Free Bipolar Expeditions by Emily Martin Page B

with bipolar disorder, but once he was defined as bipolar by the doctors, his effort was taken as additional evidence of his irrationality.
    There is an important element of “performativity” in Mr. Burton’s rounds, as there is in the other rounds and in the small, mocking performances I described in chapter 2 . In the words of the philosopher J. L. Austin, “performativity” means that “There is something which is at the moment of uttering being done by the person uttering.” 21 When a judge of the appropriate kind says the words, “I now pronounce you man and wife,” the uttering of the words brings about, performs, the state of marriage. For the couple, two new subject positions, a “husband” and a “wife,” come into being. 22 Because the rounds physicians are by definition the ones with the knowledge and authority to diagnosis mental illness, their words—Mr. Burton has bipolar disorder—performatively bring about a new subject position for him: he becomes a person living under the description of bipolar disorder. The other form of subjectivity that often struggles (but fails) to emerge in rounds is the rational subject, one who has self-knowledge and agency and, most important, the ability to make sense of unfolding events. Paradoxically, from the point of view of the person being diagnosed, saying “no” to the categories of mental illness, though the speaker may wish otherwise, is often taken to mean, constitutively, that the speaker is “mentally ill” and hence not capable of being a proper “subject” at all.
    Patients in rounds, in striving to articulate an oppositional stance to the medical categories, are expressing a positive desire for a number of things: some wish for a kind of subjectivity and agency that would allow them to refuse to be described in pathological psychiatric terms because their individual cases do not fit it (Mr. Burton, who declared he wasn’t crazy); some wish for a kind of subjectivity that would empower them to refuse the legitimacy of psychological tests (Ms. Miller, who wouldn’t spell “cloud” backward); others wish for a kind of subjectivity that would enable them to make their definitions of normal and functional stick (Ms. Vincent, who thought she was normal when she was speedy). These are probably only a few of the wishes and desires contained in these events, all of which go to make up one of the main forces pushing the waves in the ground-sea: the assertion of these patients’ subjectivities in a place where the medical model provides little room for it.
    In the final analysis, the medical taxonomy used by the doctors naturally enough wins out in the context of rounds, despite patients’ occasional efforts to refuse diagnostic tests or to turn the diagnoses back on the doctors. The patients are literally on the hospital grounds, where doctors control almost completely the medications prescribed, the length of stay offered, and the reports filed. In addition, most patients want and need the doctors’ goodwill and accumulated experience, which would, if the appropriate diagnosis could be matched with a tolerable treatment, ease their suffering. Many patients have been in this very hospital before and at least sometimes say that they benefited from their treatment. What I intend to illuminate through these brief glimpses into ongoing and complex processes are the many facets of the struggles patients engage in to demonstrate that the pathological irrationality entailed by their psychological condition does not encompass their personhood entirely. I also hope it is possible to see that the medical categories themselves have looseness in them, as any taxonomic system would—fuzzy borders and conditions that overlap with each other—which students can only learn to apply through analysis of cases. This system does not come with clear, unambiguous rules about how