Stories, writes sociologist Arthur W. Frank in his now-classic The Wounded Storyteller, "are the self's medium of being." Illness narratives do not simply recount experience, according to Frank; they enact selfhood, bring a version of identity into being, and so have the potential to undo the kinds of stigmatizing prejudices that attach to many forms of disease and disability. Storytelling thus acts as a reclamation project, allowing the memoirist to present selfhood in ways that might directly counter the authority of medicine or the cultural and literary symbolism of bodily difference. Stories individualize, offering discrete perspectives against the anonymity of symptoms or etiologies, but they also represent, creating communities of shared experience or newfound comprehension.

And so Lisa Johnson concludes toward the end of Girl in Need of a Tourniquet that "there is a story that makes sense of all this." She refers primarily to the diagnosis of borderline personality disorder, which — in confirming that "something is in fact wrong" with her — has the paradoxical effect of calming rather than exacerbating the self-harm and self-loathing that have troubled her mood and relationships for many years. But the story-that-makes-sense is also the memoir itself, a lyrical counter-diagnosis that goes far beyond simple acquiescence to psychiatry's Diagnostic and Statistical Manual (the DSM, currently in its fourth edition; on counter-diagnosis, see Price). Girl in Need depicts Johnson's effort to bring emotional confusion into clarity in a form that tries to mimic, and at times obviously celebrates, a disorderly mode of being in the world, and it is written with the express intention of offering solace to others diagnosed as borderline and understanding to those who are not.

A similar concern to dismantle the stigmatized category the author repeatedly calls "madness" also animates Emily Martin's Bipolar Expeditions. An NYU anthropologist and self-identified person with manic depression, Martin approaches her subject as an autoethnographer; she is that "denizen of a strange land" that Anne Hunsaker Hawkins once named as the speaker of illness pathography. Martin's position as an academic matters to the story she tells about bipolar disorder because much of the book concerns the silence imposed upon mental illness in work settings. Diagnosis creates a circular trap, she argues, in which the individual who has been placed in "the subject position of the irrational" will always "be" irrational, regardless of — or perhaps in direct proportion to — her resistance to that label. An overt aim of the book is to investigate not so much bipolar disorder as what Martin calls "people living under the diagnosis of bipolar." This is "people first" language with a twist, since it puts "people" at the farthest possible distance from the disability; emphasizes the constructedness of identity categories ("diagnosis") and their coercive effects ("living under"); and also insists on the independent perseverance and agency of those so categorized ("people living").

As some in the field of literary disability studies have contested (James Overboe and Richard Ingram among them), the very endeavor of "making sense" — a basic goal of much psychiatric and literary critical work, in addition to memoir itself — presumes that viable personhood inheres in linear narrative, in the capacity to self-appraise in language and with some understanding of logical causality. Other scholars have complained that literary disability studies takes narrative as its subject nearly to the exclusion of any other literary form, such as poetry (essays in the inaugural issue of the Journal of Literary and Cultural Disability Studies make this point clearly). The very category of "mental illness," moreover, in pathologizing the condition a self may be in, can have the effect of denying that self the status of rational or fully functioning person. Two questions then arise. How does an author write about the "strangeness" and "dysfunctional logic" of her moods and decisions, to quote Johnson, without capitulating to the pressures of ideology or conventional form? And how does one read accounts of emotional or cognitive disability without adhering to the structures that circumscribe an individual's ability to act out, in words or otherwise, who she is?

Johnson (a literature and gender studies professor at the University of South Carolina Upstate, also my co-editor on a collection of critical essays on Nancy Mairs) responds to this conundrum with a memoir that deliberately eschews traditional narrative patterns. Girl in Need reads as what I've elsewhere called a book-length lyrical memoir, by which I mean to signal not so much that the prose has an overtly poetic quality — though it does, with frequently lush and arresting imagistic and symbolic moments — but more that the text is an expanded instance of what we think of as lyrical essay. A notoriously slippery form to define, lyrical essay is distinguished from its cousin the personal essay in being more associative and experiential; where personal essays in the mode of a disability writer like Mairs, or her forebear Montaigne, might ruminate and meander, circling a question rather than arguing a case, lyrical essays often dispense with storytelling altogether in favor of a more fragmented, allusive style. Lyrical essays have the leaps as well as compression of poems, the truthfulness of essays, the surprise and revelation of ecstatic experience, and it is precisely this combination of qualities that makes Girl in Need of a Tourniquet so provocative a book.

A reader will immediately notice the graphic choices whereby Johnson's memoir simulates the disorganization of borderline experience. Chapters are highly fragmented, comprised of chunks of text with frequent interruptions in differing fonts and type sizes, capital letters, indentations and alternating spacing. Sections may be divided by blank spaces or by dark blotchy lines that evoke the cuts we come to know Johnson makes in her own flesh in periods of intense emotional strain, as well as streaks of ink, insisting on the corporeality of the text, its composition in wild swings of desire and despair that manifest in and are acted on through the body. "My voice sometimes splits," Johnson also tells us, invoking the subjective incoherence that derives from shifting allegiances — with other people diagnosed as borderline, with her parents and two younger sisters, with lovers, with self — and the form of the memoir exaggerates that sensation of fracture.

Nor is the "voice" of the book consistently Johnson's own. Extended quotations from psychoanalytic theory and the scholarly literature on borderline personality disorder ground the extremes of Johnson's story in the assurances of professional authority; however much Girl in Need reads like one of the "tantrums" Johnson suggests erupt from unresolved "rage and sorrow," its author sometimes settles down to research her own condition. But the stabilizing effect of academic explanation doesn't last — or at least, doesn't override the book's distinctive technique, its enactment of rapid-fire shifts of feeling and obsessional thought. To the contrary, one of the more intriguing features of this text is the trustworthiness of its narrator; we want her to maneuver us through the bewilderments of her childhood, her romantic entanglements with a student and partnered colleague, not the psychological experts.

If the story told in Girl in Need of a Tourniquet doesn't exactly make sense of its author's experiences (at least not in any conclusive way), it does present us with an emotional and cognitive style. This is how Emily Martin refers to the performative quality of mania to accentuate the possibility that "people with manic depression possess volition," and are therefore capable of the kind of autonomous action that we associate with personhood. Both Girl in Need and Bipolar Expeditions seek to complicate a putatively unbridgeable "abyss," in Martin's terms, between the rational and irrational, "'normal people' from the 'mentally ill.'" When moods and behaviors are depathologized as fixed (and in turn fixable) brain states and recast in terms of the performance of individual psychological styles, conditions like borderline and bipolar might "join hands" with a whole continuum of human emotional experiences.

Details of Martin's personal story are minimal in Bipolar Expeditions, but the book does include multiple interviews and conversations Martin had with others diagnosed as bipolar. These narratives are crucial to the project of dispelling not just the stigma associated with mental illness or depression, but also the aura that surrounds mania as a positive and even desirable personality trait. Martin conducted extensive research and field work: she joined and then led support groups for people with manic depression, studied the psychological and psychoanalytic history of manic depression, attended clinical rounds with an Affective Disorder team at a hospital in Baltimore, interviewed patients and physicians, examined psychotropic drug ads, and surveyed media references to mania as both an inherent feature of and an asset to working in financial markets.

All of this thick description coalesces as the social context in which modern bipolar disorder emerges, a historically specific interaction between brain chemistry and cultural norms of emotion, mood, and self-regulation. And it provides precisely that "other kind of knowledge" with which Martin seeks to complicate a too-easy acceptance of the explanatory power of the DSM. Despite the academic sensibleness of her book, Martin would surely agree that making sense of behavior according to established categories of mental illness can be dangerous in that it "automatically demote[s]" the individual from the status of full personhood. Still, she does stress the importance of familiarizing so-called irrational actions. If "not every action can be understood as having sense," in her words, we can nonetheless reorient our understanding of certain behaviors away from brain chemistry and toward the styles and situations according to which people decide to act.

Without using this language, both Bipolar Expeditions and Girl in Need of a Tourniquet offer what might be called a post-social model of psychiatric disorders — they are, in other words, representations of conditions that acknowledge the influence of society and discourse on the meaning of impairment, but also return to embodiment and emotion with phenomenologically rich accounts of what a particular state of mind feels like. They will take their place in the growing personal and sociological literature of disability, as manifestos and manuals for making mental illness less strange.

Works Cited

  • Frank, Arthur W. The Wounded Storyteller: Body, Illness, and Ethics. Chicago: University of Chicago Press, 1995.
  • Hawkins, Anne Hunsaker. Reconstructing Illness: Studies in Pathography. West Lafayette, IN: Purdue University Press, 1993.
  • Price, Margaret. "'Her Pronouns Wax and Wane': Psychosocial Disability, Autobiography, and Counter-Diagnosis." Journal of Literary & Cultural Disability Studies. 1.1 (2009): 11-33.
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