FPR-UCLA 4th Interdisciplinary Conference - Summaries
Session 4 Summary: Cultural and Biological Contexts of Bipolar Disorder
The next talk by anthropologist Emily Martin discussed BPI from the perspective of Science and Technology Studies (STS). The guiding questions in STS are not “what is wrong and how can we fix it,” or, “where is there suffering and how can we ameliorate it,” but rather “how is knowledge produced” and “what gives certain forms of knowledge authority.” Although the “weaker” forms of knowledge produced by an STS-guided ethnography are likely to be sidelined, subtly devalued, and underfunded, they are of vital importance in terms of understanding how social and cultural phenomena “work,” about which far less is known than how they impact biological material. She said the impact between biology and social and culture factors that lend themselves to scientific investigation represents “the tiniest moment in the life of a social and cultural existence.” Recognition of this limitation is important, she said, in terms of where to allocate resources for intervention.
Martin’s ethnographic work is based on 10 years of participant observation in support groups as a person “living under the description of bipolar disorder” and in a university psychiatry department, as well as interviews with mid-level pharmaceutical sales persons and marketers and with employee training firms. The purpose of the project is to explore and describe persons’ conceptions of the human mind, particularly ideal states of mind.
According to Martin, major institutions in our society (including academia) tend to assume a dichotomy between socially preferred “rational” behavior (hyper-cognitive, self-disciplined, calculated, normal) and unacceptable “irrational” behavior (pathological, reason-impaired, suffering, abnormal). Bipolar disorder, which the DSM defines in terms of both mood and motivational states, sits uneasily between these two “poles.” Mania (particularly as it relates to goal-directed activity) is increasingly being seen as valuable, especially economically, despite being clinically irrational. (Martin noted that a colleague, historian Elizabeth Lunbeck of Vanderbilt University, suggests that the link between mania and enhanced motivation may be traced to a much older way of distinguishing psychological states on the basis of the will.)
Martin then discussed various ways in which depression and mania are pictorially represented in advertisements. While depression connotes a lack of productivity in the workforce, mania (in the larger cultural setting, as depicted in an ad for an Internet service provider) is associated with being alert, creative, and productive. Martin described one productivity exercise organized by a training firm that aims to teach groups of employees what it is like to be manic by having them engage in embarrassing or other rule-breaking activities in public, i.e., if they emulate this behavior in the workplace they will be productive. She cautioned against such valuations and other “just right” conceptions of behavior.
In her concluding remarks, Martin responded to trauma psychiatrist David Kinzie’s plea, “Don’t take the DSM away from us” in regard to anthropology’s challenges to the Western psychiatric diagnostic system. She made it clear that she was not critiquing the practice of psychiatry, nor the medical profession. One of her interviewees emphasized her comfort in knowing a pill was made “just for her illness,” and as such medications have value in people’s lives. Online support group members tend to use DSM labels to section off their subjective experiences and keep them from public scrutiny. Rather, Martin wanted to point out that medications as well as the DSM itself are deeply imbued with cultural meanings.