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Madness: A Study of Bipolar Disease, Book Review Example

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Book Review

Does madness inspire creativity? That is one of the underlying questions that remains just below the surface throughout Madness, by Marya Hornbacher, a gripping account of Bipolar disease, both treated and untreated. On one hand, the depression side of manic depression can make it virtually impossible to do anything, let alone create. On the other hand, the manic level may create imaginative thoughts and behaviors, but these impulses come in such rushes and bursts that they can end up being psychotic. Throughout her existence she is continually in motion, in and out of manic, depression, mixed, and various other extreme episodes (Book Review: Madness, 2010.) The issue of whether or not medication quiets the mind enough to write or paint or stifles the imagination and inhibits the whole process remains. The debate about whether artistic production is stimulated by mental illness has arisen many times in the past regarding Sylvia Plath, Vincent van Gogh, and countless other brilliant minds. This paper will discuss Hornbacher’s book, and its overlap with the mental health and health systems in the United States.

Off medication, Hornbacher reliably falls into a turmoil of confused self-destruction, which, as she would be the first to acknowledge, means heartbreak and worry for her friends and relatives, challenges for her doctors, and, in the age-old contradiction, new fodder for her muse (Zuger, 2008.) While mental illness stimulates creativity, as described in Hornbacher’s book, if left untreated it takes charge of the whole process, spinning it into a life of its own. With her moods swinging from one end of the universe to another and then all over again, Hornbacher is constantly frightened, having to swallow pills constantly to keep her demons at bay, yet remains undiagnosed for years before finally receiving the diagnosis of bipolar illness. These episodes occurred at least once a year since she had been a child. In addition to her hellish mood swings, Hornbacher also suffered from a variety of maladies, including alcoholism, drug addiction, hypersexuality, paranoia, and excessive compulsive spending. One can easily understand that all of those illnesses were secondary to her bipolar disease, efforts to soothe her untreated illness in the absence of any significant and successful treatment by a psychiatrist. Her untreated life should feel more depressing to the reader, but actually it doesn’t. She allows us to get inside her brain, participating along with her as she climbs up and falls down, with those swings taking on the physical devastation of tornadoes or hurricanes inside her mind (Hornbacher, 2008.) Amidst constant stays in hospital psychiatric wards, she finds eloquent ways to describe vividly the images accompanying her mood, such as, “the shrieking has stopped, and my mind floats in a bath of sedatives, sunning itself on its back like a seal.” Can anyone argue about the creativity of the troubled mind, or at least her troubled mind?

Hornbacher documents the way that her mania comes out of the clear blue, attacking her suddenly, crippling her, like insurgents in a wartime battle. She describes the way she would suddenly wake up and find it sitting across from her in the kitchen, familiar in an old bathrobe, unpleasant, intrusive, uninvited (Frase, 2008.) Her madness feels like an unwelcome guest who drops in without calling first. Words become scattered, strung together into beautiful, incoherent sentences, racing through her brain like “a pit of snakes.” Her illness was misdiagnosed until she reached the age of 23 which, according to Hornbacher, occurs in 70 to 75% of its victims. Instead of a proper diagnosis, much like the experience of women who are seen as psychosomatic or hysterical, she was labeled “depressed” and put on Prozac; this had an idiosyncratic effect on her mania, causing it to become exacerbated. None of this was apparently noticed by her doctors. Freudian therapists advised her to undergo psychotherapy in order to address her issues. Hornbacher bitterly mocked the doctors, and was clearly, justifiably, furious with the so-called experts. When she described her process of being able to touch the sky one minute and that the next instant, she was so low down that she was unable to get up, the clinicians saw that as progress because she was finally “feeling her feelings.” The cumulative effect of psychobabble, such as “being in your body,” and “using these tools” caused her to leave one of her sessions feeling so desperate that she promptly went home and slashed her arm with a razor, leaving a cut so deep and she hit the bone. The manic scenes are described with a comical tone, making it easier for the reader to tolerate the undeniable horror of what Hornbacher was actually experiencing.

This portrayal of bipolar illness truly describes what mania looks like. For example, when Hornbacher is in a good mood, she goes out to buy nine purses, 12 scarves, and six hats without which she cannot live at that moment. She describes her desire, during those periods, to wear as many of those accessories as she can possibly put on, presenting a totally disheveled and inappropriate appearance which she believes is high-fashion. The medical community does not come across well in this memoir. In one instance of psychotic mania, Hornbacher’s husband brings her to the emergency room, a very common occurrence, and before the doctor comes in Hornbacher jumps onto a cabinet top like a bird, babbling nonstop. When the doctor comes in, and the husband begins explaining her behavior, the doctor simply asks, “Why is she on the cabinet?” The husband responds, “because she’s crazy”, unruffled, because he is accustomed to the ridiculous, simplistic, concrete questions posed by these healthcare experts.

Despite her incredibly crippling ups and downs, by the age of 33 Hornbacher graduated from college, taught creative writing, developed an arts section for magazine, wrote articles, published three books, toured and lectured nationally, while simultaneously participating in running a household as well as being part of a marriage. This is not uncommon for people with bipolar illness: the mania masquerades as extreme accomplishments, brilliance, and people who appear to have it all. Undoubtedly, that is one of the many reasons why the illness goes undetected so frequently: the people who suffer from it are viewed as wonderful employees, perhaps quirky but very productive. Like people with obsessive-compulsive disorder, those who surround people with bipolar illness often benefit from their nonstop action, which may involve things like constant cleaning, buying gifts for them, painting an entire house, etc. Who wouldn’t want to have such a go-getter around?

Throughout the book, Hornbacher raises basic issues about authenticity as well as individuality and character. She wonders if there is a fundamental self within, if she will ever be a real person. The struggle to form a cohesive self is a lifelong one for Hornbacher and others with her disease. Unlike many accounts of mental illness, this account of a serious condition with its complete focus on Hornbacher’s struggle inward and outward is not weighed down by self absorption. Instead, her account is presented with common sense and a wonderful ability to capture dialect that is vivid, authentic, and permits the reader to learn who she really is, at least to the degree that she can figure it out herself.

Hornbacher’s difficulty in receiving an accurate diagnosis is not uncommon, and in particular, bipolar disorder and its diagnosis prevents challenges since according to the National Institute of Mental Health, there are four distinct categories that that all full under the category in the DSM-IV-TR. Bipolar I disorder describes the more classic view of the disease because it involves manic episodes, or symptoms along with depressive episodes. Bipolar II is characterized by depressive episodes that swing back and forth with hypomanic episodes, but do not result in full-blown mania. Another catch all category for similar symptoms but which do not fall into the formal bipolar definitions is bipolar disorder not otherwise specified, when a person has symptoms of the disorder but not enough to meet the diagnostic criteria for Bipolar I or II. Finally, cyclothymia is a mild form of bipolar disorder (American Psychiatric Association, 2000.).

The mental health system in the United States has several shortcomings, including disagreements among professionals about diagnostic categories; a tendency to minimize or overlook symptoms or diagnoses that evoke discomfort in the doctor, such as those associated with dissociative disorder or compulsive behavior involving sexually risky behavior. In addition, another problem with the mental health system is that the insurance companies focus on treating mental illness with medication rather than psychotherapy so that their desired practitioners are psychiatrists who simply prescribed psychotropic medications rather than engage in talk–psychodynamic, cognitive or behavioral– therapy. As a result, it is difficult for doctors to form accurate mental health diagnoses because they simply do not have enough access to patients over an extended period of time because of insurance limitations on numbers of sessions allowed, as well as the emphasis on seeing a great many patients rather than fewer people with whom doctors can spend more time.

The health care system in the United States generally has many problems as well. Access to healthcare is a major obstacle: location of medical services, the lack of transportation to obtain those services, and the inability to pay for health services form some of the major challenges for the system. Although the United States pays more for health care services, the quality of care is not necessarily commensurate with that cost (Klein, 2007.) Doctors are not compensated based on the quality of their care but rather on the number of patients that they see in a given day or week. In fact, managed-care companies reward doctors who spend less time seeing patients and more time prescribing medication; they would rather pay for 15 min. Medication visits rather than allowing doctors to spend office time listening to patients. In addition, unlike the complaints in countries where universal healthcare is the norm, but wait times are long, the United States health care system is not plagued by long waits to see physicians but that is primarily because so many patients can’t afford to pay for medical care. As a result, there aren’t enough patients to prevent those who have insurance to make appointments and see their doctors in a timely way.

References:

Book Review: Madness by Marya Hornbacher. (2010, October 12). Retrieved December 2, 2012, from Depression and Bipolar Support Alliance: http://dbsapaloalto.org/?p=390

Frase, B. (2008, April 4). Marya Hornbacher: Her Extreme Selves. Retrieved December 2, 2012, from Star Tribune: http://www.startribune.com/entertainment/books/17274934.html?refer=y

Hornbacher, M. (2008). Madness: a Bipolar Life. New York: Houghton n Mifflin.

Klein, E. (2007, November 2). 10 Reasons Why American Healthcare Is so Bad. Retrieved December 2, 2012, from The American Prospect: http://prospect.org/article/ten-reasons-why-american-health-care-so-bad

Zuger, A. (2008, April 29). Quieting the Demons and Giving Art a Voice. Retrieved December 2, 2012, from the New York Times: http://www.nytimes.com/2008/04/29/health/29book.html

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