Does illness have a meaning? Does mental distress represent underlying patterns? In experiencing the major mood shifts that constitute bipolar disorder, are we playing out unconscious thoughts or feelings from our earliest years? Darian Leader, writing in the Guardian (Bipolar memoirs: What have I done?), is sure that there is more meaning to be found in psychoanalytic interpretations of bipolar than in the continually expanding and ever more complex diagnostic categories of the “bipolar spectrum”.
Judging by reactions to Leader’s article, people with the condition hold a whole range of opinions on the matter. Some people feel that it is useless, insulting even, to seek meaning in suffering. For those who hold that bipolar is essentially a disorder of genetic quirks leading to poorly balanced brain chemistry, there is no underlying meaning to be sought. The medium, or rather the malady, is the message. There is no need to dig, to explore, to search for significance.
Bipolar sufferers with a strong personal faith may appear to at odds with those whose understanding of the condition is rooted in biology. But for people with faith, too, there may be little need to establish “meaning” in actual mood states. The emphasis may be less on the behaviours driven by bipolar, than on the individual’s response to pain and the potential for suffering to lead to greater personal and spiritual development.
Speaking for myself, I am not sure 100% sure that my bipolar has meaning, but neither am I convinced that it doesn’t. Bipolar is the biggest emotional thing that has ever happened to me. Distressing life events – bereavement, divorce, or debt – the kind of things that friends describe as “the worse thing that ever happened to them”, pale into insignificance in comparison acute, suicidal depression or the agitated distress of mixed mood. It seems to me quite natural to want to find some sort of context or even, yes, meaning for that the suffering I experience, just as I felt the need to look for meaning in the acute physical pain of childbirth.
The job of psychoanalysts is to work with the client to help them contextualise distress within their early experiences and current unconscious mental processes. I am not anti-psychoanalysis; indeed a decade ago I made much use of Jungian techniques to explore early memories and how they connected to my current mental distress. I used all kinds of art and writing techniques to dig deeper than my surface feelings about my illness. Through these techniques I learned that my feelings about my early experiences were legitimate, and that I needed to look after my younger, damaged self in order to more forward. I felt empowered by having found some meaning that resonated for me.
Where I take issue with Leader’s current focus on bipolar is that he is discerning and ascribing meaning to a condition that is not his. It’s true that he has clinical practice to draw on. It’s also true that he has sought out first hand accounts of bipolar, referencing a number of well-known bipolar memoirs as well as therapists’ case studies. As someone in the process of writing a memoir about growing up with untreated, uncontrolled bipolar, I of course want to people to read life writing about the condition. My goal is that eventually people will be able read my book and have improved insight into what it is like to live with the bipolar. But it is, in my view, a mistake to believe that reading bipolar memoirs and treating bipolar patients gives you permission to determine the “meaning” of bipolar disorder from the outside.
Leader’s article (he has a book coming out, so I assume this is just a snippet) focuses heavily on the accounts of people who experience mania, and in particular on the financial irresponsibility that can be characteristic of a high. The spending sprees of mania, he rightly points out, are often seen as “selfish, narcissistic rampages.” Leader, however, discerns a form of altruism at play. Manic people, he states, often squander money on other people’s behalf. Looking back to the childhoods of writers including as Kay Redfield Jamison and Stephen Fry, Leader identifies experiences in their childhoods which might have led them to feel grateful for their survival. He goes on to suggest that “the manic person might in her behaviour be showing her perception of being in debt, and the altruistic side of her manic episode might be an attempt to cancel the debt.” This sense of debt, Leader suggests, cannot easily be resolved for the bipolar person. It “crystallises neither as paranoia (‘The other is responsible’) nor as melancholia (‘I am responsible’), seesawing instead between highs and lows. If responsibility departs in the mania, it returns with a vengeance in the depression.”
At this point, I am so very tempted to contradict Leader, to bring in the accounts of bipolar people I know (and I am in contact with very many bipolars every single week via my blog and through Twitter) to explain how counterintuitive I find his gratitude/altruism theory. I could go on at length about how it is far more common to find bipolars who felt miserable, worthless and alone in their childhoods. It doesn’t make me look particularly good, but I could share my own example, along with many others, of hypo/maniac episodes filled with entirely self-centred, pleasure-seeking behaviours.
But I won’t go there, because my central point is this: a person does not get to decide the meaning of another’s illness. Not even if they share the same diagnosis, and certainly if they do not. A therapist might well become involved in guiding, assisting a client towards a meaningful interpretation of their condition. But the client, not the therapist, must discern that meaning in order for it to resonate, to be of use in living with the condition. Every time somebody with no personal experience of bipolar tells us what it represents, or what our actions mean when we are in acute phases, they are imposing their interpretation on our lives. I don’t believe I have the right to ascribe meaning to the behaviours and feelings of other bipolars; why Leader seems to think that he can analyse the entire bipolar community from the outside, based on books and case studies, I’m really not sure.
What I see at play here is the tension between “experts by training” and “experts by experience”. It would have been laudable of Leader to simply have exhorted people to pay greater attention to the lived experiences of bipolar people. The diagnostic categories can be confusing, and there is much truth in the idea that shared first hand experiences can by much more powerful than the medical profession’s parcelling up of mental health conditions into numbers or symptoms and number of days. But having wrested power from the doctors and given it back to bipolar writers, Leader simply superimposes another “expert by training” worldview on bipolar people’s experiences. It takes no account of people’s personal sense of meaning, nor of those bipolar people who feel strongly that there really is none.
Telling people to listen to us while shutting us up at the same time. More about selling books, from where I am sitting, than doing any service to the bipolar community.