Issue #64, September 2003
Let me begin with this: lots of people have mental illness. Many people go through their lives with such illness without ever being diagnosed. When you have one and have yet to be diagnosed with a named condition, it seems like the "illness to be named" is normal. In your own head and body, it feels like this is the way one's life just "is," and the way one's body is supposed to behave. What else do you have to compare your experiences to?
That is, until something goes terribly awry. Perhaps it is a full-blown panic attack, when your body is suddenly (often quite suddenly) thrown into a combination of physiological patterns: racing heartbeat, waves of intense nausea (usually some nasty vomiting goes with this), a racing mind (where you turn over lots of really negative stuff about your fears and anxieties in an endless whirl of panicky circularity), wildly fluctuating body temperature, the shakes, and an inability to be physically still.
Or maybe a condition has lain dormant in your body for years, only to appear some day out of the blue. This happened to me with bipolar disorder (also known as manic depression). I knew it ran on my father's side of the family, and that this condition likely explains the alcoholism, drug abuse and suicidal tendencies that plague several of my relatives. People with bipolar disorder often go undiagnosed for years; many end up self-medicating with booze or illicit drugs — downers mostly, because they help control, if you can call it that, the manic swings of the disorder. Alcohol is one of the most socially available depressants, and is relatively cheap compared to the costs of many pharmaceutical remedies, be they anti-depressants, anti-psychotics, or anti-anxiety drugs. Without good health insurance, the burden of paying for these drugs and the doctor's visits are simply untenable for most people. To put bipolar disorder into a bit of cultural perspective, according to one estimate, roughly 20% of alcoholics are said to suffer from the condition.
I didn't expect to get bipolar disorder myself. Of course, does anyone really expect to get the mental illnesses that run in one's family? You're more likely to hope like hell that it somehow skipped you, genetically, or by the simple grace of chance. Maybe some people do go through life expecting to inherit the disorders that occasionally, or regularly, appear in one's relatives, but I went through most of my early life confident that I wouldn't fall victim to them. I certainly feared the drug abuse and the deeply troubled and explosive personalities of my relatives — particularly my father. So much of the public discourse about alcoholism makes its familial inheritance seem inevitable. Somehow I'd managed to avoid becoming the alcoholic child of an alcoholic father. I thought my ability to steer clear of the alcohol addiction signified I might be in the clear, safe from the shadowy physiological conditions that produced the alcoholics in my family in the first place.
No such luck. Besides suffering severe depression as a late teen, by my mid-twenties I fell victim to panic attacks. Horrible, physically uncontrollable panic attacks. By age 29, I found myself besieged by wild and sudden shifts in mood. Unlike a run-of-the-mill mood swing, the swings I experienced occurred in the time-space of a second. After one bite of a sandwich at lunch, I could be a different person, angry rather than the calm I had just exuded; pissy and bitched out rather than the depressive person I had just been. On some days, I would experience at least ten of these "swings." Those around you are left scratching their heads — and are usually horribly disturbed — by the "mood swing" they have just witnessed. It's not pretty, and it's not fun for anyone.
After several months of psychological "talk" therapy, my condition didn't improve. I decided I couldn't gain control over these mood swings, so I visited a psychiatrist, and left his office with a handy, if not deeply disturbing, diagnosis of bipolar disorder. The disease still remains shrouded in mystery. Its causes are uncertain, but its symptoms are rather clear. In psychiatric parlance, the "swings" of bipolar disorder are called "cycling." Rapid cyclers experience multiple swings, often of severe intensity. My diagnosis came after a bout of "rapid cycling." Imagine having 10+ violent mood swings in a day — that's rapid cycling. Some people cycle regularly. If you ever watch NBC's "ER" when Sally Field's character is on, you're seeing the fictional depiction of a rapid and regular cycler. Some people have cycles once every 5 years. Some people swing down more than up; others have intense manic swings that can be expressed through blow-out shopping trips (and as a result, many sufferers of bipolar disorder have serious debt problems), then deep depression, bouts of sobbing, and debilitating tiredness, among other things on their down swings. This set of symptoms gets lumped into the category of "bipolar affective disorder." Other forms of bipolar also have the manic/depressive cycling, but the differences lie in which kinds of swings are more common for some people and how wide the range of behaviors are along the swings. Like many mental illnesses, there is still a lot to be discovered about bipolar disorder and how it works. Today I exist in a day-to-day reality free of manic/depressive swings thanks to Wellbutrin and an occasional anti-anxiety pill. In fact, no one can tell I have bipolar disorder just from looking at me.
I have only told the closest friends of my condition, save for a few times when I've met another bipolar person or someone who has actually experienced full-blown panic attacks. I've written this in hopes of raising some ethical and intellectual questions about the experience of "outing" oneself as mentally ill — I even hate to call these conditions mental illnesses, because to me they are so thoroughly physiological, and not just "mental" (e.g., in the brain), that calling them "mental" seems inaccurate to say the least. Perhaps I argue for something that resembles 19th century models of "nervous exhaustion," minus the upper and middle class misogyny that defined it. In Barbara Ehrenreich and Deirdre English's classic study of the sexual politics of sickness, only affluent classes of women suffered from "female invalidism," a combined mental and physical condition only explainable through codes of class distinction and the fetishism of feminine leisure. Nineteenth century understandings of mental illness understood them to affect the whole person. Illness of the mind emanated from an apparently "wounded" physiology. While this is no model for mental illness today, particularly for women, the move to define mental illness solely through chemical imbalances in the brain misses the possible physiological sources of illness. If the 19th century defined mental illness through the wounded bodies of affluent women, the early 21st century defines mental illness through the brain.
At some point we need to see mental illness as a physical condition. Mental illness not only affects the whole body (e.g., weight loss and gain, sleep loss or gain, changes in behavior around sex and food and sociality, etc.), it also could be caused by physiological changes or acute physical disorders. I say physiological because I'm convinced that my own panic attacks result from a combination of factors that arise when my blood sugar dips very low. I'm an insulin-dependent diabetic, and each of my panic attacks, save for one, has been accompanied by bouts of extremely low blood sugar. There's a physiology to this, likely related to the heavy release of adrenaline when blood sugar levels drop too low as a result of insulin shock.
I consider both panic attacks and bipolar disorder evidence of "something going terribly awry" in one's life. For those of you out there who have these or other conditions, you likely know what I'm talking about. You can't work, let only physically function, while having a panic attack. They are completely scary, exhausting and downright embarrassing. You want only the most unconditionally loving people to ever see you having a panic attack or the potentially wild swings of bipolar disorder, at least until you can get a good anti-anxiety drug down the gullet to put an end to your biochemical misery.
I've been particularly intrigued by the experiences I have had when I've "come out" to friends about these conditions. Many of these interactions have been bewildering. A few friends have responded by saying, "Oh, I have mood swings too. Don't we all?" This is the "de-bunking" response, which asserts that bipolar disorder isn't "real" or isn't specific enough or distinct enough to be given a psychiatric diagnosis because "everyone has mood swings." They question the label of a condition that on the surface sounds so everyday that it doesn't, on the face of things, deserve to be called a pathology. Some people will continue along this line of assertion for awhile, pressuring me to either deny the diagnosis or putting me into the position of reluctantly defending the psychiatric profession. After all, it is the psychiatric profession that gave my symptoms a name, and palliative cure — at least for the moment. If one thing defines bipolar disorder and panic attacks, it is uncertainty: the uncertainty of when your body and mind will go topsy-turvy and under what conditions; the uncertainty of how, or if, the meds will continue to work; and the uncertainty of ever really, fully managing either condition.
The description of "mood swings," however, cannot fully capture the experience of bipolar disorder — and I would hazard to guess that most people do not have swings like a person with bipolar disorder. Once I describe my own set of experiences of the condition — particularly how debilitating it was before I was put on meds — most people tend to at least verbally agree that it sounds different than what they consider to be an "everyday" mood swing, and that they likely haven't experienced this condition. But I still wonder whether they really believe it.
The de-bunking response is very common. It shows up the deep suspicion many people have — rightly so — of the fields of psychiatry and clinical psychology. I think it primarily comes from a suspicion of the "talking cure" methods of psychological counseling, and the even larger phenomenon of mass mediated therapeutic approaches to social problems, which are quintessentially embodied in the tabloid television talk show, and even the local TV news. There's a growing consensus in psychiatry, however, that many mental illnesses cannot be cured through talk or through cognitive re-structuring — e.g. learning to create a different way of thinking about one's behaviors and tendencies. People cannot be taught to control the biochemical and physiological conditions of mental illness with their minds. This is not a case of mind over matter.
Another common response that can accompany or sometimes replace the debunking response is the related claim that most people have some form of mental illness. The idea here is that mental illness is a general condition, and that the specificity of particular mental illnesses really does not matter. Many mental illnesses are still under-studied. Oftentimes the psychiatric and scientific communities have little power to explain them, which also means there is little scientifically-knowledgeable popular discourse available to the public. When outing myself to folks who claim, often in latent form, that the very condition of modern life is mental illness, they express a desire to identify with me over some general social condition of mental illness of which they feel a part. Some of these folks may have mental illnesses themselves, or experiences they label as mental illnesses even if they haven't been officially diagnosed. This claim often rides in parasitical fashion on the back of debunking claims — it can provide an explanation for why the speaker invests in their critique in the first place. What distinguishes their identification with my mental illness from debunking is the sense that such illness is universal, and that the speaker him or herself identifies with a broad category of mental illness. If everyone has some kind of mental illness, then psychiatric diagnosis makes mental illness "exclusive," a club everyone apparently wants to join.
The belief in a shared universality of mental illness strikes me as particularly bewildering. It's based in the desire to identify with an idea of mental illness, but not its reality. Perhaps this desire stems from mental health community's continuous talk about the social magnitude of mental illness and the problem of under diagnosis. After all, doing so helps them reach new "clients" and argue for their own necessity. When the mental health community and pharmaceutical companies emphasize the magnitude of undiagnosed mental illness, and find ways to define individual symptoms as potential signs of full-blown disease, their discourse easily slips into a more general claim that mental illness must be nearly universal. Are you nervous in crowds? Do you feel out of place at social gatherings? You might have social anxiety disorder; take a Xanax. Feeling blue? Suffering from unexplainable nightmares? You might have post-traumatic stress disorder; take a Zoloft. Really, who doesn't love that bouncing smiley pill in the Zoloft commercials? Pills look so fun, cute and smooth!
With this kind of pharmaceutical marketing discourse, it looks like we live in, if not desire, a shared culture of psychological wounds. Wounds, though, they appear easy to fix with a pill. No matter how good or comforting it looks, I still don't understand why anyone would want to identify with this vision. What do you get out of identification with mental illness? Does it give meaning to your shitty life? Does it provide a handy explanation for your unhappiness or things in life that are out of your control? Does it release you from social and individual responsibility? Maybe identifying with mental illness helps you feel like you're a part of the "club" of chronic mental illness. Maybe not having a mental illness has become a sure sign that something must be wrong with you — like, how can you exist in this messed up world and not suffer psychologically? Or maybe mental illness makes you interesting. We are a culture that fetishizes the discovery of hidden illness and perverse desire that lurks behind the smiling veneer of people's professional, public face. There must be something desirable about the diagnosis and pharmaceutical treatment of mental illness that encourages people around me to identify with my panic attacks and, admittedly less so, my bipolar disorder. I think manic depression scares more than it intrigues people. I have had several people sit and quietly stare at me after I've announced I am bipolar. Perhaps the mystery of this illness, and its stigmatization in film and television portrayal, sets it apart from a more general feeling of social "panic."
Perhaps we should try to limit and narrow the cultural discourse of "panic," and of all the other mental pathologies represented as so unmoored from cause and so collectively shared. Mental illness offers poor metaphors for modern life, particularly if you have any investment in being able to imagine better social worlds, and better ways of living. Pathology and pills don't offer a very visionary route to such imaginings. The fetishism and false universalism of mental illness some people express may speak to their own desires to understand and name their own experiences as mental illness. For some, this is appropriate. For the others, I hope they can find the strength and imagination to ward off their own identification with mental illness.
Ann Dutton is a writer and educator. You can contact her by email at firstname.lastname@example.org.
Credit: Panic drawing copyright ©2003 Mike Mosher. Bipolar women from psicosite.com.br. Pill from erowid.org