Strictly Bipolar

To those unfamiliar with psychodiagnostics, Bipolar 3.5 might sound like the latest Apple software. To psychoanalyst Darian Leader it is indicative of the relatively recent proliferation and growing elasticity of bipolar disorders. For about the last twenty years, argues Leader, the bipolar spectrum has been tailored to a pharmaceutical industry eager to shift attention away from ineffective antidepressants and toward newly developed mood stabilizers. A household word since the mid-1990s, "bipolar" is now widely considered to be biological and hereditary. Its loosened parameters have saddled large swaths of the population with a chronic illness requiring life-long medication. Strictly Bipolar (Penguin, 2013) is a trenchant case for the reexamination of the "bipolar revolution" and for a return to the older diagnosis of manic depression. Leader points out that while bipolarity is at the center of modern capitalist subjectivity - the principal feature of twenty-first-century worklife, which encourages and rewards herculean productivity and exuberant all-nighters -- manic depression is a structural, much narrower and less frequent problem. The highs and lows of manic depression are not merely behavioral or ominously genetic but, rather, rooted in an individual's early history: relationships with primary caregivers, fantasies regarding one's symbolic place within the family. Manic depression also has common motifs that reflect its structural basis and identifications. Mania announces itself, for example, in fits of housecleaning, shopping sprees, and grand gestures of altruism. Manic episodes often begin with a steady stream of words - extravagant metaphors and brilliant rhetorical leaps -- a levity in the symbolic, as Leader puts it. These great themes of mania are traced in Strictly Bipolar to personal stories of guilt, responsibility, and debt; distant or inconsistent parents and grandparents who expected too much or overwhelmingly little and elicited (split off) aggression and hate. We learn that manic-depressives struggle with the overproximity of the Other, attempting to keep the Other separate and safe from all that is bad, from murderous rage, from oneself. Strictly Bipolar offers compelling clinical material and vivid biographical descriptions of the "signature motifs" of manic-depression. In reading the book, I could see how one might be tempted to lean too heavily on surface behaviors and mood states in thinking and diagnosing manic depression. Yet, as Leader points out, manic-depressives have a troubled relationship with time and find it difficult to integrate their own histories. It therefore behooves therapists not to join them in this, redoubling the problem. In the interview, Leader characterizes manic depression and other psychoses without the usual prognostic pessimism - not as problems of subjectivization resulting in social exclusion, medication, or institutional scrutiny but as "ways of being in the world."