Bipolar Boundaries: a Geography Lesson

USA Canada Puzzle Concept
A puzzling, cross-boundary bipolar diagnosis.
Will I be crazy in Canada?

I just got my passport and I am psyched! This November I am hightailing it to the Canadian, BC border. My sister Maureen, 1970’s style made a big political move north – and while she retains her American citizenship – she has never moved back.

She is as Canadian as maple syrup and Molson’s Ale, eh! Different and yet the same, geography has shaped who she is. Maureen’s longitude and latitude have shifted her worldview. Different and yet the same, geography has both shaped and redefined her.

So I ask again, will I still be crazy in Canada? Will I be just as unhinged north of the border as below?

Last week with “Inked!”, I posted my 60th post here on U&U. And it seemed as good a time as any to look back at a year’s worth of data – to see how U&U is doing. Who’s reading, who’s following, who’s commenting, who’s “liking”, who’s sharing.

I am obsessed with my WordPress app, compulsively checking stats on visitors and views after each week’s post. And daily I am amused to discover where my readership resides. Googling — folks from across the globe stumble upon U&U. And it makes me smile.

This little blog is a worldwide phenomenon (wink, wink, nod, nod!): 13,648 views, 8,233 visitors, and 300 followers. Read in over 80 countries, the lion’s share of my readers are, of course, in the U.S., followed by the UK, Canada, Australia, Germany, and France.

My numbers are in the “tens” in Russia, Italy, the Philippines, Belgium, Poland, the Netherlands, New Zealand, Spain, Ireland, Switzerland, and South Africa.

I have a couple of readers each from Finland, Thailand, Uraguay, Colombia, Nigeria, Slovakia, Vietnam, Greece, Egypt, Lebanon, Lithuania, Luxembourg, Argentina, Iraq, the DR, Costa Rica, and Kenya.

And I am a one hit wonder in Jersey, Cameroon, Portugal, Estonia, Algeria, Zambia, Zimbabwe, Croatia, Uganda, and Saudi Arabia!

(Are you smiling? Me too.)

A few years ago, I read a most provocative book, “Crazy Like Us: The Globalization of the American Psyche” 2010, by Ethan Waters. In a diverse world, Waters writes, there is a diversity of ways of going mad. Likewise all across the map, there is a rich variety of ways, humanity maps the mind’s terrain.

Western hegemony, he says, has homogenized our understanding of mental health. Exportation of the Diagnostic & Statistical Manual has obliterated cross -cultural expressions of mental illness. Powerful pharmaceutical companies profit not just from the drugs but from the diagnoses they advertise and promote.

“Crazy Like Us” tackles this global issue at the local level. Specifically Waters tells the story of people with four different diagnoses in four different countries: “The Rise of Anorexia in Hong Kong”; “The Wave That Brought PTSD to Sri Lanka”; “The Shifting Mask of Schizophrenia in Zanzibar”; “The Mega-Marketing of Depression in Japan”.

The data he shares is persuasive. The stories told are compelling. The questions he raises are profound. Waters’ investigation contextualizes the West’s experience of mental illness and calls into question our scientific theories and therapeutic practices.

So I ask the question again. Will I be just as crazy in Vancouver as I am in Virginia?

For me specifically the question is about bipolar disorder. Does it cross borders? Is it the same in any language?

My answer to this question is incarnational.

You see, deep down in my bones, I know that both my mania and my melancholia are both organic and spiritual, local as well as universal.

My answer is yes.

And oddly enough, after doing a little research, I find that my findings concur with a study done by the World Health Organization in 2011. The World Mental Health Survey (WMH), used consistent methods, (yes, the DSM-IV), and collected data in eleven countries in the Americas, Europe, Asia, the Middle East, and New Zealand.

Bipolar disorder indeed crosses borders — but not uniformly or without cultural variation. Bipolar spectrum also differs in degree from country to country. The United States has the highest lifetime rate of 4.4% and India the lowest, with 0.1%

Dr. Sarah Bodner, assistant professor of psychiatry at the University of Miami, attributes the differences to diverse factors.

It could be genetics; it could be environment. It could also be the way individuals in different cultures are willing to respond to this kind of inquiry. Cultural awareness plays a very big role in psychiatry. Some cultures have a huge reluctance to speak about such things.”

 Cultures with a higher rate of stigma had a lower rate of the disorder. But those very same cultures’ traditions may also help inoculate and protect that culture’s corporate psyche. America’s highly mobile lifestyle is counter to stability in family structures and community support, making bipolar disorder more of a first world problem.


But a article cites another quite unique theory behind what makes America the most manic country in the world: the melting pot. And it is the topic of at least one book:

“’The Hypomanic Edge: The Link Between (a Little) Craziness and a (a Lot of) Success in America,’ by John D. Gartner, an assistant professor of psychiatry at Johns Hopkins, discusses the hypomanic qualities entrepreneurs and leaders who took risks to come to America.”

 Hypomania is that Bipolar sweet spot, in which a person experiences exuberance, creativity, and focus and gets a sh*tload of things done! (This is my favorite place to be!)

David Schlager, a psychiatrist with the Lone Star Circle of Care concurs:

The U.S. attracts people who believe they can achieve a better life. They come to believe they can pick up and start again. It’s a self-selected sample of people who are grandiose and impulsive. It takes a suspension of belief to actually believe you can come here and make it happen.”

Those are a significant percentage of people in the bipolar spectrum.”

Bipolar disorder is strongly heritable. Two thirds of bipolar folks have a close relative who is also manic-depressive. My Irish American ancestors bequeathed this brain to me. It’s the gift that keeps giving in my family: my grandmother, my mother, and me.

My brain is both blessing and curse, emphasis on the first. Hypomania is God’s gift to me – yes – God’s gift to me. Manically and daily, I pray that in this sweet, sweet, sweet spot – I can manage to stay.

Often I succeed, sometimes not. And that’s okay. I would not have it any other way.

So I am grateful to God for my genes; I am grateful to God for my DNA. I am grateful to the Great Creator who made me this way — created in the image of a crazy and wondrous God.

Crazy in Virginia. Crazy in Vancouver. Crazy all over the world.

Canada, here I come.



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