Free Bipolar Expeditions by Emily Martin Page A

interdictions against bringing certain social practices, identities, or roles together in the same context. Even the emergence of a particular subjectivity may be shaped by “certain absences, certain other enunciations that cannot or must not be expressed.” 15 We might call this kind of concealment social rather than psychic repression. We might expect the interdictions involved to draw on common forms of social bias, for example on discrimination by race, sex, or class.
    The sociolinguist Don Kulick provides a telling analysis of “social repression” as it works to produce gendered subjectivities. Kulick argues that sexual subject positions are crucially structured by “enunciations that cannot or must not be expressed.” 16 A person who is socially a “‘heterosexual woman’ is supposed to say ‘no’ [to male desire for sex]—this is part of what produces a female sexual subject. A person who is socially a ‘heterosexual man’ is supposed to not say ‘no’ [to female desire for sex]—this is what produces a male sexual subject.” 17 When a “gay man” approaches a “straight man” with a request for sex, the “straight man” is placed in a position he often feels to be intolerable. Having elicited the gay man’s desire puts him in an impossible position. If he says “yes” he will be in the subject position of a gay man; if he says “no” he will be in the subject position of a woman. When a straight man feels degraded by being forced into the subject position of either a gay man or a woman, that is when violence often breaks out against the gay man. These various subjectivities—gay, straight, man, woman—are shaped by social rules that prevent particular behaviors from being brought together. 18
    The case Kulick analyzes is quite different from rounds, because saying “no” to the categories of the doctors (though the speaker may wish otherwise) is not part of a system of “nos” (as in the case of Kulick’s analysis) that people actively use to produce the subjectivity they desire. On the contrary, saying “no” to a medical diagnosis is often taken by doctors to indicate that the speaker is “mentally ill.” Indeed studies in psychiatry explicitly regard “poor insight,” defined as disagreeing with the psychiatric diagnosis one is given, as diagnostic of mental illness. 19 The set of possible medical meanings for a person living under the description of mental illness is limited in such a way that efforts to refuse and resist are redefined as illness. In Mr. Burton’s rounds, his attempts to describe his intentions and motives were met with a diagnosis of mental illness. He presented himself as an upright young man, well mannered and well loved by his family, who had already had significant successes at school and in work. His exposure to PCP caused him to become paranoid and suicidal and to obtain a gun; he reacted to an overload of past and present stress by leaving college. He realized he was in trouble and called for help, whereupon, in the Riverside emergency room, he was terrified because he was completely alone and threatened with injections he mistrusted. 20 In the psychiatric description, in contrast, depression and anxiety led to changes in his daily habits, his ability to study, and his ability to tolerate being away from home. Depression also played a part in his suicidal and paranoid thoughts and his purchase of guns. PCP was granted a possible role, but overall Mr. Burton displayed a pattern of depression followed by mania: on admission his tangential speech and grandiosity indicated he was in florid mania. Because of the psychiatrists’ knowledge and authority, there is no question that their descriptions will become operative in the hospital. Mr. Burton in effect tried to say “no” to the subject position of a person