"A progressive downward spiral": The circulation of risk in "bipolar disorder"

Abstract

By some accounts, prevalence estimates of bipolar have increased 240-fold over the past three decades, and are twice as high in the United States when compared to worldwide averages. In this article, I argue that these numbers (at least in part) emerge from a circulation of risk in the bipolar milieu—it is now by-and-large one’s potential madness that is diagnosed and drugged. I map out how this circulation occurs via a number of psy technologies: kindling, recurrence, diagnostic hypervigilance, early intervention, excess, reproductive counseling, prophylaxis, drug-induced diagnoses, pharmaceutical marketing, and pharmaceutical consumerism. In turn, I consider how these technologies’ collaborative biologizing, classifying, and pharmaceutilizing of risk interacts with the U.S. political climate of intensified surveillance and security. I thus use bipolar as a site to explore the reconfiguration of psy assemblages within a shifting context of discipline and terror. (PsycINFO Database Record (c) 2013 APA, all rights reserved)

Full text

“A Progressive Downward Spiral”:
The Circulation of Risk in “Bipolar Disorder”
Rachel Jane Liebert
City University of New York
By some accounts, prevalence estimates of bipolar have increased 240-fold over the
past three decades, and are twice as high in the United States when compared to
worldwide averages. In this article, I argue that these numbers (at least in part) emerge
from a circulation of risk in the bipolar milieu—it is now by-and-large one’s potential
madness that is diagnosed and drugged. I map out how this circulation occurs via a
number of psy technologies: kindling, recurrence, diagnostic hypervigilance, early
intervention, excess, reproductive counseling, prophylaxis, drug-induced diagnoses,
pharmaceutical marketing, and pharmaceutical consumerism. In turn, I consider how
these technologies’ collaborative biologizing, classifying, and pharmaceutilizing of risk
interacts with the U.S. political climate of intensified surveillance and security. I thus
use bipolar as a site to explore the reconfiguration of psy assemblages within a shifting
context of discipline and terror.
Keywords: bipolar disorder, risk, psy technologies, affect, discipline, security
Bipolar, Surveillance, and Security
‘Bipolar Disorder’, as a diagnostic label, en-
tered the Diagnostic and Statistical Manual of
Mental Disorders (DSM)—the dominant man-
ual of its kind in the United States—for its third
edition (APA, 1980). At this time, bipolar was
considered to exist within 0.1% of the U.S.
population (Healy, 2008). Come the turn of the
century however, and—while some put preva-
lence estimates as high as 24% (Angst et al.,
2003)—the “lifetime risk” most commonly
cited in scientific articles was (and continues to
be) five percent (Akiskal et al., 2000), a number
twice as high as worldwide averages (Merikan-
gas et al., 2011). It follows that since 1980, one
could conservatively claim a 50-fold increase in
bipolar in the U.S., while a 240-fold increase is
also able to be substantiated. Moreover, bipolar
was (is) thought to be largely underdiagnosed,
particularly in youth; 10% of 18 to 24 year olds
are considered to warrant diagnosis (Hirschfield
et al., 2003). This increase disproportionately
materializes in women’s bodies (Curtis, 2005),
and circulates in ways that are peculiarly
classed and raced (Martin, 2007).
More recent figures also indicate extremely
high and increasing prescription rates for the
pharmaceuticals prescribed in response to bipo-
lar diagnoses (IMS Health, 2010). While previ-
ously dominated by lithium, the bipolar market
was first colonized by anticonvulsants in the
mid-90s. Following approval in 2003 from the
U.S. Food and Drug Administration (FDA)—a
governmental regulatory agency whose purview
includes oversight of the testing and allocation
of drugs for different diagnoses—a number of
atypical antipsychotics and a handful of antide-
pressants were also deployed (Healy, 2006).
Since this time, atypical antipsychotic use in
particular has grown sevenfold; one percent of
the U.S. population is now estimated to be using
the drugs (Domino & Schwartz, 2008). Further-
more, by 2009 three (out of nine) bipolar phar-
maceuticals had made the top 15 individual
global products in terms of U.S. sales (IMS
Health, 2010). And these numbers have even
This article was published Online First November 26,
2012.
Special thanks to the five people whose personal and
professional stories and expertise all inspired this analysis;
to the International Society for Theoretical Psychology for
providing intellectual and financial support for the talk from
which this paper emerged; and to Michelle Fine and Mi-
chelle Billies for your support, brilliance, and questions.
Correspondence concerning this article should be ad-
dressed to Rachel Jane Liebert, The Graduate Center, City
University of New York, 365 Fifth Avenue, New York, NY
10016. E-mail: rliebert@gc.cuny.edu
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Journal of Theoretical and Philosophical Psychology © 2012 American Psychological Association
2013, Vol. 33, No. 3, 185–198 1068-8471/13/$12.00 DOI: 10.1037/a0030456
185