Once you pass the fourth page of Strictly Bipolar you will not encounter any more statistics. Having been jolted out of complacency by being told that the overall diagnostic rate of bipolar disorders has risen by 4000% in the last 20 years we plunge into deeply human territory. Patterns of language replace numerical trends, personal narratives are elevated over medical histories, and a high dose of understanding is the only medication on offer.
Darian Leader offers us a short, sustained, and uncluttered example of why psychoanalytic thinking about the heavily medicalised bipolar disorders is as relevant as ever. This book is no supplement, however. Leader never denies the potential value of contemporary pharmacology, but he is not simply offering sugar for these abundant pills. Instead, Strictly Bipolar argues for a completely different approach to bipolarity and manic-depression.
That conjunction is no typo. Although bipolar disorder is the term de jour, Leader’s exploration of the historical concept of manic-depression, with what is revealed to be its highly consequential hyphen, precipitates the radical re-evaluation of the notion of bipolarity itself. Leader argues that manic-depression is a form of psychic organisation. He thinks this fundamental insight has been worryingly forgotten, and the blame rests at three doors.
First, Big Pharma is admonished for its role in the rising incidences of bipolar diagnoses. The existence of financial incentives to increase the range of diagnostic categories and broaden the bipolar spectrum arose as a side effect of lapsed patent laws, proliferating pharmacological resources (both new drugs and licences for novel uses of old ones), and increased marketing revenues. This perfect storm interacts with the second source of blame, namely contemporary forms of social organisation and the circulation of ideals in modern life which have structures resembling bipolar forms of experience. We work in more creative ways, are encouraged to connect and network, to seek significance and meaning in the prosaic, and so on.
These features are linked inseparably, prompting recall of Ian Hacking’s notion of a “looping effect” which is associated with “human kinds”—that is, descriptive categories levelled at various aspects of human life. Greater pharmacological resources lead to narrower diagnostic categories (often because new drugs regulate the unwanted effects of the old ones). These categories provide people with new ways of describing and labelling their self-experience, but ultimately these labels are not inert. They “loop” back, and influence the very character of the lives they now describe. Naming a condition is a good means of increasing its incidence. Occasionally categories ripple into each other, which may explain the prevalence of differential diagnoses of bipolarity and borderline personality disorder.
Leader does not dwell heavily on these sources of real concern, however urgent and complex they are. Other books, like Garry Greenberg’s Manufacturing Depression, have cleared the way for Leader to explore the ramifications of the third and most interesting source of blame: a conceptual error laid at the feet of the German psychiatrist Emil Kraepelin, who under-emphasised the extent to which manic-depression was a unique condition and not merely the exaggerated coupling of mania and depression as found in other forms of disorder. In working back through the consequences of this error, Leader advances a distinctly “analytic” approach to manic-depression.
Strictly Bipolar is a book that works to revive and explore the simple idea that—amidst the forest of contemporary bipolarity, the thickets of Bipolar 1-6 , and the meadowlands of cyclothymia —we can identify “true manic-depression.” For Leader, this label describes one way the psyche can be structured. It is a genre of mental experience, if you will, which arises in certain contexts and is characterised by specific motifs, as literary genres are. Much of the book is a subtle exploration of these reoccurring motifs.
What Leader achieves, in a confined space, is to show how manic-depression can be regarded as a kind of solution to a person’s life experience. He leads us to think afresh about the origins of manic-depression precisely by forcing us to pay close attention to the particular patterns of this condition. A rewarding feature of this book is the lightness with which we are drawn into original psychoanalytic territory. Leader turns productively to Lacan and Klein, but without the jargon of the latter or what Jonathan Lear termed the “dense and slithering” prose of the former. Indeed, you’re more likely to encounter Kevin Bacon or Dragons’ Den than arcane theoretical dispute.
The motifs of manic-depression are varied yet related, chaotic but ordered by underlying logic. Leader documents them with dexterity. Manic subjects display a great need for connectedness and communication. Intoxicated by the perceived interconnectedness of common phenomena, manic desire tumbles frantically into incessant and unpunctuated speech, a runaway train of free associations that parodies psychoanalytic openness. It would be a mistake to suppose this is mere babbling. Manic speech is triggered by, and manifests in, the proximity of others; for want of the interpersonal, “manic subjects, unlike others, will not talk to themselves.” Moreover, manic speech is funny. Jokes, puns, banter; the full arsenal of the verbal play is deployed and all this presupposes a subtle acknowledgement of another person. You cannot sustain someone’s laughter if you lack empathy or understanding.
This need for an addressee arises in other guises, such as the pursuit of promiscuous sexual activity. Even the apparently selfish forms of dramatic expenditure, clichéd through cinematic depictions of shopping sprees, extravagance and waste, betray on closer examination a deep sacrificial logic and altruistic edge in which others are never fully absent. Money is lost, but given to the needy or less fortunate, or deeply connected to a latent sense of indebtedness with a historical anchor point (the role of a grandparent; a witnessed act of heroism). Debt heralds responsibility, and Leader tracks the ways in which responsibilities are eschewed and regained in the pitch and roll of manic-depression.
In the limit case, manic subjects work to address and refashion themselves, assuming “false and precarious” identities, often with the literal donning of new, possibly stolen, clothing. All of us from time to time catch half-glimpses of ourselves in fantasy. But in mania these shadowy aspirations cascade into elaborate forms of pretence. This is no mere dissimulation. Often pretence can bootstrap itself into creative or social success. Leader’s examples of Stephen Fry, Spike Milligan, Andy Berhman, and others attest to the penumbral overlap between the imagined products of a re-envisioned, more consummate self, and the fruits of actual creative energy. Incidentally, Leader aptly exposes the perverse ideology of much chatter surrounding manic-depression, art, and “genius” whereby “creativity becomes, at one extreme, a circus exhibit, and at another, a localizable and marketable property of the psyche.”
The reinventions at the heart of mania are structured by ideals of perfectibility, yet paradoxically the manic subject feels liberated from restrictive norms, whether social, religious, or self-imposed. This lightness is quickly veiled in the sunless depressions that follow (depressions that receive less of Leader’s attention than mania, sadly). In depression, the self turns against itself, and the extravagance and licence in mania provide ample catalysts for damning judgement. Mania’s connectedness and interlocution become self-torment and paranoid aggressive fantasy in the depressive phases.
Here, however, the hyphen is important once again. A manic-depression is not simply melancholic, a bit of a downer after a euphoric weekend. It can be an aggressive and pacey form of destructiveness. Leader contrasts the self-critiques of melancholia with the exogenous, equivocating, and temperamental forms of depression in manic-depression. Indeed, these depressions “can be manic” just as mania need not be euphoric. People crash into depressions via violent and aggressive thoughts with all the runaway intensity, unpredictability, and oscillations of manic speech, but without the freedom from responsibility. Alternatively, mania and depression merge into so-called “mixed states”. Leader suggests these latter situations, in which mania and depression restlessly mingle, gesture towards the underlying structural aim of true manic-depression; that is, the urge to separate and split the experienced world. “The hyphen in the name embodies what the condition tries to do: create a separation between two states. Good and bad have to be kept apart at all costs.”
Here Leader’s appropriation of Melanie Klein’s conception of the Manichean world of the so-called “paranoid-schizoid position” is most powerful (his skill is manifest in our being spared the jargon). Manic-depression is cast as a response to an underlying need to bifurcate experience, “rather than grappling with the messy, turbulent mixture of love and hate, destruction and admiration, the manic-depressive person opts for a more extreme and ultimately more coherent solution: to separate love and hate categorically, so that one does not contaminate the other. This means, effectively, that the world of the manic-depressive is peopled with devils and angels. It is either copiously full or desperately empty.”
The origins of this need to psychically divide and rule are left somewhat opaque, but Leader emphasises the importance of focusing on the historical contexts in which individual manic-depressive subjects develop. Conflicting and erratic forms of parental attention—often caused by the manic-depression of a parent—have a role in the onset of the disorder; hence Leader’s frustration with the contemporary ahistorical approach of many clinicians. If manic-depression is a solution to an archaic bind that structures someone’s psyche as they develop, then it can be addressed only if the qualities and personal resonances of that bind are explored. Leader calls for the rejection of proliferating medical epicycles in favour of an approach to the meanings and motifs of a particular manic-depressive episode that is unafraid to leave them within the unique historical context from which the disorder derives its power.
Strictly Bipolar subtly attempts to halt the manic speech of contemporary medicalised discourses about bipolarity, which incessantly seek to prevent the conversation from changing. Yet the analytic approach that Leader proposes in its place also has its price. This book is an intriguing and self-supporting intervention in recent attempts to rethink how we approach mental disorder, but it supplies no practical vision. Analysis is costly at the best of times and lies out of the reach of many who would benefit from it. Of course, the very argument of this book inveighs against a quick bifurcation between the costly and the inexpensive, the fast and the slow cure. In its place the reader is offered a human analytic encounter and will leave the book looking for the “dialectical transformation” which will make the analytic approach to this debilitating form of experience politically possible. However, in a manner analogous to Leader’s description of how manic-depressive bifurcations are overcome, this “will almost invariably produce the effect of sadness.”
Luke Brunning  is reading for a DPhil in Philosophy at St John’s College, Oxford.