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Bipolar Expeditions: Mania and Depression in American Culture
Reviewed by RIF S. EL-MALLAKH,
Am J Psychiatry 2008;165:268-269. doi:10.1176/appi.ajp.2007.07101687
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by Emily Martin. Princeton, NJ, Princeton University Press, 2007, 400 pp., $35.00.

Emily Martin is an accomplished anthropologist specializing in modern American culture. She also has bipolar disorder. Beginning in 1996 and continuing through 2001, Martin embarked on a series of “expeditions” to explore how bipolar disorder is viewed by people suffering from the illness, the pharmaceutical industry, and American society at large. Bipolar Expeditions: Mania and Depression in American Cultureis the synthesis of that work. This book is exceptional in that it spans the fields of anthropology, psychology, psychiatry, and sociology. Martin expertly incorporates the literature from these fields with lay perspectives and experiences from support groups and clinical subjects. This book provides new insights and a deeper understanding of the bipolar experience in America.

The book is arranged in two major sections with an introduction. The introduction discusses general views of manic depression in America—a theme on which Martin subsequently elaborates—and describes Martin’s research methods.

Part I focuses on the experience of being diagnosed with manic depression, which Martin refers to as “living under the description of manic depression.” In Chapter 1, she notes that in America, an individual is considered rational and able to choose his/her actions, but with the diagnosis of manic depression, “one’s status as a rational person is thrown into question.” She provides an important insight into bipolar illness when she states, “manic depression might be called a ‘meta’ state. It is not a member of the class of emotions, but an emotional condition that contains classes of particularly intense emotions.” In Chapter 2, Martin discusses insight into one’s own illness, utilizing Louis Sass’s term “double bookkeeping” to refer to the patient’s knowledge of the effect of the illness and their ability to function in society despite the illness. She describes the looseness and lability of mania in terms of “internal multiplicity,” or the apparent coexistence of a multitude of people within one individual. She goes on to compare the loss of inhibitions that occurs in a crowd or mob with the loss of inhibitions that occurs within the crowded mind of an individual with mania. Chapter 3 is a series of vignettes from support groups describing how people live day to day with the illness. Chapter 4 is a series of clinical case presentations. Both of these chapters are aimed at better understanding the experience of having manic depression. Chapter 5 discusses the diagnostic categories of the illness and introduces the idea that “DSM categories are highly abstract ‘text-atoms,’” which are “powerful in their abstract precision.” Chapter 6 discusses the pharmaceutical industry and attempts (unsuccessfully) to argue that “marketers and advertisers attempt to invest psychotropic drugs with attributes that make it possible to think of them as ‘persons.’”

The second part of the book discusses the role of manic depression in the larger social context, for according to Martin, “manic or depressed behavior gets its meaning from the social context in which it is done.” The book clearly builds up to Chapters 8 and 9, which present the central theses of the book. Chapter 8 presents the current American view of mania as an attractive, desirable state that leads to success. Martin attempts to contrast this uninitiated view of mania with the personal, more frequently tragic experience of mania. Unfortunately, she is not successful in making the distinction between the public image and the reality of mania. Chapter 9 personifies the economy of the United States as if it were an individual with manic depression. This chapter is successful in transmitting the lay impression that manic energy and manic styles are valued in the business world but inadvertently reinforces erroneous stereotypes.

One of the more disturbing aspects of this book is the frequent confusion of normal behavior with manic behavior. This does not happen in discussing depressive symptoms. In this regard, Martin follows and reinforces the very definitions she says permeate lay American culture. This persistent confusion of “manic style” and true mania is troubling because it gives the impression that driven, hard-working, successful individuals have bipolar disorder. Martin fails to discuss the wide range of what can be considered normal human experience and instead paints individuals with high levels of energy or success as “manic.” She does attempt to clarify the distinction, stating “the entrepreneur departs from the pattern of manic depression because he is (ideally) always manic,” but these statements are so rare and unconvincingly stated that they do not undo the damage. On rare occasions Martin makes simple errors (e.g., asserting that lithium causes liver damage rather than renal adverse events) that are understandable, given her lack of medical training.

Despite these shortcomings, the volume is innovative in its attempt to define the cultural views and role of mania, depression, and bipolar disorder. It is an enjoyable book to read, and it does provide insights that are not apparent from either a psychiatric or psychological viewpoint. Due to its interdisciplinary and broad stance, the book lies at an undefined intersection. While clearly groundbreaking and instructive, it is not a rigorous scholarly work, nor is it a book I would recommend to my patients.

+Book review accepted for publication October 2007 (doi:10.1176/appi.ajp.2007.07101687).

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