The Social Stigma of an Afflicted Mind

“Dream not, Coleridge, of having tasted all the grandeur and wildness of fancy, ‘til you have gone mad.”

— Charles Lamb

In my first year of graduate school, I reluctantly realized there was something very wrong with me. I did not admit it, but I knew it. And so did everyone else.

The truth was I was afflicted. Not “crazy” mind you, no, no. Crazy people choose to be crazy, I thought; I was quite clearly choosing sanity and not receiving the benefits of my free will. Something, therefore, was wrong.

Recently, my frame had liberated 20 pounds because the energy one normally needs from food had become unnecessary. Sleep too was no longer a requirement. And without either the need or want of food or sleep, the superhuman emerges — the one that runs on pure adrenaline and behaves as if it has just snorted a half gram of cocaine.

That is, until the clocks changed. Then oddly, the affliction subsided and I forgot about it. After a long summer of even longer nights, I would be tired. I was more than tired; I was worn. Shorter days meant less energy, and I welcomed the crepuscular afternoons of autumn, the return of sleep, the sanctity of stability.

Yet all along, I never really questioned any of it. For 10 years, I chalked it up. Stress, bad spleen, the vapors, whatever. It was the incessant stomach pain that finally drove me to the doctor. I was 28.

I suppose you can imagine my shock when I walked in with a stomachache and walked out with manic depression. That I questioned. Come on, manic depression? Or, I guess I should refer to it by its more asinine moniker, bipolar disorder. True, at one time or another I had displayed every single symptom short of psychosis: grandiosity, hyperactivity, insomnia, euphoria. But me — ? I couldn’t even say the word.

The list of history’s famous manic depressives is so long that, it is said, it would be much easier to list those who were not. (Google famous manic depressives.) Suffice it to say that writers from the Honore de Balzac to Virginia Woolf, composers from Berlioz to Tchaikovsky, poets from Burns to Whitman, artists from Gauguin to Pollock, actors from Brando to Mae West, and a smattering of scientists and politicians from Newton to Napoleon, are all united by the tincture of madness. It seems to be a disease infinitely capable of producing artistic genius — the Sistine Chapel,  the Fifth Symphony, Starry Night, “The Great Gatsby,” the theory of gravity, Vito Corleone — and it has existed since at least the days of Plato and Aristotle. It also produces infinite self-destruction, and some of the more familiar endings you already know. Virginia Woolf, Hemingway, Van Gogh, Kurt Cobain. Hunter S. Thompson is probably its latest victim.

The treatment of mental illness underwent nothing short of a revolution with the invention of Thorazine, the much maligned “chemical strait jacket.” Prior to anything even approaching a medical understanding of these disorders, treatment amounted to no less than a parade of horribles. According to Robert Whitaker’s “Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill,” Benjamin Rush, signer of the Declaration of Independence, theorized that circulatory defects were to blame — the cure? Bloodletting and board spinning. Water boarding enjoyed the state-of-the-art spotlight, as did sterilization during the 19th century eugenics obsession when these illnesses ceased to be viewed as afflictions in need of care, but as the blight of the weak and feeble-gened. Henry Cotton, a New Jersey doctor, attributed them to tooth decay, so he yanked teeth and then eventually lopped off other body parts for a tidy kill rate of 43 percent. John Talbott and Kenneth Tillotson, both Harvard men, favored swaddling patients in freezing blankets until their temperatures dropped ten to twenty degrees below normal; Manfred Sakel induced insulin comas, and Ladislas von Meduna administered metrazol, a consulvant so violent it could crack bones, rip muscles and dislodge teeth. Then, of course, electroconvulsive therapy and lobotomies entered the scene, the latter performed with ice picks generally inserted through eye sockets.

The advent of Thorazine and other drugs liberated patients from the madhouse. Thorazine quelled psychosis so well that many patients were able to lead fairly “normal” lives, and the process of de-institutionalization began and continues today (although HMO’s have poisoned the process by refusing to pay for in-patient stays long enough for admittees to regain normal functioning. HMO’s have and will force the release of patients who are clearly psychotic). Thorazine’s terrible draw back is a condition known as tardive dyskinesia, which causes involuntary muscle spasms such as facial tics, but modern anti-psychotics have trumped its place on the list of effective medications with fewer side effects. Electroconvulsive therapy, or ECT, continues today, although in a much more humane form, and it is often wildly successful for patients with severe, intractable depression. ECT succeeds for the same reason that re-booting one’s computer does: it refreshes and debugs the circuitry. However, people still rollick in slinging the mud of ECT stigma. Lee Atwater, who was the 1960’s equivalent of Karl Rove and a master of the smear tactic, obtained and leaked the medical history of Thomas Eagleton, a Democratic Senator and manic depressive who had undergone ECT in the past, to his Republican opponent who told the media that he did not deal with people who had been “hooked up to jumper cables.” Eagleton, of course, lost.

I arrived in the shrink’s office right on time because the average age of diagnosis for manic depression is 28, which means that I lost roughly 12 years of my life to a wretched condition that persisted undetected and untreated. Manic depression needs time to ripen and then flourish before it distinguishes itself as such; happiness is happiness but grandiose euphoria is something else entirely, and the same is true at the other end of the spectrum. We are all prone to sadness and grief, but depression takes grief and puts it into a form so vile that it can only be described as the emotional equivalent of Hurricane Katrina. One can only hope that the condition is discovered and defeated before its truly invidious and destructive symptoms have taken hold.

I am one of the lucky because I have a rather mild form, although left to its own devices, still devastating and potentially lethal. Lithium, which is no more than a common salt, no longer occupies the front line in the treatment of mania because the anti-convulsants used to treat epilepsy, for reasons unknown, also quell mania and are preferred for their relative lack of toxicity. While I have heard many people scoff at the endless array of anti-depressants cluttering the pharmacopeias, they are virtual one-way tickets out of Hades. That is why I visibly flinch and sometimes growl when people toss the phrase, “off your meds?” with total flippancy.

Society’s refusal to deal equitably with these illnesses, and the media’s willingness to foment the flames of hysteria with front page splashes of the latest “lunatic” taken to random murder, is this century’s version of the board spin and the blood let. Of all the wild emotional tumult that my malformed brained is capable, social stigma, by far, outranks the pain of all of it. Stigma imputes shame and denial, and to add it to the mix is the equivalent of giving whiskey to a teenager with the keys to a very fast race car.