to Vaknin. “I understand my condition fully,” he says, “but I’m as virulently narcissistic as I’ve ever been.”

Romero-Urcelay insists that Wayne should seek proper medical help. But in both Wayne and Vaknin I detect a faint glimmer. There is an intelligence, isn’t there?

“Narcissists are robotic,” Vaknin bats back. But what of the self-reproach – that, surely, belies an emotional honesty; room, perhaps, for the love of another. “It’s a calculated honesty,” Vaknin says, without missing a beat. “I am a pathological narcissist. I need attention. Everything I do is calculated.”

Some names and details have been changed

Adrian Tempany is a freelance writer. His last piece for the magazine was about palliative care teams. Read it at www.ft.com/palliative

…………………………………………..

NPD – the diagnosis

A victim of narcissistic personality disorder will exhibit at least five of the following traits

1. A grandiose sense of self-importance

2. A preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love

3. A belief that he or she is “special” and can only be understood by, or should associate with, other special or high-status people (or institutions)

4. A requirement for excessive admiration

5. A sense of entitlement – unreasonable expectations of especially favourable treatment or automatic compliance with his or her expectations

6. Interpersonal exploitativeness – taking advantage of others to achieve his or her own ends

7. A lack of empathy and an unwillingness to recognise or identify with the feelings and needs of others

8. Enviousness of others – along with the belief that others are envious of him or her

9. A tendency to arrogant, haughty behaviours or attitudes

Source: Diagnostic and Statistical Manual of Mental Disorders IV

© Copyright The Financial Times Ltd 2010. 

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what is missing from "Just manic enough..."?

What is missing from the article below:

Just Manic Enough: Seeking Perfect Entrepreneurs

By DAVID SEGAL 

Where are those living under the diagnosis of bipolar disorder, who may not be the perfect entrepreneurs?

Where are those for whom medication is not a perfect solution?

Where is the political economic context that places such continuous energy and creative output at a premium?

 

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Just Manic Enough: Seeking Perfect Entrepreneurs By DAVID SEGAL

September 18, 2010

Just Manic Enough: Seeking Perfect Entrepreneurs

Cambridge, Mass.

IMAGINE you are a venture capitalist. One day a man comes to you and says, “I want to build the game layer on top of the world.”

You don’t know what “the game layer” is, let alone whether it should be built atop the world. But he has a passionate speech about a business plan, conceived when he was a college freshman, that he says will change the planet — making it more entertaining, more engaging, and giving humans a new way to interact with businesses and one another.

If you give him $750,000, he says, you can have a stake in what he believes will be a $1-billion-a-year company.

Interested? Before you answer, consider that the man displays many of the symptoms of a person having what psychologists call a hypomanic episode. According to the Diagnostic and Statistical Manual — the occupation’s bible of mental disorders — these symptoms include grandiosity, an elevated and expansive mood, racing thoughts and little need for sleep.

“Elevated” hardly describes this guy. To keep the pace of his thoughts and conversation at manageable levels, he runs on a track every morning until he literally collapses. He can work 96 hours in a row. He plans to live in his office, crashing in a sleeping bag. He describes anything that distracts him and his future colleagues, even for minutes, as “evil.”

He is 21 years old.

So, what do you give this guy — a big check or the phone number of a really good shrink? If he is Seth Priebatsch and you are Highland Capital Partners, a venture capital firm in Lexington, Mass., the answer is a big check.

But this thought exercise hints at a truth: a thin line separates the temperament of a promising entrepreneur from a person who could use, as they say in psychiatry, a little help. Academics and hiring consultants say that many successful entrepreneurs have qualities and quirks that, if poured into their psyches in greater ratios, would qualify as full-on mental illness.

Which is not to suggest that entrepreneurs like Seth Priebatsch (pronounced PREE-batch) are crazy. It would be more accurate to describe them as just crazy enough.

“It’s about degrees,” says John D. Gartner, a psychologist and author of “The Hypomanic Edge.” “If you’re manic, you think you’re Jesus. If you’re hypomanic, you think you are God’s gift to technology investing.”

The attributes that make great entrepreneurs, the experts say, are common in certain manias, though in milder forms and harnessed in ways that are hugely productive. Instead of recklessness, the entrepreneur loves risk. Instead of delusions, the entrepreneur imagines a product that sounds so compelling that it inspires people to bet their careers, or a lot of money, on something that doesn’t exist and may never sell.

So venture capitalists spend a lot of time plumbing the psyches of the people in whom they might invest. It’s not so much about separating the loonies from the slightly manic. It’s more about determining which hypomanics are too arrogant and obnoxious — traits common to the type — and which have some humanity and interpersonal skills, always helpful for recruiting talent and raising money.

Some V.C.’s have personality tests to help them weed out the former. Others emphasize their toleration of mild forms of mania, if only because starting a business is, on its face, a little nuts.

“You need to suspend disbelief to start a company, because so many people will tell you that what you’re doing can’t be done, and if it could be done, someone would have done it already,” says Paul Maeder, a general partner at Highland Capital. “There are six billion human beings on this planet, we’ve been around for hundreds of thousands of years, we’re a couple hundred years into the industrial revolution — and nobody has done what you want to do? It’s kind of crazy.”

ON a recent Saturday evening, Seth Priebatsch is sitting in his office/bedroom in the 26,000-square-foot space that houses Scvngr (pronounced “scavenger”), which he founded in early 2009. Dozens of toy race cars fill a bookshelf on one wall; the other is covered with lists and drawings. The sofa where he crashes in his sleeping bag lies between the two.

He will explain the genesis of Scvngr, and offer a sort of guided tour of his mind, while sitting on a stool in his bare feet, wearing jeans and a Princeton T-shirt. A pair of Oakley sunglasses are perched, as they nearly always are, atop his head — part talisman, part personal branding.

He is lean, smiley and partial to the word “awesome,” which he uses as a noun — as in “an extra dose of awesome.” He speaks quickly and with what sounds like a Canadian accent, which seems odd because he was raised in Boston.

He first pitched Scvngr as a freshman at Princeton, to a professor linked to an annual business plan contest open to undergraduates and graduates. “I told him I wanted to build the game layer on top of the world,” Mr. Priebatsch recalls. “And he didn’t say, ‘You’re insane.’ So I said, ‘And I want everyone in the world to help me build it.’”

Scvngr won first prize, which came with $5,000 and emboldened him to apply to a seed financing company, DreamIt Ventures, which gave him $35,000. The victory also caught the eye of a venture capitalist, Peter Bell of Highland Capital, who read about Mr. Priebatsch’s prize while surfing the Web one night. Mr. Bell popped off an e-mail.

“It was Saturday night, pretty late,” Mr. Bell recalls. “I said, ‘If you ever come to Boston, I’d love to meet you.’”

Mr. Priebatsch replied immediately: he’d decided to drop out of Princeton and move to Boston. The university would be around a long time, he reasoned, but the moment to start Scvngr was fleeting and couldn’t wait a few weeks, let alone three years.

So, what is this potentially globe-altering enterprise?

“Scvngr is a game that you play on your phone, and playing Scvngr is incredibly easy,” he begins.

The game allows you to compete and win rewards at stores, gyms, theaters, museums and so on. A Mexican restaurant, for instance, might offer half off your next soda if you fold the tin foil on your burrito into origami, then snap a picture of it.

If this sounds like little more than a gimmicky way to lure in consumers, well, you haven’t listened to Mr. Priebatsch long enough.

“We play games all the time, right?” he says. “School is a game. It’s just a very badly designed game.” American Express cards, with their escalating status, from green, to gold to black — they are a game. So are frequent-flier miles.

“But game dynamics aren’t consciously leveraged in any meaningful way, and Scvngr does that.”

This, apparently, has enormous implications. “If we can bring game dynamics to the world, the world will be more fun, more rewarding, we’ll be more connected to our friends, people will change their behavior to be better. But if this is going to work it has to be something that anyone can play and that everyone can build.”

This, he says, is the key: Scvngr is both a game and a game platform. Anyone can create a Scvngr challenge, free, using four default games or tools the company offers. There are now 20 million Scvngr challenges in the United States, according to the company, most of which are simple tasks, like “stand in this spot and say something.”

In addition, about 1,000 companies and organizations — including the New England Patriots, Zipcar, Sony and Warner Brothers — pay Scvngr to create and manage their challenges.

“The last decade was the decade where the social framework was built,” he says — most successfully by Facebook. “The next decade will be the decade of games.”

Judging this pitch by reading it, as opposed to hearing it in person, is like appraising a song based solely on its lyrics. Mr. Priebatsch describes Scvngr and the future it portends with burbling fluency, as if it were a country he has visited and one that you must see. He is especially good at giving “the game layer” an aura of inevitability.

It is hardly clear, though, that such a layer will catch on or, if it does, whether Scvngr will be the company to build it. The field of location-based tech games is crowded, and include standouts like Foursquare and Gowalla.

The particulars of Scvngr seem nitpickable, too. The game’s points will earn you whatever goodie is offered on the spot, but there is nothing else you can do with them. And some users have found Scvngr’s challenges to be pretty lame. More than a few of the contests seem like barely veiled marketing ploys — like retailers that “challenge” you to come up with three words that describe the store.

Reviews so far have split the crowd. As of last week, a third of the roughly 1,000 people who had weighed in on the latest version of Scvngr in the iPhone’s App Store gave it the highest rating and one-third gave it the lowest.

“Not relevant to having fun,” read one review.

But Mr. Priebatsch’s pitch has worked, at least by the standards of start-ups, most of which die in the blueprint phase. Part of the reason could be pinned on the investing and tech world’s raging case of Next Zuckerberg Syndrome — the urge to find another Mark Zuckerberg before he starts another Facebook.

But nobody inspires N.Z.S. without a promising idea, intelligence and a lot of charisma. Scvngr today has 60 employees, many of them veterans of very successful tech start-ups. As of December of last year, it also had $4 million from Google Ventures.

Any list of the qualities that have netted all this talent and money should include Mr. Priebatsch’s quasirobotic work ethic. He does not socialize. He no longer reads books, nor does he watch TV or movies. He works from 8 a.m. until 10 p.m., seven days a week. He was reluctant to have a photographer visit for this article because he worried that it might distract employees.

Doesn’t he miss going to bars, just hanging out, being 21? Here’s where Mr. Priebatsch starts to sound like a teenage Vulcan.

“I had friends at Princeton; I’m sure it’d be fun to see them,” he says. “But I know that what I’m going after is huge and others are going after it, and if they’re not, they’re making a mistake. But other people will figure it out, and every minute that I’m not working on it is a minute when they’re making progress and I’m not. And that is just not O.K.”

THE hypomanic temperament is, of course, not limited to entrepreneurs. It’s found in politics (Theodore Roosevelt) the military (George S. Patton), Hollywood (the studio head David O. Selznick) and virtually any field where outsize risks yield enormous rewards.

But the business world has contributed more than its share of hypomanics, particularly the abusive, ornery kind. The most colorful of the breed was arguably Henry Ford.

“He epitomizes the unhinged, entrepreneurial spirit,” says Douglas G. Brinkley, a history professor at Rice University and author of “Wheels for the World,” a book about Mr. Ford and his company. “He became monomaniacal in his belief that the internal combustion engine should be fueled by gas, at a time when everything was electric, and nobody thought you could put gas on a hot motor.”

Mr. Ford could be both charmer and ruthless jerk. When he visited rural America to extol the horseless carriage, listeners were often left hoping that he would run for president. With employees, on the other hand, he was an autocrat who never brooked dissent. He clung so stubbornly to his vision — black cars, and only black cars, for the masses — that the company almost went bust when rivals like General Motors started offering more choices.

Nearly all conversations about contemporary hypomanics start with the Apple chief executive, Steven P. Jobs. Like Mr. Ford, he is a pitchman extraordinaire with a vaguely messianic streak, and, like Mr. Ford, he can anticipate what people will want before they even know they want it.

Mr. Jobs is also routinely described as a despot and control freak with a terrifying temper, says Leander Kahney, author of “Inside Steve’s Brain.”

“Even the prospect of a chewing out by Steve Jobs makes people work 90 hours a week,” says Mr. Kahney. He treats employees as tools, Mr. Kahney went on, as a means to an end, with the end defined as a universe of Apple products and services that are tailored precisely to his specifications.

“I would argue that Jobs has used his control freakery to advantage,” Mr. Kahney says. “The hallmark of Apple is the way it controls the entire user experience — the ads, the stores, the iPods. Nothing is left to chance. That comes from Steve Jobs.”

Scholars in organizational studies tend to divide the world into “transformational leaders” (the group that hypomanics are bunched into, of course) and “transactional leaders,” who are essentially even-keeled managers, grown-ups who know how to delegate, listen and set achievable goals.

Both types of leaders need to rally employees to their cause, but entrepreneurs must recruit and galvanize when a company is little more than a whisper of a big idea. Shouting “To the ramparts!” with no ramparts in sight takes a kind of irrational self-confidence, which is perfectly acceptable, though it can also tilt into egomania, which is usually not.

“We have a grid personality scorecard, across 10 or 12 dimensions, attributes that are critical to success,” says Michael A. Greeley, a general partner at Flybridge Capital Partners in Boston.

The goal is to spot the really erratic characters, whom Mr. Greeley calls “rail to rail”:

“One day they get up and their favorite color is pink. The next day, it’s green. I’ve worked with hypomanics, and where I think it can be quite insidious — people like this turn on colleagues quickly. An employee could be an incredible contributor, and then, after one mistake, they are out of the lifeboat.”

BEFORE Highland Capital invested in Scvngr, Peter Bell gave Seth Priebatsch’s life and résumé the vigorous frisking that is standard in the venture capital business.

Mr. Priebatsch was 19 at the time, which meant that he didn’t have a lot of former colleagues or bosses. What he did have, however, was a surprisingly long track record in business.

Scvngr is actually the third company that Mr. Priebatsch has founded. At the age of 12, with money from his parents, he started Giftopedia, a price-comparison shopping Web site. When he was in eighth grade, the company had eight employees — six in India, two in Russia.

Nobody who worked for him ever asked him his age, and he never volunteered it. “I wouldn’t say that I kept my age a secret,” he says. “I just never offered that information. Nobody knows how old you are on the Internet.”

All communications were handled via e-mail and Skype, often while he was typing on a laptop while sitting in class. For a long time, his teachers thought that he was simply taking copious notes, but he was actually sending instructions overseas with a wireless connection.

“One day, I forgot to hit the mute button on my laptop and it started ringing during French class,” he recalls. The Giftopedia server was down that day, and it was a crisis.

“I got up and told my teacher, ‘I’m really sorry, but I have to take this call.’ ”

Giftopedia was profitable, but a little late to the field, Mr. Priebatsch says. Ultimately, he sold the domain name for five figures and, at 17, founded PostcardTech, which created and mailed out promotional mini-CDs on behalf of tourist destinations and universities. For that company, he rented part of a factory in China, which, he said, was time-consuming but surprisingly easy and didn’t even require a trip to Asia.

Mr. Priebatsch handed PostcardTech off to some friends, who did little with it, and the company has since folded. But it left Mr. Priebatsch with a chunk of money — he won’t say how large — that he has since invested in Scvngr.

Dr. Gartner, the author and psychologist, says he believes that hypomanics come by their disposition genetically. But it is hard to tease out what Norman and Suzanne Priebatsch — a biotech entrepreneur and a financial adviser at SmithBarney, respectively — bequeathed through their DNA and what they instilled in Seth and his older sister, Daniella Priebatsch, as they grew up.

Because chez Priebatsch sounds like boot camp for the brain.

“With both my kids, my wife and I pushed them very hard,” says Norman Priebatsch, who is a native of South Africa. “Very invasive, very intrusive, doing things, planning things continuously.”

As a child, when Seth started to read along with his father — high-level math, physics and history books were the staples — the elder Mr. Priebatsch would often turn the books upside down, adding a degree of difficulty to the experience, and presumably some fun.

The upshot is that Seth can now read as quickly upside down as right-side up, something to keep in mind if you ever find yourself sitting across a desk from him.

“People assume that if you’ve got a sheet of paper in front of you that no one else can read it,” he says, “and that is false.”

Vacations, Seth says, made school seem relaxing. He and his sister were expected to research destinations — Istanbul, Shanghai and Rome, for instance — and then plan most of the itinerary down to the hour. On the trips, they would tour all day and night, leaving time for the children to upload photos to a laptop and type up a detailed account of everything they’d seen.

“We were the scribes of those trips; that was a requirement,” says Daniella, who now works on a sales team at Google. “Every detail — what it was like at the museum, people we met. Even the room number of the hotel, in case it was a good room and we ever came back.”

The rigor and intensity of Seth’s upbringing have left him with a peculiar combination of rarefied skills and mundane deficiencies. He is a gifted software engineer but a terrible driver. (“I hit things,” he says.) He’s perfectly at ease negotiating with V.C.’s, but has had just one girlfriend, a relationship that ended abruptly when someone asked how long they’d been dating.

“We answered simultaneously and she said six months and I said two weeks,” he recounts, sounding amused. “Two weeks earlier we’d had this conversation, and I said, ‘And so now we’re dating, correct?’ And she said yes.”

He shrugs.

“I thought I’d been really clear,” he says. “I find business relationships are easier. You have to sign a piece of paper.”

IN late 2008, as part of the investment process, Mr. Priebatsch had to visit Highland Capital’s offices and present his plan to the firm’s partners.

It went well, but there are still skeptics at the firm. Mr. Maeder of Highland still wonders whether Scvngr is the scaffolding of a major business. At the same time, he regards the $750,000 investment as a bet on Mr. Priebatsch as much as a bet on his company.

“Seth has such a fertile mind; you just know that he’ll attract great people to the company,” he says, “and the ideas will continue to flow and morph until he finds something great.”

You also get the sense that Mr. Priebatsch won’t stop, even if Scvngr is a glorious triumph.

“I like winning,” he says. “I’m addicted to the act of winning, the process. When you are in the act of winning, everything is great. Once you’ve won, that’s boring. It’s cool, it’s better than having lost, but it’s boring.”

Great piles of money would not slow him down, either.

“I’m not anti-money,” he says. “I like nice bikes, I like nice computers. I like that money is a representation of success, but the actual entity itself is not interesting for me. There is little that I would want that I don’t have, and the things that I want money can’t buy.”

Like?

He doesn’t pause.

“I want to build the game layer on top of the world.”


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Review of Bipolar Expeditions in The Lancet

THe Lancet review.

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Another review of Bipolar Expeditions

Find attached a book review that was accepted for the American Journal of Psychiatry residents’ edition.  Most of it will be familiar from the mini-talk you invited me to do last November.  Sorry I couldn’t do more justice to your wonderful book, but I figure one of my roles is to get psychiatrists to read things they need to but wouldn’t ordinarily.  

 

See you soon,

Helena

 

Book Review

 

Bipolar Disorder as Culture Bound Syndrome: 

A Review of Anthropologist Emily Martin’s

Bipolar Expeditions: Mania and Depression

in American Culture

 

By Helena Hansen, MD, PhD, PGY4

NYU Medical Center Department of Psychiatry

 

Contact Information:

 

Helena Hansen MD, PhD, PGY4

Phone: (212) 562-2240

Email: helena [dot] hansen [at] nyumc [dot] org

If Kay Jamison,who argued that bipolar disorder fosters creativity by retrospectivelydiagnosing famous artists and authors in history, helped to usher an era inwhich mania is valorized, Emily Martin might be the anti-Kay Jamison.  Both Martin and Jamison write from thevantage point of their own diagnoses, but that is where the parallel ends.  Rather than asking how bipolar disorderfosters creation, as Jamison does, Martin issues a sharp critique by asking howbipolar disorder itself is works as a concept in popular culture, and what usesthe increasingly widespread concept has in contemporary American society.

Emily Martin is anaward winning medical anthropologist of renown among social science andhumanities scholars.  With thepublication of Bipolar Expeditions: Maniaand Depression in American Culture (Princeton University Press, 2007), sheturns from her previous subjects of inquiry (women’s physiology, immunology) tothe problem of bipolar disorder, applying her formidable skill to unearth howthe details of clinical practice reflect popular culture. 

An ethnographythat interweaves her self-reflection with interviews and observations ofbipolar support group members, clinicians treating bipolar disorder, andpharmaceutical marketing professionals, Martin’s book does not recognizeboundaries.  Like a psychoticperson, it breaks down the distinction of self and other; it does not respectprivate property.  And privateproperty is precisely what the book takes on.

In BipolarExpeditions, Emily Martin uses herself to challenge the idea that living withthe diagnosis of manic depression is an intimate, personal affair.  She cannot keep her own diagnosiswithin the confines of her psychiatrist’s office; at every turn she shows howher experience affects her students, her colleagues, her written and spokenwords.  She wrestles out loud withstanding “in a doubled position” as a person who uses psychopharmacology andtherapy, but also questions their historical and cultural significance.  As a member of the support groups aboutwhich she writes, she offers her story in order to replace “secrecy and fear”around the stigma of mental illness with “collective responsibility.”  At the same time she avoids glamorizingthe diagnosis as a famous anthropologist coming out as bipolar.  She points out that the bipolarcreativity portrayed in the media is one that furthers the status quo ratherthan challenging it.  Moreover, shedocuments how the creative potential of the people in her study is hinderedrather than helped by bipolarity. 

Emily Martinshatters common sense distinctions of public and private, individual andcommunal.  In the process, shemakes sense of what may seem counter-intuitive on the surface: the consciousself-presentation and sociality of people living with the diagnosis of manicdepression.  As Emily Martin putsit, even a “mad” manic can be social.

Manic people, shepoints out, are conformist: they engage; they gravitate to others; as producersthey are “tightly bound to social conventions” and “innovative…in terms themarket can value” (Martin 2007: 259). They are disruptive because they are social to excess: in their pursuitsand seduction they invade, they irritate. Depressed people withdraw, but as they descend it is impossible to do sowithout others noticing.  As theyget so depressed that they are not able to carry on everyday life, it becomesobvious to all, and all are moved in some way.  In both mania and depression, disrupted social rhythms callattention to the sufferer; they bring about a lack of privacy.  Mania and depression are enactedthrough social relations, like those in the support groups that Martindescribes.

It is an ironythat something as private as mania and depression have such a social impact andare experienced through social connections.  The “privacy” of the psychotherapeutic cultural model thatAmericans have for dealing with relational problems is unique: traveling greatdistances to consult in a sound-proofed room with someone we choose because heor she does not know anyone we know, and can guarantee confidentiality.  Consider how different the model isfrom the majority of non-European societies, where relational problems aremediated collectively in the community. Perhaps psychiatrists help to sustain a myth of privacy (of industry,property, individual psyches).  Yeteach of us brings our personal history to the present, and this history iscreated by our experience of other peoples’ emotions and realities. In thatsense, no act of consumer choice, foreclosure, plant construction, orpharmaceutical advertisement can be private.

Martin exposes asecond irony of manic depression. American media have propagated the idea that the mood of the economy, inparticular the stock market, reflects the mood of individual consumers andinvestors as it cycles between extreme optimism and risk taking on the onehand, pessimism and withdrawal on the other.  But the media have not shed light on the ways that theeconomy itself creates individuals with mood disorders.  Using examples ranging from magazineads that portray Ted Turner’s bipolarity in order to boost his image withstockholders, to stockbroker training programs that teach new traders to “behypomanic,” Martin argues that bipolarity is symbolically cultivated as aheroic property.  In the newmillennium, bipolarity has become a way of seeing the world, a way of makingsense of individuals, making sense of markets, and a way of demonstrating one’svalue. 

Martin’s argumentabout bipolarity builds on a literature historically linking psychiatricdiagnoses to the ethos of their time. A version of this history, reproduced by people as varied as David Healy(2006), Nikolas Rose (2007), and Jonathan Metzl (2003), is that post WWIIpsychiatry offered the metaphor of anxiety disorder and the panacea ofbenzodiazepines to a generation obsessed with insecurities about the cold war,changing gender and race relations. In the 80’s, with the introduction of Prozac, an aggressively marketedselective antidepressant free of the side effects of earlier antidepressants,the psychiatric metaphor shifted from anxiety to depression. The Prozacgeneration of baby boomers confronted the decline of American colonialism, andhit the limits of economic expansion. At the same time, physicians’ diagnosticpatterns shifted just as dramatically from anxiety to depression, with aneight-fold increase in antidepressant prescriptions written between 1990-2000(Rose 2007). 

Emily Martindescribes the third wave: the bipolar generation.  Thrust into broadband speed by the internet, and hardened bybooms and busts, from dot coms to the war on Iraq, this generation’s economy demandsimprovisation, risk taking, and perpetual motion.   Martin astute observation goes beyond metaphor.  Like the Indian theater she references,one can create the “conditions that excite a mood” rather than locating moodsin individuals.  In other words,mental illness may not necessarily come from deep within; it may beoverdetermined by the setting that directs its performance. 

The shift to thepsychiatric metaphor of bipolarity in the market has been accompanied by anexpansion of the diagnosis and treatment of bipolar disorder in actualclinics.  A standing joke in mydepartment involves attendings in whose care every patient ends up diagnosedwith bipolar disorder.  Variationson the diagnosis of bipolar disorder are proliferating, which new categoriessuch as “pseudounipolar depression” in those with no manic or hypomanicepisodes, but reporting irritability with depression, and often familyhistories of bipolar disorder, who are thus prescribed mood stabilizers.

In addition, thediagnosis of Bipolar II, which does not require patients to meet full criteriafor a manic episode, is leading young psychiatrists to rediagnose many peoplewho have long been diagnosed with depression.  Psychiatrists cite studies indicating that a number ofpatients mistakenly diagnosed with depression were actually sent into a manicepisode as a result of taking antidepressants without mood stabilizers.  It is striking that currently, patientson the inpatient service in my hospital are rarely discharged on an antidepressantalone.  These days, most leave withsome form of mood stabilizer or antipsychotic.  Among prescribers, there is a mania about the risk ofcausing mania with antidepressants. As a result, doctors prescribe bipolar medications.  Does the fact that Lamictal was onpatent until this year have anything to do with this?  What about the fact that second generation antipsychoticssuch as Seroquel and Zyprexa, whose patents both expire in 2011, are FDAapproved and promoted for use in bipolar disorder?

Products createconsumers, and new diagnoses create patients.  The market literally has turned bipolar, with Seroquel(making $2.76 billion/year), Lamictal (at 0.8 billion pounds/year) and Zyprexa(at $2 billion/year) named the top three profitmakers for pharmaceuticalcompanies by 2006. (health.dailynewscentral.com 2006, Glaxo SmithKline Annual Review2006).  Martin calls forpsychiatrists’ vigilance regarding the social effects of diagnosis, writing“The authority behind the act of naming means that the person will be treatedas if he or she had the condition; this is the sense in which the act ofdiagnosis is performative” (Martin 2007:148).

If we attempt totake Emily Martin’s social analysis to its logical conclusion, what does allthis mean?  Her book gives us someclues.  Bipolarity serves certainpurposes of the market.  Bipolardisorder is sold to Americans as a problem of self-regulation, of impulsivedecisions in an era of too much choice. The irony is that the marketing industry within popular media is soadvanced, as a technology of social manipulation, that bipolarity is ever morepredetermined.

 

Works Cited:

Healy, David. Let Them Eat Prozac: The Unhealthy Relationship Between thePharmaceutical Industry and Depression. NYU Press, New York 2004.

Jamison, Kay Redfield (1989):  “Mood Disorders and Patterns of Creativity in BritishWriters and Artists. ”  Psychiatry52(2):125-134.

Emily Martin. Bipolar Expeditions: Mania and Depression in American Culture PrincetonUniversity Press, Princeton 2007.

Glaxo SmithKline Annual Review March 30 2006.  Electronic document www.flixotidecopd.co.uk/investors/reps05/annual_review_2005/business_operating_review.htm). 

health.dailynewscentral Feb 3, 2006.  Electronic documentwww.health.dailynewscentral.com.

Metzl, Jonathan. Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs. DukeUniversity Press, Durham 2003.

Rose, Nikolas. The Politics of Life Itself: Biomedicine, Power and Subjectivity in theTwenty-First Century.  PrincetonUniversity Press, Princeton 2007.

  

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Radio interview on Bipolar Expeditions

Dear Dr. Martin,

Thank you so much for such an enlightening and important interview.  I was a pleasure to speak with you.

I have posted the audio file a the following sites

Psychjourney Podcast
http://psychjourney.libsyn.com/index.php?post_year=2009&post_month=02
Psychjourney Podcast Blog

I have sent you and your publisher a copy of the audio file of the interview through Send This File.  You can download the audio file to your computer and then upload the interview to your website and blog.  I request that when you post the interview you include a link to Psychjourney www.psychjourneypodcast.com   Thank you.

The length of the interview is 44 minutes, 4 seconds.

Best,

Deborah

Deborah Harper
President, Psychjourney
(408) 365-8933
(408) 613-2532

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Review of Bipolar Expeditions in Metapsychology

 

Dear Prof. Martin

 

I thought you might be interested to know of my review of your excellent book, just posted on this online website.  The anonymous colleague in the review is Sander Gilman at Emory, who I presume you know.  Perhaps we can communicate on our joint activities in the future. You might be interested in my book The Concepts of Psychiatry

 

http://metapsychology.mentalhelp.net/poc/view_doc.php?type=book&id=4440&cn=158

 

Regards

 

Nassir Ghaemi

 

S. Nassir Ghaemi MD MPH
Director, Mood Disorders Program
Tufts Medical Center, Dept of Psychiatry
800 Washington Street, #1007
Boston, MA 02111
Phone:  617-636-5735
Fax:  617-636-4852
Email: nghaemi [at] tuftsmedicalcenter [dot] org

Research assistant:   Elizabeth Whitham (ewhitham [at] tuftsmedicalcenter [dot] org) 617-636-3025
Author website:  www.nassirghaemi.com
Blog:  www.mindbrainworld.com

 

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