Clockwise from upper left: (1) "The Bipolar Child" from the Sunday 14 September 2008 issue of The New York Times Magazine; (2) The Center Cannot Hold by Elyn R. Saks; (3) a popular antidepressant, also used to reduce spinal nerve pain; and (4) Hurry Down Sunshine by Michael Greenberg
"The Lord will afflict you with madness, blindness, and confusion of mind; you shall grope about at noon as blind people grope in darkness, but you shall be unable to find your way."
—Deuteronomy 28:28-29a
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The whole world seems to have gone mad.
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I am in the middle of two books on madness. The first is the autobiography of Elyn Saks and her "journey through madness," The Center Cannot Hold. It is a harrowing firsthand account of her slip into moments of mania and depression and intense psychosis. The second is Hurry Down Sunshine, the biographical account of Michael Greenberg's daughter Sally as she is "struck mad" at the age of fifteen. This is a companion look at madness from the vantage point of an "outsider," a family member.
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There are two main ideas that come creeping toward me as I read these two books. The first is the difficult of diagnostic criteria. The second is the need for control mechanisms.
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The difficulty of diagnostic criteria is that the different forms of madness seem to overlap. Mania and depression seem to be polar opposites that play in many forms of mental illness—bipolarity and other mood disorders, schizophrenia and other psychotic disorders, anxiety disorders, personality disorders—as well as being mood disorders in their own right. Hallucinations and delusions can likewise occur in various forms of mental illness. So how does one distinguish between bipolar disorder and forms of schizophrenia? And, if there is difficulty in determining to which category the symptoms and signs of an individual's madness belong, then how can the disease that is the summation of those symptoms and signs be treated?
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I have more questions than I have answers. I am talking to myself. I am thinking "out loud."
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It seems important to me that control mechanisms are sought out. If order cannot be restored, then where is hope?
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The control mechanisms that I have been able to identify in the two books, thus far, are (1) hospitalization; (2) physical restraint; (3) isolation; (4) individual therapy; (5) group therapy; (6) pharmaceuticals; (7) lobotomies, physical or chemical; (8) strong family structure; and (9) religion. I am sure there are more to come and some that I have overlooked.
Some of the control mechanisms have worked well, some fairly well, and some not at all. There seems to be a need for more than one, a willingness to adapt to fluctuating symptoms and signs by either adopting or abandoning control mechanisms, as needed.
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In his short story, "Classical Scenes of Farewell," Jim Shepard shows us the power of religion to act as a control mechanism. In this particular case, it is used to curb the murderous appetite of Lord Gilles de Rais as he rapes and kills the children of peasants. It functions as a legal system to convict him and curb his pychosis and its attendant crimes. In this case, death is required as punishment and thus ends his madness.
In Hurry Down Sunshine, Michael Greenberg also shows us the power of religion to act as a control mechanism. In this particular case, it is used to rally around a mentally ill individual and recognize that they are gifted by God in ways that we cannot fathom. A group of Hasidic Jews takes care of a stricken relative, believing him to have "achieved devaykah, the state of constant communion with God." His madness is absorbed into their religious beliefs and protected, perhaps even fostered, in a circle of strong family support.
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"When Moses announced the penalties for disobeying God's laws, madness was first, before blindness and poverty, before the death of children, before war. Like the Hasid, I try to improvise my own area of protection around Sally. But I have little faith to draw from, either in medicine or God."
—page 57, Hurry Down Sunshine by Michael Greenberg
What happens when the control mechanism fails? What happens when the despair and the depression and the madness become too much to bear? It seems that a new control mechanism needs to be put in place, such as institutionalization; the madness has to run its course; or, perhaps death ends the need for another control mechanism.
On Friday 12 September 2008, novelist David Foster Wallace chose the latter. Death became preferable to the darkness of the absolutized moment. Therefore, he took his own life by hanging himself.
I cannot imagine the loneliness, the aloneness, the despair that he must have felt, even though I have been ravaged by my own share of depression and anxiety and panic attacks at times. Having known a certain level of debilitation, albeit minor in comparison to what I guess DFW experienced, I know those things and the power that they can have. However, I still find it difficult to fathom the depth of the abyss that he must have stared into that would press him into the hands of death.
When I heard the news of DFW's death, I was stunned, paralyzed.
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I didn't know David Foster Wallace. I had read a few of his essays here and there, but have never tackled his postmodern magnum opus Infinite Jest. I have often intended to purchase it and read it, but instead thumbed through it and glanced at a few sentences or paragraphs or footnotes. Then, I would think about its dense and rich and chewy 1,100 pages and place it back onto the shelf from whence I grabbed it.
Instead, I knew him through the other authors and writers that he influenced. I knew him through the work of his contemporaries, even if I didn't directly know his work, except in fragments.
So, why did it affect me so? I am sure that it is due to the craziness of the current climate of our culture—vapid celebrity politicians of all stripes, reality television stars whose fifteen minutes of fame was really sixteen minutes of unbearableness (you do the math!), the entertainment "news" of CNN and Fox and MSNBC—all while our country is bogged down in an unpopular war in Iraq, we are being led by a unpopular fundamentalist idiot of a president, the greed of Wall Street is bringing our economy to a screeching halt, the price of staple foods is soaring world wide, and natural disasters are looming due to our reliance upon fossil fuels and our unwillingness to acknowledge our addiction. And, in the midst of all of that, I see a bit of myself reflected back from David Foster Wallace's own struggle with madness and depression.
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Carl Jung would call it synchronicity. Some would call it the work of the Holy Spirit, others coincidence. I think it was perhaps due to heightened awareness to madness simply because I was surrounded by it, immersed in it's presence. But, there, on the cover of The New York Times Magazine of Sunday 14 September 2008, were the words "The Bipolar Kid." Opening up the magazine and delving into the article, I discovered that the same stories I was reading in two books on madness were being told again. Yes, the names and circumstances were different, but the stories were the same.
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