2—
"Never Was Anyone So Tossed Up & Down by the Body As I Am":
The Symptoms of Manic-Depressive Illness

Afflicting approximately 1 percent of the general population, manic-depressive illness is a mood disorder that can profoundly modify cognition, personality, judgment, sleep patterns, and metabolism (the chemical changes supplying energy to all body cells). Even during relatively euthymic (not ill) states, some patients experience mild variations in the intensity of their perceptions and feelings.^[1] All these changes can significantly, though temporarily, affect behavior—particularly since sufferers often remain unaware of any shift in mood. Changes in affect (overall emotional state) are difficult to detect because mild mood swings are normal (the Monday morning "blues," the Friday evening "highs"); unless it presents distinguishable psychotic features, a psychiatric disorder of mood differs only in degree from those normal ups and downs. An affective psychosis is therefore defined as "a severe mood disturbance in which prolonged periods of inappropriate depression alternate either with periods of normal mood or with periods of excessive, inappropriate euphoria and mania."^[2] Such terms as excessive and inappropriate should not imply that the diagnosis of an affective disorder depends on a purely subjective reaction to a patient's behavior. One of Ronald Fieve's patients has described just how fundamental—and yet how subtle—the changes can be as she slips first into hypomania (a mild euphoria), then into frank mania, and, finally, into depression:

When I start going into a high, I no longer feel like an ordinary housewife. Instead I feel organized and accomplished and I begin to feel I am my most creative self. I can write poetry easily. . . . My mind feels facile and absorbs everything. I have countless ideas. . . .

. . . However, when I go beyond this stage, I become manic, and the creativeness becomes so magnified I begin to see things in my mind that aren't real. . . . I saw [them] as clearly as if watching them in real life. . . .

My first depression came out of the blue. . . . I seemed to get no pleasure out of living. I had no feeling toward the babies or my other two children. I tried to do extra things for the children because I felt

extremely guilty about my lack of feeling. . . . My mind seemed to be obsessed with black thoughts.^[3]

Leonard saw the same phenomenon in Virginia, a discernible shift in mood from her usual perceptivity to impaired reality testing:

I am sure that, when she had a breakdown, there was a moment when she passed from what can be rightly called sanity to insanity. On one side of this line was a kind of mental balance, a psychological coherence between intellect and emotion, an awareness and acceptance of the outside world and a rational reaction to it; on the other side were violent emotional instability and oscillation, a sudden change in a large number of intellectual assumptions upon which, often unconsciously, the mental outlook and actions of everyone are based, a refusal to admit or accept facts in the outside world.

. . . suddenly the headache, the sleeplessness, the racing thoughts would become intense and it might be several weeks before she could begin again to live a normal life. But four times in her life the symptoms would not go and she passed across the border which divides what we call insanity from sanity. She had a minor breakdown in her childhood; she had a major breakdown after her mother's death in 1895, another in 1914, and a fourth in 1940. In all these cases of breakdown there were two distinct stages which are technically called manic-depressive. In the manic stage she was extremely excited; the mind raced; she talked volubly and, at the height of the attack, incoherently; she had delusions and heard voices, for instance she told me that in her second attack she heard the birds in the garden outside her window talking Greek; she was violent with the nurses. In her third attack, which began in 1914, this stage lasted for several months and ended by her falling into a coma for two days. During the depressive stage all her thoughts and emotions were the exact opposite of what they had been in the manic stage. She was in the depths of melancholia and despair; she scarcely spoke; refused to eat; refused to believe that she was ill and insisted that her condition was due to her own guilt; at the height of this stage she tried to commit suicide, in the 1895 attack by jumping out of a window, in 1915 by taking an overdose of veronal; in 1941 she drowned herself in the river Ouse. (Beginning Again 76–79)

Leonard's observations fit quite closely the typical profile of manicdepressive mood swings. He follows the Kraepelinean model: without attempting to ascribe meaning to her delusions, her violent outbursts, or her refusal to eat, he focuses on her symptoms themselves.

When manic-depressives fall ill, they may exhibit a multiplicity and variety of symptoms that can mystify and frustrate not only their families but their doctors as well. The variations in individual manifestations of this illness Kraepelin himself described as "absolutely inexhaustible."^[4] Unipolar patients show signs only of depression; bipolar, or "circular," individuals alternate either between manic episodes and "well" periods or between mania and depression with intermittent well periods. One useful descriptive system for expressing the variable intensity of both poles employs four categories: MD (for bipolars who suffer both mania and depression at moderate or severe levels or with psychotic features), Md (for frank manias but mild depressions), mD (for mild manias but pronounced depressions), and md (for cyclothymia).^[5] (MD and Md are also known as Bipolar I and mD as Bipolar II.) During her serious breakdowns Virginia experienced MD levels, but often she had milder bipolar episodes, as she noted in her diary and letters:

I must note the symptoms of the disease, so as to know it next time. The first day one's miserable: the second happy. (Diary 2: 108)

Also my own psychology interests me. I intend to keep full notes of my ups & downs, for my private information. And thus objectified, the pain & shame become at once much less. (Diary 5: 64)

. . . I've been rather bad again—the result I suppose of those 4 days in London. Sleep this time—seems to have gone: and as you know this leaves me very melancholy and restless by day. . . . The Dr. said I must expect ups and downs for at least 2 months more. This is a down; but an up will come. Forgive me for being so egotistic. (Letters 6: 43)

Although most bipolars experience both mania and depression (frequently in cycles), the speed, duration, and intensity of the mood swings may vary greatly from individual to individual and from episode to episode in a given individual. On the average, manic episodes begin more abruptly (over a few days or hours) than depressive ones (which can take weeks to develop fully).^[6] Some individuals suffer episodes of mania or depression that last for months, even years. Others make a complete bipolar circuit in a matter of minutes ("micropsychosis").^[7] Still others suffer from "mixed mania," in which mania and depression are experienced concurrently; these patients report feeling both euphoric and despairing, lethargic and energized,^[8] which suggests that mania and depression are not merely chemical alterations in one system of neurons but involve at least two

systems that can malfunction simultaneously and produce opposite effects. As Quentin Bell notes of an interval in 1910 between rest cures:

[Virginia] seemed very self-confident, she was elated and excited about the future, looked forward to fame and marriage; at the same time she was irritated by trifles, exaggerated their importance and was unable to shake off her excessive concern with them.^[9]

Leonard noted that Virginia experienced various durations and intensities of mood shifts, although, for the most part, she was euthymic (see also Appendix, below):

"normally" my wife was no more depressed or elated than the normal, sane person. That is to say that for 24 hours of, say, 350 days in the year she was not more depressed or elated than I was or the "ordinary person." Normally therefore she seemed to be happy, equable, and often gay. But (1) when she was what I called well, she was extremely sensitive to certain things, e.g. noise of various kinds, and would be much more upset by them than the ordinary person. These upsets and depressions were temporary and lasted only at the most a few hours. (2) Whenever she became overtired and the symptoms of headache, sleeplessness, and racing thoughts began, the symptoms of depression and elation began. (3) In (1) and (2) I do not think that anyone would have thought the nature or depth of the depression or elation was irrational or insane, but in the two cases in which, in my experience, the symptoms of headache, sleeplessness, and racing thoughts persisted and ended in what to me seemed insanity, the depression and elation, in nature, content, depth, seemed to become irrational and insane. (L. Woolf, Letters 548–49)

Mood swings can begin in adolescence—some even in childhood, though in muted form.^[10] Diagnosis before adulthood is difficult. Early manifestations of bipolar disorder can be masked by the ups and downs of adolescence; mild mania can easily be misdiagnosed as hyperactivity, and mixtures of mania and depressions may look like conduct disorder or schizophrenia.^[11] Full-blown manic psychosis does not appear before puberty. One hypothesis, that an immature nervous system is incapable of expressing frank mania, seems to be supported by the fact that prepubertal children do not exhibit a marked euphoric response to amphetamines, whereas adults do.^[12]

Manic-depressive illness is a recurrent illness.^[13] From 85 to 95 percent of patients who have an initial manic episode suffer recurrences of either depression or mania; 50 percent to 85 percent of patients who experience

one major depression will undergo subsequent depressions.^[14] These later episodes need not occur frequently. Clifford W. Beers, a famous American manic-depressive who wrote a book in 1907 about his experiences, was institutionalized only twice in his lifetime: once in his twenties and again in his sixties. In the forty-year interval, he lived a happy and productive life.^[15] Some bipolars, however, especially women, fall ill more often as they grow older, and those who, like Virginia, are classed as "mixed" or "cycling" run a risk for chronic illness four times that of the other groups.^[16]

Rarely does a breakdown result in an important personality defect or psychological deficit, though the experience itself can be quite upsetting. The "madness" is temporary and seems not to be related in any meaningful way to the individual's normal personality.^[17] Leonard's observations of Virginia bear out this assertion:

When Virginia was quite well, she would discuss her illness; she would recognize that she had been mad, that she had had delusions, heard voices which did not exist, lived for weeks or months in a nightmare world of frenzy, despair, violence. When she was like that, she was obviously well and sane. (Beginning Again 79)

Virginia recognized that she experienced drastic alterations in perspective, judgment, and self-esteem as she dropped from a mild mania into a mild depression:

one night we had a long long argument. Vita started it, by coming over with [George] Plank, & L. (I say) spoilt the visit by glooming because I said he had been angry. He shut up, & was caustic. He denied this, but admitted that my habits of describing him, & others, had this effect often. I saw myself, my brilliancy, genius, charm, beauty (&c. &c.—the attendants who float me through so many years) diminish & disappear. One is in truth rather an elderly dowdy fussy ugly incompetent woman vain, chattering & futile. I saw this vividly, impressively. (Diary 3: 111)

For Woolf, this problem of relatedness—the connection between the "sane" Virginia and the "insane" Virginia, the brilliant one and the incompetent one—was crucial. She was quite aware of her instability: "You know how cameleon I am in my changes—leopard one day, all violet spots; mouse today" (Letters 5: 209). And, like other manic-depressives, she needed to know that somewhere beneath the bewildering panoply of symptoms (the "Jekyll and Hyde syndrome," as one patient put it)^[18] lay a real Virginia, that central, wedge-shaped core Lily Briscoe feels intuitively is

the hidden essence of Mrs. Ramsay, that subterranean self Mrs. Dalloway sinks into when personality has become mere chatter, vanity, and invention. Woolf sought the pure being that she hoped lay below her everchanging (and, as she called it, "egotistical") consciousness. This issue of how identity is tied to mood and perception was especially crucial for a woman who struggled to throw off Victorian dogma that limited who and what a woman could be. It was a challenging task. In a diary entry in 1923, Woolf discusses the problems of such a search for pure being. She meditates on a sudden depression that had sprung up after a short holiday. Such depressions

make my life seem a little bare sometimes; & then my inveterate romanticism suggests an image of forging ahead, alone, through the night: of suffering inwardly, stoically; of blazing my way through to the end—& so forth. The truth is that the sails flap about me for a day or two on coming back; & not being at full stretch I ponder & loiter. And it is all temporary: yet. . . . One must throw that aside; & venture on to the things that exist independently of oneself. Now this is very hard for young women to do. Yet I got satisfaction from it. . . .

I will leave it here, unfinished, a note of interrogation—signifying some mood that recurs, but is not often expressed. One's life is made up, superficially, of such moods; but they cross a solid substance, which too I am not going to hack my way into now. (Diary 2: 221–22)

Fifteen years later she again faced the same abyss of depression (this time worrying about critical attacks upon Three Guineas), and she used the same reasoning to overcome her fear that she was merely a walking shadow, not a whole human being:

Now the thing to remember is that I'm an independent & perfectly established human being: no one can bully me: & at the same time nothing shall make me shrivel into a martyr or a bitter persecution maniac. . . . I mean to stand on my own feet. (Diary 5: 163)

Are these the words of a repressed neurotic afraid to face ugly truths about herself? I argue that Woolf had nowhere to go for help but back into her own mind, calling upon her own reserves to assay the meaning of a perplexing disorder, to establish a sense of self that resembled neither Savage's submissive drudge nor Freud's emasculated male. To establish an identifiable sense of self is especially difficult for manic-depressives, for changes in mood and perception can be drastic or mild, brief or drawn-out, with various symptoms, each posing a problem in perception and interpretation.

Mania

The manic phase is characterized by an elevated and expansive mood (patients describe it as "going high"), but, because various biologic components (endocrine glands, electrolyte metabolism, peptidergic hormones to "fine-tune" brain activities, and electrical and chemical systems in brain cells, among others) are involved, mania can be mild, moderate, or severe, with or without psychotic features (hallucinations and delusions, marked formal thought disorder, or grossly disorganized behavior).^[19] Moreover, psychosis is not necessarily related to the depth of the mood. The manic mood may range from dreamy or infectious cheerfulness to ecstasy and exaltation. Or joy and love of mankind may change without warning to vitriolic hatred marked by verbal abuse.

Manics often evidence low tolerance for frustration coupled with explosive anger, "affective storms" that resemble temper tantrums or extreme touchiness, what Quentin Bell has called Virginia Woolf's ability to turn "purple with rage" and create "an atmosphere of thunderous and oppressive gloom."^[20] As bipolars fall in and out of moods, their tempers fluctuate. Duncan Grant remembered that, although Virginia was sometimes "very shy" and quiet in company, there was also "the danger of sudden outbursts of scathing criticism," and Elizabeth Bowen described Woolf's flashes of temper as "fleetingly malicious, rather than outright cruel" or prolonged.^[21]

The manic's irritability lies at the center of a critical debate in Woolf studies. Freudians typically read intent in Woolf's manic rage, as if it revealed the real feelings of the real Woolf, not the ill one. Susan M. Kenney, for instance, argues that "surely her violent aversion to Leonard Woolf during other attacks was a reaction against the silent reproach she felt in his actions," that is to say, his supposed moral disapproval of her having fallen ill.^[22] But Leonard himself said he believed that there was "nothing moral" about her breakdowns (Letters 191) and that manic-depressive illness "really is a disease" that was "not really under [Virginia's] control."^[23] Furthermore, modern medicine warns us that, since we cannot know whether statements made by a manic in the throes of an affective episode represent attitudes held by the individual when normal, we should amend Kenney's "surely" to read "perhaps" and look for more convincing corroborating evidence than Leonard's silence. Manic rage is usually unrelated to the patient's long-term feelings; it seems to be a component of the manic's potential for paranoia. In an apologetic letter to Ethel Smyth, Woolf specifically connects an outburst of temper to madness:

This no doubt seems to you wantonly exaggerated to excuse a fit of temper. But it is not. I see of course that it is morbid, that it is through this even to me inexplicable susceptibility to some impressions suddenly that I approach madness and that end of a drainpipe with a gibbering old man. (Letters 4: 298)

Not all manic outbursts end so peacefully. In rare cases, patients feel So fearful and persecuted that they attempt suicide to escape, thinking that their loved ones intend to murder them.^[24] Both manic delusions—either that the world is full of magical people and things, or that it is full of demons and tyrants—result from the distortion produced when elevated mood and dysregulated brain chemistry mediate perceptions in uncharacteristic ways over which the individual has no control. When reality testing fails completely, in severe mania, hallucinations result.

Mild mania (hypomania), however, can be fairly pleasant, especially in social situations. Manics are "people seekers": they love attention. In return, they can be sociable, witty, and inventive, the life of the party, the "bubbly, and elastic individual who bounds into a room vigorously inquiring about everybody and everything," producing a torrent of ideas and words connected by complex webs of associations, rhymes, puns, and amusing irrelevancies.^[25]

The manic's entertaining social behavior can escalate into the startling or absurd. Manic speech may become theatrical, elaborated by dramatic mannerisms and even singing.^[26] Uninhibited impulsivity can lead to accidents. Her mishaps earned Virginia the family nickname of "The Goat," and Barbara Bagenal remembers that Virginia "had a strange, rather clumsy way of moving," but friends who saw her in other moods commented on her grace, elegance, and fluidity of movement.^[27] Manics may also embarrass their companions by ignoring social protocol, behaving rashly, or dressing in colorful or strange clothes. Lyndall Gordon opines that Woolf acted "the cracked Englishwoman" by dressing in extremes: either in drab, dowdy outfits or in outrageous creations of her own, one of which made her look "like a young elephant," and Madge Garland remembers that "there was a presence about [Virginia] that made her instantly noticeable. But what also attracted my attention was that she appeared to be wearing an upturned wastepaper basket on her head," a basket that turned out to be a hat.^[28] Even without egocentric clothing, Woolf attracted attention when she drifted through the streets "staring, entranced." Bystanders reacted predictably to her "unaffected strangeness": they "tended to laugh" at her or feel "uneasy."^[29]

Many manic-depressives, Woolf included, feel humiliated by their involuntary effect on other people. Manics frequently become public spectacles because they are energized, unabashedly self-confident and exuberant, exhibiting a noisy hilarity and spouting high-flown ideas. Though mania seduces them into mistaking the ridiculous for the sublime, later, when they have shifted out of mania, they may remember their eccentric behavior with shame at its undiluted vanity. Over time, they come to fear the smile that mocks, the gaze that condemns, the friend who forgives with lingering suspicion, and they may decide to avoid intimacy, public display, even photographers, to spare themselves further embarrassment. But such resolutions usually last only until the next manic episode.

Ninety-nine percent feel the "pressure of speech." With or without an audience, they talk rapidly, tying together myriad ideas and leaping from topic to topic (known as a "loosening of associations").^[30] Manic thought disorder strings ideas together, "extravagantly combined and elaborated," with many irrelevant intrusions that appear either inappropriately flippant or desperate.^[31] As one patient remembered:

My thoughts were so fast that I couldn't remember the beginning of a sentence halfway through. Fragments of ideas, images, sentences raced around and around in my mind like the tigers in Little Black Sambo. Finally, like those tigers, they became meaningless melted pools. Nothing once familiar to me was familiar. I wanted desperately to slow down but could not. Nothing helped—not running around a parking lot for hours on end or swimming for miles.^[32]

Manics generally feel unable to control their racing thoughts, as if they have been inspired by a divine Muse. Some do become highly productive, but others find that the combination of overstimulation and insomnia merely spins their wheels. In a letter to Ethel Smyth, Woolf explains that, though her brain is "teeming with books I want to write," none of these visions translates into action. Rather, she feels frightened:

Never trust a letter of mine not to exaggerate thats written after a night lying awake looking at a bottle of chloral [a common prescription for mania and insomnia at that time] and saying no, no, no, you shall not take it. Its odd why sleeplessness, even of a modified kind [,] has this power to frighten me. Its connected I think with those awful other times when I couldn't control myself. (Letters 6: 44)

In mania the imagination seems to go into overdrive, finding great significance in ordinary events. The individual experiences seemingly

profound but inexpressible insights (e.g., the meaning of life), delusions, or vivid hallucinations. Hyperalert, patients may misinterpret actions by doctors and nurses as evidence of a sinister plot against them. When family or experience contradicts these misreadings, manics may withdraw into their own world or engage in even more desperate attempts to "read" their environment, to discover the elusive "truth" that will explain all, imposing meaning and a sometimes highly idiosyncratic order upon a world spinning out of their control:

Our patients were labile and frequently angry. Their "world" was not stable and rosy but changing without reason and frustrating. .  .  . [The typical patient] frequently had insight into the fact that he was ill, often at the same time he was expressing delusional or grandiose ideas . . . . For the most part, the patients remembered being wound up and unable to stop, not feeling tired but aware that something was wrong, upsetting their families, and not being able to stop.^[33]

Manics'often experience extremely vivid hallucinations, and even when they are not hallucinatory, their accelerated psychomotor activity and intensified sensory perceptions make their perceptions or visions seem profoundly meaningful: objects look significant.^[34] John Custance, a British manic-depressive who, like Clifford Beers, achieved notoriety by writing a book about his illness, when manic had "a rather curious feeling behind the eyeballs, rather as though a vast electric motor were pulsing away there," with the result that electric lights looked "deeper, more intense" and were surrounded by a "bright starlike" effect which reminded him of the Aurora Borealis. The faces of hospital staff seemed "to glow with a sort of inner light." His senses of touch, smell, and taste heightened: "even common grass tastes excellent, while real delicacies like strawberries or raspberries give ecstatic sensations appropriate to a veritable food of the gods." Heightened perceptions inspired "animistic conceptions," in which objects literally became such entities as time, love, God, peace: "I cannot avoid seeing spirits in everything."^[35] Colors were so intense that they seemed to signify real threats or blessings, messages from the devil or Christ, hints which Custance felt obliged to decipher as if he were explicating a literary text:

There was a time when I was terrified of green, because it was the signal to go, and the only place I thought I could be going to was Hell. However I eventually got out of Hell [when he recovered from

his depression] and at present green has no terrors for me. . . . [I]t stands for grass and growth.

. . . Red is the Devil's colour, and perhaps I am not quite safe from him yet. Red also means stop, and I don't in the least want to stop here for ever. However, with a certain amount of effort, concentration and prayer, I conquered the red with the help of the green and felt safe.

The next day the colours had suffered a kaleidoscopic change. Gone were the reds and the greens; there was nothing but blues, blacks and greys, with an occasional purple. The sky, which had been bright and clear, was overcast; it was raining. This new combination of colours constituted a new threat, with which I had to deal.^[36]

Delusional beliefs occur in a wide range of clinical conditions (seventyfive, by one count). They are frequently seen in schizophrenia, affective disorders, substance abuse disorders, and organic psychoses, in all of which sensory experiences can be so puzzling that even impossible delusions serve an explanatory function. In a sense, delusions are necessarily unusual ways of coping with unusual circumstances.^[37] Because perception is so greatly altered by mania, the patient's beliefs about his situation may become quite bizarre. When his often inappropriate or impossible, though to him reasonable, requests are not carried out, he may feel frustrated and angry, and withdraw even further into himself. As the mania becomes more severe, the world outside matters less and less, whereas attempts to explain it become increasingly important in themselves. The manic self feels dominant, creative, full of incipient meaning that is imposed willy-nilly upon perceptions of the world.^[38] He may feel mystically "at one" with the universe, but in fact self has divorced the world.

Manics rarely speak of mood spontaneously or examine it critically—rather, they live out their moods.^[39] Filled with great plans and designs, manics may appear supercilious and haughty, claiming to have profound visions of life's meaning which they plan to codify in some future work. One patient, a successful artist, was extremely productive during mild manias, but when his moods soared higher his work suffered from impaired reality testing:

He would think he had done something original only to discover later that his "inspiration" was ridiculous. His political and religious theories suffered from the same lack of critical perspective during his psychotic highs. He would conceive them in a flash of enthusiasm only to discover later that they were absurd.^[40]

Heightened mood and a stimulated imagination give rise to delusional belief in the self's power and importance. Woolf herself noted that mania intensifies both confidence and creativity:

Curious how all ones fibres seem to expand & fill with air when anxiety is taken off; curious also to me the intensity of my own feelings: I think imagination, the picture making power, decks up feelings with all kinds of scenes; so that one goes on thinking, instead of localising the event. All very mysterious. (Diary 4: 176)

But she was wary of unrestrained elations and their doubtful products, as, in a dreamy, hypomanic mood, she considered how to write To the Lighthouse:

The thing is I vacillate between a single & intense character of father; & a far wider slower book—Bob T[revelyan]. telling me that my speed is terrific, & destructive. My summer's wanderings with the pen have I think shown me one or two new dodges for catching my flies. I have sat here, like an improviser with his hands rambling over the piano. The result is perfectly inconclusive, & almost illiterate. I want to learn greater quiet, & force. But if I set myself that task, don't I run the risk of falling into the flatness of N[ight]. & D[ay].? (Diary 3: 37)

Understandably, manics can become intrusive, irritating, or violent if balked in their pursuit of the marvelous. Euphoria can quickly change to irritability and even anger, especially if the mania is mixed or alternates with microdepressions. Beneath the surface elation may lie deep pools of black despair:

If one allows a manic patient to talk, one will note that he shows fleeting episodes of depression embedded within the mania ("microdepressions"). He may be talking in a grandiose and extravagant fashion and then suddenly for thirty seconds breaks down to give an account of something he feels guilty about. For instance, he may be talking vigorously and in the midst of his loquacity he may suddenly talk about the death of his father for which he has felt guilty for some time. His eyes will fill with tears but in 15 to 30 seconds he will be back talking in his expansive fashion.^[41]

In one study, half of the manic patients displayed pervasive depression.^[42] Such manics can be, as Woolf herself was, "very vulnerable and childishly sensitive to criticism," for the base of their inflated confidence is hollow.^[43] Criticism strikes deep because the manic-depressive's worst fear is that at any moment he may permanently and unknowingly lose his judgment, his sanity.

Because manic delusions and hallucinations create and/or accompany ideas of sometimes cosmic proportions, they are frequently interpreted as religious experiences, especially by those who have been raised in a religion. The patient may believe that she has been chosen by God—why else would she suddenly feel so captivated? When euthymic (not ill), John Custance recognized that his religious delusions and visions were similar to the pseudo-revelations induced by nitrous oxide and other drugs, but when manic, he fervently believed that "depth beyond depth of truth" had been revealed to him, that the mystery of the universe had been "unveiled" and become "certain beyond the possibility of a doubt."^[44] Such mystical experiences of universal communion can also be induced by mescaline, LSD, and other hallucinogenic substances that alter the biochemistry of the brain.^[45]

Perhaps because abnormal brain chemistry is inherently unstable, religious delusions tend to be short-lived and variable. They seem to be used by patients as explanations for the way they feel: a mystical theory explains the elevated mood, and as moods change, explanations must change too. William Cowper (a favorite of Virginia Woolf's) explained his shifts between mania and depression in terms of Calvinist theology. When manic, he attributed his euphoria to God's saving grace; when depressed, he reasoned that he must have unknowingly rejected God and committed the sin of apostasy.^[46] The manic typically engages in immoderate projection, reading as real emotions and ideas that exist only in his mind. Strong emotion skews perception, creating an obscure symbolism, solipsistic and misleading, that convinces because it is congruent with the experienced emotion. Thus, a sudden vision of life's true meaning or God's intentions or the hearing of voices seems to explain what the manic is feeling at that moment. These explanations are both true, because they bring coherence to experience, and false, because they are merely mental constructs. They are pieces of fiction that, like all fiction, are meaningful only if we understand their objective and subjective components; they are neither empirically real nor irrelevant and false, but products of the self that incorporate and reveal an inner truth. But in manic-depressive illness this inner truth is not under the individual's integrative control. When we read or write fiction, we try to balance what we know is objectively true (that we are not the book's hero or heroine, that this rendition is not a history) and what we feel is subjectively true (we identify with the protagonist and are moved emotionally by the adventures as if they were real). But manics live in a room of mirrors and do not see the inconvenient

discrepancies between what they project and what they perceive. They re-create the world. To outsiders they appear self-indulgent, vain, egotistical, but it is an ego that no longer owns its identity, because it is incapable of insightful introspection and the self-control that insight brings.^[47]

Woolf's manic episodes ran the gamut from lively sociableness to wild and incoherent gibberish, from pure ecstasy to mixed mania. When merely hypomanic, Woolf felt energized and creative, and fiction came easily to her—"my body was flooded with rapture and my brain with ideas. I wrote rapidly until 12" (Letters 3: 428); "& these curious intervals in life—I've had many—are the most fruitful artistically—one becomes fertilised—think of my madness at Hogarth—& all the little illnesses" (Diary 3: 254). She seems to have detected the connection between the hallucinations, the heightened perceptions, and the ecstasy of more severe manic moods:

I've had some very curious visions in this room too, lying in bed, mad, & seeing the sunlight quivering like gold water, on the wall. I've heard the voices of the dead here. And felt, through it all, exquisitely happy. (Diary 2: 283)

When severely manic, she was unable to distinguish between fact and fiction, as Leonard remembers:

But one morning she was having breakfast in bed and I was talking to her when without warning she became violently excited and distressed. She thought her mother was in the room and began to talk to her.

. . . she talked almost without stopping for two or three days, paying no attention to anyone in the room or anything said to her. For about a day what she said was coherent; the sentences meant something, though it was nearly all wildly insane. Then gradually it became completely incoherent, a mere jumble of dissociated words. After another day the stream of words diminished and finally she fell into a coma. (Beginning Again 172–73)

Custance, too, connected mild mania with pleasant hallucinations of the dead, a "sense of communion [that] extends to all mankind, dead, living and to be born. That is perhaps why mania always brings me an inner certainty that the dead are really alive and that I can commune with them at will."^[48] But in severe mania, the same sense of consuming communion between self and object frightened him. He saw

demons and werewolves, strange faces of forgotten gods, and devils, while my mind played unceasingly on everything it remembered of myths and magic. Folds of the bedclothes suddenly became the carven

image of Baal; a crumpled pillow appeared as the horrible visage of Hecate. I was transported into an atmosphere of miracle and witchcraft, of all-pervading occult forces, although I had taken no interest whatever in these subjects prior to my illness.^[49]

Woolf, too, as her mania intensified lost the beneficial, nurturing images and entered a paranoid world in which Leonard and her nurses had formed a conspiracy against her.^[50] Her racing mind imposed the illusion of coherence on bird songs (they seemed to sing in Greek) and on noises from the garden (they sounded like King Edward VII uttering muffled profanities), and it vividly projected memories other dead mother (conversing with one's past is a way of thinking about it, but it is a diminished kind of thinking that cannot result in a conclusion that benefits the patient). Paranoia explained why sickroom attendants whispered to each other and why she was being restrained. Although her interpretations were uncorrceted by reality testing (so that neither a royal visit nor birds that spoke seemed unlikely), they followed a logical process shared by us all. But what of the interpretations themselves? Can we decode them? Do they evidence an unspoken hostility toward men? Frigidity? An unhealthy obsession with sex, or with her mother, or both? When psychoanalyst Shirley Panken tries to make sense of Woolf's hallucinations (in order to "demystify" them), she reads them for symbolic significance. Her premises include: King Edward, who is a father-figure, stands for Leslie's "incestuous" invasiveness; birds have hard beaks, so they might refer to the phallus; the Greek songs (by a tangled web of literary allusions to a Greek myth about two sisters who are turned into birds) symbolize Woolf's dead mother; bird imagery appears in Mrs. Dalloway; Septimus Warren Smith commits suicide in that novel. Panken reaches a conclusion by simple arithmetic: bird = phallus = death. A number of explanatory interpretations now present themselves: "Does the [bird] myth evoke Woolf's guilt regarding her mother's death? Woolf's silence regarding her half-brothers' lovemaking? Her frustrated longing to find a voice to express her repressed rage?" The list goes on: birds are resilient and passionate, Panken decides, whereas Woolf feels fragile and frigid; birds are small and victims of hunters, and so Virginia may be identifying with them; in a letter, Vanessa once compared Virginia to a bird, and, as children, the Stephens had bird nicknames, often ascribed by Leslie. Panken brings us back to the father because repetition implies repression: Leslie must be the organizing center of the hallucination. Theory demands it.^[51]

But in whom does the repetition compulsion lie, Woolf or Panken? Since her patient is dead and cannot acknowledge, deny, or correct these symbolic connections supplied by the analyst, Panken speculates without hindrance or adequate information, using Woolf's conscious associations (bird imagery used deliberately in her novels and essays) as if they were identical to unconscious connections. But it is Panken's associations, not Woolf's, that dominate here. In a sense, the psychoanalyst is behaving like the manic-depressive, the ill Custance who does not have privileged access to why he is hallucinating and therefore must free-associate with bits and pieces of remembered lore, hoping that he will hit upon the meaningful connection. The trouble is that too many seemingly meaningful connections can be found too easily. Doubtless, both Custance and Panken construct ingenious explanations, but ingenuity is no proof of insight. To apply such ingenuity to hallucinations seems misguided, since neurotics, who might be supposed to make such associations, rarely hallucinate, and manics, who often do, are driven by biochemistry, not by mental trauma.

Complete hallucinatory and delusional manic breakdowns were, fortunately, relatively rare for Virginia Woolf. For the most part, she experienced hypomania, best exemplified by what Quentin Bell labels her "conversational extravagances":

This was one of the difficulties of living with Virginia; her imagination was furnished with an accelerator and no brakes; it flew rapidly ahead, parting company with reality, and, when reality happened to be a human being, the result could be appalling for the person who found himself expected to live up to the character that Virginia had invented.

. . . she must have reduced many poor shop assistants to the verge of blasphemy or of tears, and not only they but her companions suffered intensely when she found herself brought to a standstill by the difference between that which she had imagined and that which in fact was offered for sale.^[52]

Bell's illustration is negatively charged; hypomanics can also be great fun. Virginia would use "a prosaic incident or statement to create a baroque mountain of fantasy," a childlike "freedom from banality" which her friends loved.^[53] In a letter to Leonard, Barbara Rothschild asked him to "tell Virginia that we long to see her too and to be led again into the tortuous and torturing mazes of indiscretions into which she lures the carrot followers."^[54] Lyndall Gordon describes Virginia's "mercurial public manner" at Bloomsbury parties:

With a little encouragement she threw off words like a musician improvising. Her voice seemed to preen itself with self-confidence in its verbal facility as she leant sideways, a little stiffly in her chair, to address her visitor in a bantering manner. She confounded strangers with wildly fictitious accounts of their lives or shot malicious darts at friends, who, the night before, she might have flattered outrageously.^[55]

Most of Virginia's friends considered her fantastic stories "a splendid game," "dazzling performances," "burlesque, a love of exaggeration for its own sake." They saw that she indulged in "wild generalizations based on the flimsiest premises and embroidered with elaborate fantasy . . . sent up like rockets."^[56] Nigel Nicolson valued them for precisely that reason:

Virginia had this way of magnifying one's simple words and experiences. One would hand her a bit of information as dull as a lump of lead. She would hand it back glittering like diamonds. I always felt on leaving her that I had drunk two glasses of an excellent champagne. She was a life-enhancer. That was one of her own favorite phrases.^[57]

Christopher Isherwood, noting the Tennysonian impression of unhappy fragility in Virginia's physical appearance, contrasts her "fairy-story princess under a spell" look with her liveliness:

We are at the tea table. Virginia is sparkling with gaiety, delicate malice and gossip—the gossip which is the style of her books and which made her the best hostess in London; listening to her, we missed appointments, forgot love-affairs, stayed on and on into the small hours, when we had to be hinted, gently, but firmly, out of the house.^[58]

David Garnett reported that Virginia "had the gift for sudden intimacy" (also a common manic trait), which both "flattered and disturbed" people, for her interest in details—central or irrelevant—was intense. However much her gaiety charmed and entertained, it also suggested depths. Madge Garland noted that "Virginia could be a very enchanting person," but "there were times when I felt . . . that she was more nearly enchanted. This was when she seemed removed from the people she was talking to—almost dreamlike." Another friend (and a psychoanalyst), Alix Strachey, observed that Woolf's need to know every detail of other people's lives was connected to her experience of estrangement, of being "different": "it seemed to me that her wish to know all about them sprang ultimately from a feeling of alienation from reality—an alienation which she was trying to overcome."^[59]

Mania has trade-offs; one ascends to visionary heights by distancing ordinary things. Still, we must not underestimate the assets of hypomania. Like most bipolar patients, Woolf enjoyed her flights, and her pleasure is by no means sure evidence of a neurotic attachment to being ill. "Who would not want an illness," K. R. Jamison asks rhetorically, "that numbers among its symptoms elevated and expansive mood, inflated self-esteem, more energy than usual . . . 'sharpened and unusually creative thinking,' and 'increased productivity?'"^[60] Woolf saw quite clearly the creative advantages of her mood swings, even though she also knew (as is suggested by Garland and Strachey's observations) that their usefulness would be undercut by lopsided object-relations until her euthymic periods, when she could reconnect mind and world, balanced the unrestrained imagination with an external coherence. The result then was a "moment of being":

The way to rock oneself back into writing is this. . . . [o]ne must become externalised; very, very concentrated, all at one point, not having to draw upon the scattered parts of one's character, living in the brain. Sydney comes & I'm Virginia; when I write I'm merely a sensibility. Sometimes I like being Virginia, but only when I'm scattered & various & gregarious. (Diary 2: 193)

Woolf recognized that the manic state stimulated her already rich imagination to create and project fictions that had little basis in reality but that explained (or at least embodied, if obscurely) her experienced moods. In mania, she mistook her subjective world for the objective, imposed what was inside her mind upon what was outside, and learned later through disappointment that perception was neither reliable nor simple, as she shows in two penitent letters to Leonard after one of her abusive scenes:

Dearest, I have been disgraceful—to you, I mean. . . .

You've been absolutely perfect to me. Its all my fault. . . . I do want you and I believe in spite of my vile imaginations the other day that I love you and that you love me. (Letters 2: 34)

John Custance felt much the same way about his religious vision:

Only now and then, when I am in an excited state bordering on acute mania, will it emerge from its elusive retirement and allow me to get it down. Unfortunately, when I come to read what I have written in cold blood, after the manic excitement has passed, I can barely make head or tail of it and very often its appalling egocentricity nearly makes me sick.^[61]

Shame and self-doubt frequently visit the morning after a night of magical vision, boundless joy (or paranoia), and absolute certainty that one has seen the "truth," if not about the universe, then at least about oneself. Imprudent marriages, rash purchases or career changes, and adulterous flings may seem romantic and "fated" in mania, only to become tawdry and empty and undesired after mania has passed.

What could Woolf have learned from episodes that seem extravagant and meaningless? The reconnection between mind and world threatened her with a sudden, dispiriting deflation of self. The shock of falling out of solipsistic mania taught Woolf the integrity of objects, their intractable solidity, their "otherness," independent of the illusions her "unreal" self could foster about them. When well, she could invite the external, objective world into her internal, subjective world, while still maintaining the power to create fiction; it was then that she felt she could find an all-embracing coherence that was neither self-destructive nor solipsistic. She recognized that she could not control a "moment of being"; such a moment could be frightening, but it offered a "representative" and "arranged" lesson about the nature of object-relations: "we are sealed vessels afloat upon what it is convenient to call reality; at some moments, without a reason, without an effort, the sealing matter cracks; in floods reality" (Moments of Being 142). The image here of incipient drowning is frightening because how she responded to this flood of reality was crucial: she had to be careful neither to disregard it, as she did in mania, nor to be overwhelmed and destroyed by it, as she was in depression. And yet both mania and depression, as I will argue in Chapter 6, taught her valuable lessons about what this moment of being was. Often characters in her fiction experience similar disillusionment and deflation of wishful thinking while still remembering the value, the truth, of illusion. James Ramsay, for instance, who finally sees the lighthouse building as it really is, white and stark on the black rock, blends this fact with his idealization of his childhood and his self-serving hatred of his father until all views become facets of truth: "So that was the Lighthouse, was it? No, the other was also the Lighthouse. For nothing was simply one thing. The other Lighthouse was true too" (To the Lighthouse 277 ). Inevitably, such insights into how meaning is made and unmade, never finished, yet satisfying, are life-affirming.

Depression

The manic projections of bipolar patients, however enlightening, are eventually undermined by mood swings in the other direction. Depressive

symptoms range from sadness to despair, from an uncontrollable tearfulness to a despondency beyond tears. The word depression cannot convey the nightmarish pain involved. It is, as William Styron has recently put it, "a true wimp of a word for such a major illness," with its "bland tonality." Styron prefers brainstorm to denote the "veritable howling tempest in the brain" impossible for those who have not experienced depression to imagine.^[62]

In contrast to manics' exuberance and inflated self-esteem, depressives can feel hopeless, lethargic, or suicidal. Self-deprecatory comments reflect the low self-esteem that accompanies the general loss of energy, and no outside stimuli are capable of ameliorating the helpless sadness: neither the family nor the patient has any control over the depression, and this lowers spirits further on both sides. The depressed patient feels chronically miserable, worried, discouraged, irritable, and fearful.^[63] Many experience great fatigue, insomnia, or repeated early morning waking (described by Woolf as "starts of terrified about nothing waking" [Letters 6: 376]), slowness in thinking or in motor skills,^[64] loss of interest or pleasure in usual activities, and, in three-quarters of these patients, decreased sex drive—symptoms which usually strike the patient as evidence not of depression but of something else. One patient, a prominent lawyer, shared Woolf's private conviction of damnation. He

denied being depressed. Rather, he complained of having "no feelings of any sort. . . . I have no soul, I am dead inside." When pressed, he confided that he believed he suffered from a case of "moral decay of the soul—sin sickness," as he termed it during a flash of his old courtroom eloquence. "The sentence should be electrocution rather than shock treatments." However, after receiving the latter, he no longer believed he deserved to be electrocuted; indeed, in six weeks, he was able to return to the practice of law.^[65]

Just as the elated manic may be either sociable or assaultive, so too the depressive may be either passive or aggressive, sad or angry. Some lie in bed, immobile, despondent, completely helpless in the face of despair and guilt. Others become extremely agitated by their black thoughts, fidgeting restlessly, wringing their hands, feeling shaky inside, experiencing heart palpitations but denying despair. These contradictory syndromes led clinicians to define two autonomous states of depression, a retarded anhedonic type (with a pathologically decreased capacity to anticipate and enjoy experience, especially on a sensory level) and an agitated delusional type (with increased anxiety and hostility).^[66] The two states can both be

seen in the same patient.^[67] K. R. Jamison notes that the cyclothymia suffered by Hector Berlioz combined agitated and retarded depressions: "an active, painful, tumultuous, and cauldronous one (almost certainly a mixed state), and another type, characterized by ennui, isolation, lethargy, and a dearth of feeling."^[68] The agitated depressive is so upset that he looks as if he is fighting back against total despair, and he may resemble irritable manics in nervous energy and paranoia. Quentin Bell records that Woolf suffered one such episode of agitated delusional depression in an 1896 breakdown:

[Virginia] became painfully excitable and nervous and then intolerably depressed. . . . She went through a period of morbid self-criticism, blamed herself for being vain and egotistical, compared herself unfavourably to Vanessa and was at the same time intensely irritable.^[69]

Anhedonia, by contrast, overwhelms patients with what appears to be "pure" depression, a debilitating sorrow which includes "vegetative" symptoms characterized by a general psychomotor retardation: they have little to say, interact poorly with others, and tire easily, complaining of exhaustion, "tight" headaches, or muscle aches. Constipation is very common and sometimes severe; even nail growth may stop.^[70] William Styron remembers that his voice seemed to "disappear" as his depression deepened: "It underwent a strange transformation, becoming at times quite faint, wheezy, and spasmodic—a friend observed later that it was the voice of a ninety-year-old."^[71] Sleep is disturbed. Most depressives experience insomnia and early morning waking, but some become hypersomnolent, sleeping longer at night, sleeping during the day, or taking excessive naps.^[72] Loss of appetite is typical of a general slowdown in bodily processes. Some patients complain of a bad taste, a dryness of the mouth, heart palpitations, or "the feeling of a [tight] band round the forehead,"^[73] as did Woolf:

I was walking down the path with Lydia. If this dont stop, I said, referring to the bitter taste in my mouth & the pressure like a wire cage of sound over my head, then I am ill: yes, very likely I am destroyed, diseased, dead. Damn it! Here I fell down. (Diary 3: 315)

The galloping horses got wild in my head last Thursday night. . . . Then my heart leapt; & stopped; & leapt again; & I tasted that queer bitterness at the back of my throat; & the pulse leapt into my head & beat & beat, more savagely, more quickly. (Diary 4: 121)

Sensory perceptions also change. Where mania exaggerates, depression dulls, leaving physical and mental worlds monochromatic.^[74] As John

Custance noted, any object—food, clothes, one's own body—inspired "repulsion," "intense disgust," and "unpleasure" in depression, whereas in mania these same objects elicited "intense joy," "attraction," and "pleasure."^[75] Because metabolic changes in manic-depression can be so profound, physiological symptoms often coincide with psychological ones, and so many patients' reports will associate the two, using one to bring significance to the other. In other words, patients usually seek to explain their loss of desire by associating it with some other depressive symptom, such as lowered self-esteem—reasoning, to cite only one example, that they no longer want to eat because they are unworthy of taking food from others. Self and world both appear manifestly degraded, evil, repulsive, and to perpetuate such a dismal situation by incorporating even more of the world into oneself would be unendurable.^[76] As a psychological theory, the depressive's explanation fulfills the Freudian paradigm: it produces meaning by filling the gap that occurs between two symptoms ("I have no appetite" and "I feel so bad"), and it assumes that the physical symptom expresses a psychological state, which is its cause.

To us, anorectic conscience appears delusional, or at best a rationalization, and we may dismiss it as absurd—but delusions, like scientific theories, have an explanatory power that seems as compelling to the psychotic as objective physical evidence does to the individual whose pain results from visibly lacerated skin or a broken bone. We all need to provide a continuous narrative for our experiences; this is the basis of consciousness, and anomalous or bizarre experiences call for unusual explanations to connect the dots, to account for fragmented or incomplete events.

The symptomatic form manic-depressive illness takes, however, usually reflects the individual's experience.^[77] Here biology and psychology combine. In depression there is often some reference to the patient's life (for example, a normally confident pharmacist may worry obsessively about accidentally poisoning her customers), but in severe mania the individual may lose all contact with his euthymic state (a loving husband may be unfaithful to his wife and unconcerned about his children). Like anyone else, the individual tries to formulate an explanation for his experiences; the more anomalous the experiences, the more bizarre may be the explanation, especially since a mood disorder fulfills its own prophecies by affecting what evidence the subject attends to and how he interprets it. Environmental and social factors often combine with biochemically induced delusional beliefs when the patient attempts to account for himself:

For example, suppose you are having mood swings that seem unconnected with events in your life. If you have read something suggesting that hormones (or blood sugar, or magnesium) affect mood, and you have social support for this idea, you may be less likely to conclude that some abstract force is controlling you. Similarly, if you are skeptical of miracles (or magic) to begin with, you should be less likely to conclude that a visual experience is the blood of Christ, and more inclined to look for other possibilities. Delusions should be affected by patients' cultural and social experience, particularly when the delusions are not sufficiently driven by perceptual experience to determine their character and are not constrained by alternative possibilities that are salient because of prior experience. Especially important may be the availability of alternative explanations for people's own feelings .^[78]

In worldwide surveys of delusional themes, researchers have found that Kuwaiti patients have significantly more delusions centered around supernatural phenomena such as sorcery or the devil; lower-class Egyptians are more apt to have religious delusions such as a conviction of being Mohammed or a great prophet; upper-class Egyptians display more secularized delusions such as being affected by computers, X-rays, electricity, or government spies; and Irish-Americans develop sex, sin, and guilt preoccupations.^[79]

Delusional patients not only produce odd accounts for themselves; they also try to read them to discover what they might mean. Clifford Beers, for instance, combined paranoid and anorectic ideas in his refusal to eat. He theorized that the mental hospital in which he had been placed had been secretly infiltrated by ingenious, Kafkaesque police detectives who were seeking a confession from him for an unspecified crime (though he remained ignorant of the accusation, Beers nevertheless felt it was deserved):

They now intended by each article of food to suggest a certain idea, and I was expected to recognize the idea thus suggested. Conviction or acquittal depended upon my correct interpretation of their symbols, and my interpretation was to be signified by my eating, or not eating, the several kinds of food placed before me. To have eaten a burnt crust of bread would have been a confession of arson. Why? Simply because the charred crust suggested fire; and, as bread is the staff of life, would it not be an inevitable deduction that life had been destroyed—destroyed by fire—and that I was the destroyer?^[80]

Such deductive ingenuity would be worthy of a Freudian, but for all this theorizing, Beers could not discover why he felt so despondent and

guilty in the first place. Nothing he had done had caused him to be manic-depressive. For all its plausibility, food proved to be neither the answer nor the significant, therapeutic symbol. Virginia Woolf also had problems with the association of food and guilt, as Quentin Bell notes:

she thought people were laughing at her; she was the cause of everyone's troubles; she felt overwhelmed with a sense of guilt for which she should be punished. She became convinced that her body was in some way monstrous, the sordid mouth and sordid belly demanding food—repulsive matter which must then be excreted in a disgusting fashion; the only course was to refuse to eat. Material things assumed sinister and unpredictable aspects, beastly and terrifying or—sometimes—of fearful beauty.^[81]

Virginia makes the same connection when describing a passing depression but notes that it does not hold up once she is euthymic:

I think the blood has really been getting into my brain at last. It is the oddest feeling, as though a dead part of me were coming to life. I cant tell you how delightful it is—and I dont mind how much I eat to keep it going. All the voices I used to hear telling me to do all kinds of wild things have gone—and Nessa says they were always only my imagination. They used to drive me nearly mad at Welwyn, and I thought they came from overeating—but they cant, as I still stuff and they are gone. (Letters 1: 142)

Attitude toward eating clearly differentiates Freudian and psychobiological approaches to manic-depressive illness. Critic Louise DeSalvo takes the purely psychological view when she decodes Woolf's loss of appetite:

As [psychotherapist] Alice Miller has learned, symptoms are a form of communication. To starve yourself means that someone has starved you. Virginia's feelings were also frozen—she knew that if she showed rage, anger, nervousness, she would be medicated into submission. Moreover, cutting off feeling is one way of handling sexual abuse; the results, however, are deadening.^[82]

Ironically, DeSalvo engages in the same kind of speculation that expresses Beers's paranoia, for she assumes that meaning underlies symptoms in a more or less direct line of logic. Because she assumes that Woolf's depression is a coping mechanism chosen, consciously or unconsciously, by a victim of incest, DeSalvo feels she has arrived at the symptom's origin and

meaning simultaneously, by merely reversing the definition of who is starving whom. Such a scenario might be true of a non-manic-depressive: childhood deprivation and sexual abuse may be the "message" of purely psychological symptoms created by an ego unable to cope with hurtful feelings in any other way. But how, then, do we distinguish this form of communication from a symptom the ego has not invented, the deadening of appetite and feelings and love of life produced by abnormal brain chemistry? The "message" of anorectic conscience in this case would not be "I was sexually abused" but "I feel as bad as if I had been sexually abused," or, in Woolf's case (as I will argue in Chapter 6), "I feel bad when depressed, just as I did when I was sexually abused: depression is like that, a victimization, an inescapable emptiness and hunger where even food is tasteless, repulsive, poison." Psychoanalytic critics need to familiarize themselves with modern neuropsychiatry in order to be aware that our subjective lives are complicated mixtures of mind and brain, the freely chosen and the brutally imposed, the meaningful and the unintelligible.

Hypochondriacal preoccupation with bodily functions and the belief in some physical cause for their psychological pain occur in a third of depressed patients—not surprisingly, since mood disorders are so closely linked to metabolism. Styron sensed a direct connection between brain and mind: "What I had begun to discover is that, mysteriously and in ways that are totally remote from normal experience, the gray drizzle of horror induced by depression takes on the quality of physical pain."^[83] Many patients particularize vague depressive fears by worrying about disease, commonly focusing on heart disease, cancer, and, most recently, AIDS, because in Western culture these most forcefully symbolize a personal doom. The general loss of physical energy can also affect their judgment: they consider their work and activities as trivial and their past life as a failure. Any evidence to the contrary is dismissed or misinterpreted to fit their despondent mood. Since depression interferes with memory and the brain's ability to concentrate and evaluate (Clifford Beers remembers being unable to read a newspaper, for it "appeared an unintelligible jumble of type"), the patient's work usually does suffer, adding to his conviction of inadequacy.^[84] Studies show that when depressives are exposed to new material, they are less likely than controls to link novel information to preexisting knowledge, a result that indicates some hindrance to the fundamental human capacity for recognizing significance consistently over time.^[85] Depressives' memory of events becomes jumbled, and unintegrative habit begins to dominate thought. They fall back on uncreative and inflexible

routines, which feeds their developing nihilism and pessimism; life indeed becomes empty and fragmented.^[86] While hypomanic, an employee may outperform every competitor, creatively solving problems by discovering hidden connections or correlations and by energetically exploiting opportunities. But the same individual will lose all that talent and stamina when depressed, as both John Custance and Virginia Woolf noted:

Instead of the light of ineffable revelation I seem to be in perpetual fog and darkness. I cannot get my mind to work; instead of associations "clicking into place" everything is an inextricable jumble; instead of seeming to grasp a whole, it seems to remain tied to the actual consciousness of the moment. The whole world of my thought is hopelessly divided into incomprehensible watertight compartments. I could not feel more ignorant, undecided, or inefficient. It is appallingly difficult to concentrate, and writing is pain and grief to me.^[87]

This is the worst time of all. It makes me suicidal. Nothing seems left to do. All seems insipid & worthless. (Diary 3: 186)

Depressives habitually look on the gloomy side of any question. They come to believe that their very existence bodes ill for themselves and their families. The future is perceived as grim, empty, hellish, and death seems the only escape. Deeply depressed patients are unable to feel emotions at all; the brain is unable to process even pain. Often, as if to explain to themselves why they feel so low, they accuse themselves of terrible sins, or of being responsible for family tragedies. Sometimes they hear voices which make these accusations for them, and experiencing these hallucinations further convinces them that they are deservedly losing their minds.^[88] The messages of these voices are usually related to the content of their particular delusion concerning (or explanation of) their experiences. If a patient explains his depressive fears as feelings of persecution ("I feel so scared, someone must want to kill me"), the voices are usually berating or derogatory. If he finds thematic unity in a general nihilism ("Life is terrible, worthless; total nuclear annihilation is unavoidable"), the voices may threaten doom and destruction.

Because any theory used to explain our personal experience affects how we make decisions, the decision to die is thus a frequent feature of the depressive state. At least 15 percent of manic-depressives, if left untreated, commit suicide; this is thirty times the rate found in the general population and is higher than for any other psychiatric or medical risk group.^[89] But Winokur found that an overwhelming 82 percent of his depressed

bipolar patients had suicidal ruminations.^[90] Thus, it is difficult to tell who will attempt suicide and who will not: even seemingly strong people with a wide range of personal assets may, when depressed, reinterpret those assets as liabilities (e.g., ambition is no longer seen as a positive sign of success but as an empty gesture or rude pushiness or an unforgivable crime at the expense of others). Suicide itself is not a reliable indicator of strength of character or neuroticism, or the quality of the suicide's previous life, or the amount of support and love given by family and friends.^[91] For some patients, it is the memory of happiness once known, or even the potential for future happiness that now seems beyond reach, that makes their despair seem unendurable.^[92] Pointing out a depressive's available resources or opportunities for satisfaction (the love of his family, his potential for success, etc.) may only exacerbate his sense of the internal abyss that separates him from what he feels he needs most. Some suicidal patients are very adept at disguising their hopelessness, especially if a resolution to end their misery offers them their only hope, in which case they can appear calm and in better spirits shortly before they kill themselves.^[93] Moreover, suicidal tendencies are often masked; they can occur in the absence of delusions, hallucinations, or psychomotor retardation, and the patient may not voice self-destructive wishes.^[94] Clinicians and family members must look for other, subtler symptoms: alcoholism, insomnia, loss of weight and appetite, irregular heart rhythm, recklessness, social withdrawal.

Why did Woolf kill herself? Psychoanalyst Alma Bond devotes an entire book to the question of Who Killed Virginia Woolf? and finds, predictably enough, too many readily available answers: the threat of a German invasion, Virginia's fear of becoming an inescapable burden to her Jewish husband, her belief that her sister, Vanessa, was withholding her love, her knowledge that her lesbian lover was unfaithful, her anger that Leonard was domineering, her despair at the thought that she might lose the power to write. With so many reasons for suicide, wouldn't an emotionally weak woman be overwhelmed and offer us a compelling, dramatic climax to a life of neurotic conflict? Bond's speculation begins well enough: she wonders why Woolf killed herself when so many other people at the time endured similar trials. Because she is a Freudian, Bond explains Woolf's vulnerabilities by privileging (first hypothesizing the existence of) unconscious conflicts. Invasion, infidelity, loss, self-devaluation—all become more than Virginia can bear, not because they are in themselves unbearable but because they replicated her untimely weaning as a six-week-old baby, her mother's emotional distance, the infant Virginia's masochistic wish to

surrender to a defensively idealized mother, the daughter Virginia's envy of her father's penis, and the sister Virginia's sexual abuse at the hands of her half-brothers. As usual in a Freudian landscape, family life is hell; why else would anyone fall ill? Bond still relies on Freud's sixty-five-year-old description of psychosis as an unreconciled conflict between the ego and an intolerable reality and on Jacobson's thirty-three-year-old idea that manic-depressives experience pronounced shifts in mood and self-esteem because an immature superego has failed to modulate psychic energy (primarily anger toward parents, in mania, and anger toward self, in depression).^[95] Asserting, with confidence, that "all delusions reflect the central conflict of a tormented psyche," Bond works backward to reconcile what would appear to her (indeed, to anybody who enjoys a reasonable sense of reality granted by sanity and stable brain chemistry) to be the only "meaningful" conflict.^[96]

"Nobody has explained to my satisfaction what brought on that last attack" of 1941, Bond states. If personal satisfaction is the prime requisite, the closure of death requires an artful, even melodramatic explanation:

Virginia Woolf was not an integrated individual. She labored all her life to consolidate her personality, with only temporary success. . .

In my opinion, there was one means left to Virginia to unite her discordant selves: In her death she discovered the way to integrate the "orts, scraps, and fragments" (Woolf, 1941, p. 215) of her splintered soul. Then at last the important strains of her life—including the untimely disruption of the symbiosis with her mother and her early loss again through death, the highly ambivalent relationship with her father, the sadomasochistic interaction with her sister Vanessa, the loss of Vita as her lover, Virginia's disillusionment with Leonard and the "puncturing" of the family myth, the frightful experience of the war in the light of her inability to deal with aggression, and the death of Thoby and many of her friends, which reenacted the early traumatic deaths of her adolescence—all intermingled to culminate in her final act at the river Ouse.^[97]

Like the conclusion of a melodramatic Victorian novel, Bond's version of Woolf's death threads disparate strands together in an aesthetically satisfying ending. Do manic-depressives think about suicide in such pathetic terms? Sometimes, but only when depressed. Elaborated reasons for a tragically appropriate end fill in the blank nothingness of depression, expressing its corrosive power of shaping perception and cognition so that past events seem ominously prophetic. When the patient is euthymic or manic, these same memories take on entirely different connotations: "My

Figure 1.
Peak Occurrence of Suicide by Month
(Based on review of 61 studies.
Jamison [MDI  243])

mother's death blighted my life forever" then becomes "My mother's death hurt, but it taught me to appreciate life more." Unfortunately, psychoanalysts are compelled by Freudian theory to view a patient's euthymic disavowal of unhappiness or despondency as a manic defense, or at least a neurotic repression. This theoretical position assumes, arbitrarily and destructively (for the patient), that the depressed view is the "true" expression of the patient's deepest, most authentic feelings. By focusing on depression, Freudians reduce the three states of bipolar disorder (manic, euthymic, depressive) to one state and inadvertently encourage the patient to think of his depressed self and its sad history/fiction of fated disappointments as most central to his identity. This clinical exaggeration of the significance of the patient's ill thoughts over his well thoughts can lead, tragically, to even more suicides.

Why did Woolf die? We must relinquish the demand for an answer that satisfies our need for narrative unity. Studies suggest that the frequency of manic-depressive relapses increases with age,^[98] so perhaps Woolf died for nothing more meaningful than the fact that the biochemistry of aging bodies changes and intensifies depression. Or perhaps it was the season. There is a striking peak incidence of suicide in May, a rise that begins in March (see Figure 1), as do the rates of hospital admissions for depression;

affective disorders are intimately connected to the body's circadian and seasonal rhythms. So perhaps Woolf died because age and winter combined to exacerbate depression. A third possibility exists: Woolf's last physician, Octavia Wilberforce, suspected in 1940 that her patient might be an alcoholic. If Woolf, like 35 percent of other manic-depressives, medicated herself with alcohol in the last year of her life, the resulting neurochemical changes could have contributed to the severity of her last depression and increased the risk of suicide.^[99]

In the end, we cannot hope fully to explain Woolf's suicide by means of traumatic events in her life. Depression alters the patient's perception of the story line of those events, and it would be a matter of blind luck (or an expression of mood disorder in ourselves) if we could empathize so completely as to see her death with her eyes. It is tempting to approach psychotic thinking as if it were just a matter of conflicted thinking resolvable by therapeutic insight, to assume that delusions reliably provide the curative clue. But such a perspective obliterates the troubling différance of insanity (the depressive lives in the same world of blue skies, comfortable houses, clean parks, bountiful malls, and loving families that you and I do but, perversely, feels tortured and damned by it all). Our superior attitude toward people who resort to suicide tells more of our needs and wishes than of those of the deceased. Ironically, although suicide can seem the most personal of all our life decisions, it can also be the most impersonal, for the biology of our brains operates in ways that may seem most inhuman. To explain why Woolf died we must explain why anyone dies—of disease, of injury, of birth defects. . . . Our free will is only one element in a complex configuration of forces interacting in ways that are often beyond our understanding. To dramatize this violation of ego's need for continuity in psychobiography, my discussion of Woolf's death appears here, rather than in the last chapter of this book. It ends without conclusion, as so much in life does.

Biology has profound personal consequences that invade the most private realms of our souls, our character, our self-insight. Perhaps this is nowhere more floridly depicted than in depression's power to induce a false sense of guilt. Ruminations on guilt are seen in one-third of depressed patients.^[100] First, they feel ashamed of losing control, of behaving bizarrely, of indulging in violent outbursts against those they love the most. If they do permanently alienate their loved ones, desertion and chronic loneliness may be taken as proving depression's insidious whisper that they are unlovable and unforgivable. If the loved one does not understand the impersonal origins of these eruptions of rage or distortions of personality

and desire, he or she may, implicitly or explicitly, reinforce the depressive's nearly unbearable self-condemnation. We read of the suicides of estranged spouses and rejected lovers in the newspapers every day, but we usually do not think beyond a tepid condemnation of their weakness of character or lack of foresight. We forget Satan's admonition in Paradise Lost that "the mind is its own place, and in itself, / Can make a heav'n of hell, a hell of heav'n."^[101]

Second, depressives feel guilt for which they cannot find a valid cause. They tend to think back over the years and center obsessively on some past event—an unpardonable sin (to explain their hopelessness and guilt), or a traumatic experience (to explain their helplessness and life's emptiness), or the loss of a significant person (to explain their extraordinary sense of abandonment and loneliness). Here emotion often serves as an informational cue: bipolars tend to remember positive experiences when in a positive mood, negative experiences in negative moods.^[102] An emotional state may influence memory storage and access.^[103] Studies have found that depressed patients are better able to recall words with negative content or negative experiences than positive words or experiences.^[104] The tragedy that seemed to Woolf to explain her emptiness, despair, and lack of a stable self-structure was the loss of her mother in 1895. Julia's sudden death apparently triggered Virginia's first manic-depressive breakdown, but, more important—for Woolf and for us—it became Woolf's metaphor for the birth of a bipolar identity, the stream in which she pictured herself as a fish, fixed, "held in place" by "invisible presences" (Moments of Being 80). It offered a coherent story line for experiences that would otherwise seem senseless and impersonal.

If personal history provides no such emblematic event, some depressives will castigate themselves for sins that are entirely imaginary or that they themselves cannot remember. After an unsuccessful attempt at suicide (like Woolf, he jumped out of a window), Clifford Beers interpreted everything that happened to him in terms of his despondency and guilt. When doctors applied hot poultices to his broken feet, his "very active association of mad ideas convinced me that I was being 'sweated'"—given the "third degree" by police intent upon gaining a confession from him for an unknown crime; "with an insane ingenuity I managed to connect myself with almost every crime of importance of which I had ever read."^[105] It is not the sin itself that is important, not even as a hypothetical, unconscious wish. The patient seizes upon sin as the only cause to be found for an indefinable despair. One patient

admitted to having committed the unforgivable sin but when [the psychiatrist], very interestedly, tried to find out the awful details, he replied "That's just it, I don't know what it is". The content of these ideas and delusions is consonant with the patients' personalities and activities. Thus a television newscaster felt that he was involved in a recent murder that had evoked much publicity. A conscientious doctor was convinced that he had poisoned a patient (actually alive and well) with an overdose of a drug in his prescription.^[106]

Leonard had suspicions that Virginia's depressed guilt had no simple origin:

Pervading her insanity generally there was always a sense of some guilt, the origin and exact nature of which I could never discover. . . . In the early acute, suicidal stage of the depression, she would sit for hours overwhelmed with hopeless melancholia, silent, making no response to anything said to her. (Beginning Again 163)

Other depressives fill the void by developing fixed false beliefs that symbolize their present mental states: they are guilty of having wished their parents dead, God has refused to forgive them for alienating the affections of a past lover, they are being spied on and persecuted, they have no intestines, their brains are rotting, the furniture in a room has been altered simply to irritate them, they have become the focus of universal abhorrence, or the world itself is disintegrating or plunging toward Armageddon because of their personal inadequacies and failures.^[107] In such a moral nightmare, suicide would seem a welcome release or at least an appropriate conclusion to a narrative of utter hopelessness. No wonder, then, that Freudians described such negativity as a self-induced attack on the ego. Since, as they saw it, all matters of punitive conscience arose from the superego, depression served to convince them that the superego could be vicious, even homicidal. But since neuroscience shows us that a depressive symptom can be elicited by the administration of certain drugs, by illness, or by brain injury, we must wonder if the attack is always "motivated":can the superego be turned on and off by physical changes? A specific depressive symptom may be the result of an unconscious conflict and be a good candidate for psychoanalysis, but global despair more likely has its source in a neuronal system that mediates all perceptions, feelings, and beliefs.

Because depressives are convinced they have been singled out for their personal shortcomings, they feel doomed, disconnected from the world, yet vulnerable to attack.^[108] Depressives' striking passivity led Willard Gaylin

to describe the symptoms of depression as "non-symptoms." Normally, in neurosis, symptoms are attempts to compromise one's way out of a conflict situation; they are reparative maneuvers executed by the threatened ego. But in endogenous depression, Gaylin observed, reparative mechanisms are at a minimum. Depressives are not victims of illusions: they have no illusions—and no protection against a dark world that is empty of meaning because the self has no power to create a satisfactory meaning.^[109] This produces a problem for the analyst, who must rely in part on the patient for his diagnosis. Depressed patients cannot always give true accounts of themselves, for mood is difficult to gauge; it undermines the brain's capacity to achieve self-insight, interpret experience, and make judgments about whether a present mental state conflicts with past states.^[110]

In the manic state the omnipotent subjective world dominates the objective, but the depressive state reverses these positions, rendering self powerless, hopeless, worthless, and uncreative, without even the desire to defend itself against its own perceptions. When biochemistry falters, the brain's ability to distinguish incoming from self-generated stimuli is undercut; interpretations become either predominantly positive or predominantly negative, depending on mood. If they are negative, the self feels impotent and the world seems hideously empty and malevolent. Although the patient may seem the picture of uncontrollable tearfulness and bitter sorrow, to him his emotions may seem "blocked" or "frozen," and so he may experience his self as unreal or as an open wound that will never heal.^[111] He feels truly depersonalized, self-less. Suicide looks attractive because the mind is already experiencing a death of the soul.

Woolf's depressions exhibited most of these symptoms, and she distinctly perceived their physical dimension:

I know the feeling now, when I can't spin a sentence, & sit mumbling & turning; & nothing flits by my brain which is as a blank window. So I shut my studio door, & go to bed, stuffing my ears with rubber; & there I lie a day or two. And what leagues I travel in the time! Such "sensations" spread over my spine & head directly I give them the chance; such an exaggerated tiredness; such anguishes & despairs; & heavenly relief & rest; & then misery again. Never was anyone so tossed up & down by the body as I am, I think. (Diary 3: 174)

In fact, many of her descriptions of symptoms that precede breakdowns emphasized physical changes: headaches or numbness in the head, insomnia, nervous irritation, a strong impulse to reject food.^[112] More important, she recognized that such physical changes had psychological consequences:

This is the worst time of all. It makes me suicidal. Nothing seems left to do. All seems insipid & worthless. . . . Mercifully, Nessa is back. My earth is watered again. I go back to words of one syllable: feel come over me the feathery change: rather true that: as if my physical body put on some soft comfortable, skin. (Diary 3: 186)

The physicality of manic-depressive illness can help us differentiate it diagnostically, in four ways, from the Freudian notion of neurotic depression. First, Woolf usually connected her depressions to physical changes or ailments that accompanied or preceded mood swings, an association research has shown does exist in mood disorders with strong biochemical components, though seldom in psychological mood disorders. Second, she was often able to state the time of onset of illness: whereas neurotic-reactives find it difficult to determine when they shift moods, manic-depressives can sometimes date onset to within the hour:

I woke to a sense of failure & hard treatment. This persisted, one wave breaking after another, all day long. We walked on the river bank in a cold wind, under a grey sky. Both agreed that life seen without illusion is a ghastly affair. Illusions wouldn't come back. However they returned about 8.30, in front of the fire, & were going merrily till bedtime, when some antics ended the day. (Diary 1: 73)

Third, neurosis rarely interferes with reality testing (that is, it is not accompanied by visual hallucinations), and it is often seen by the patient himself to occur as a response to a traumatic life event. Manic-depressive illness, in contrast, often inhibits reality testing and frequently occurs without any discernible exterior "psychological" cause unless physical stress accompanies it. And, fourth, in endogenous mood swings, symptoms tend to be more severe and more frequent than in neurosis. The patient perceives his illness more clearly as a distinct change from his usual self and complains more often of a loss of pleasure in activity and a loss of reactivity to usually pleasurable stimuli,^[113] as in these descriptions by Woolf of two depressions and their effect on her sense of self:

Here is a whole nervous breakdown in miniature. We came on Tuesday. Sank into a chair, could scarcely rise; everything insipid; tasteless, colourless. Enormous desire for rest. . . . [A]voided speech; could not read. Thought of my own power of writing with veneration, as of something incredible, belonging to someone else; never again to be enjoyed by me. Mind a blank. Slept in my chair. Thursday. No pleasure in life whatsoever. . . . Character & idiosyncracy as Virginia

Woolf completely sunk out. Humble & modest. Difficulty in thinking what to say. (Diary 3: 103)

[It's] a physical feeling as if I were drumming slightly in the veins: very cold: impotent: & terrified. As if I were exposed on a high ledge in full light. Very lonely. L[eonard]. out to lunch. Nessa has Quentin & don't want me. Very useless. No atmosphere around me. No words. Very apprehensive. As if something cold & horrible—a roar of laughter at my expense were about to happen. And I am powerless to ward it off: I have no protection. And this anxiety & nothingness surround me with a vacuum. (Diary 5: 63)

Like Rhoda in The Waves, the depressed Woolf feels naked and vulnerable, stripped of all illusions, as empty on the inside as the world seems to be on the outside. It has long been noted that depressed patients often identify the self with the external world,^[114] and this confusion between inner and outer destroys the perceiver's sense of an autonomous identity. All of Woolf's worst fears seem validated by what she perceives. In both of the episodes quoted above, self is blank, with no capacity to generate meaning or fiction, which would at least provide evidence that self existed. The situation is doubly difficult for a female depressive, since society tends to deny value and power to women's selves. Fiction, however, could, like a mother, like the mother Virginia had lost, validate and nurture. Thus Julia became a crucial emblematic part of Woolf's fictional world, which she consciously and repeatedly used to explore both her illness and her wellness.

Woolf needed to rework her experiences in fiction because in depression perceptions defy synthesis: the brain is incapable of integrating the full spectrum of the individual's feelings and desires, past or present. A wall of overly negative perceptions is raised that frustrates attempts by the therapist to cheer the patient. Helpless and overwhelmed by despair, Woolf felt as if the "veils of illusion" had been drawn, leaving her "to face a world from which all heart, charity, kindness and worth had vanished" (Letters 3: 50), feeling a "horror—physically like a painful wave swelling about the heart—tossing me up . . . spreading out over me. . . . One goes down into the well & nothing protects one from the assault of truth" (Diary 3: 110–12). Yet, even in the depths of despair Woolf found something of value to work with in her novels, a "truth" not glamorized or distorted by human illusions and human vanity. This truth was thus potentially inhuman, perhaps even inexpressible but certainly felt, and it contained the essence of reality that the "egotistical" manic Woolf overlooked. Just as the manic's "truth" reveals rampant subjectivity, with wishes and illusory

theories leveling out ambiguities and distinctions, the depressive's vision seems to him to unveil a severely objective truth, the world of stark objects unmolested by wishful thinking or vanity, as Woolf reports:

The depression however now takes the wholesome form of feeling perfectly certain that nothing I can do matters, so that one is both content & irresponsible—I'm not sure that this isn't a happier state than the exalted state of the newly praised. At least one has nothing to fear. (Diary 1: 214)

Identity and Bipolarity

If our sense of self is expressed in our words and actions, then Woolf's problem as a writer was to find a self underlying her disparate experiences, what she called "a core" in this 1921 letter to Sydney Waterlow:

You say people drop you, and don't want to see you. I don't agree. Of course I understand that when one feels, as you feel, without a core—it used to be a very familiar feeling to me—then all one's external relations become febrile and unreal. Only they aren't to other people. I mean, your existence is to us, for example, a real and very important fact. (Letters 2: 455)

Woolf understood Waterlow's situation because mood disorders have a powerful effect on a patient's sense of self, as one psychiatrist has observed:

I contend that because of the nature of this illness affective patients emerge with particular problems in organizing a sense of self that are specific to this illness. . . .

When a patient has a major affective episode, his or her normal self disappears. The patient becomes someone foreign, another self. By definition, this self has a different affective organization from the normal self. There are different thoughts, behaviors, and personality traits. Physiological rhythms and drives are dramatically altered. . . .

Unipolar patients have two personae: depressed and euthymic, "psychobiologese" for out-of-episode. Bipolars have three: depressed, manic or hypomanic, and euthymic. . . . The spectre of a recurrence can become a vivid phantom self, something or someone who might again take them over. Who, then, is the real self for someone who has been up and down and in between? Is the real self who one is when one is euthymic? Is it possible or even necessary to construct a whole self out of an amalgam of the "self-in-episode" and "self-out-of-episode"? Can this integration ever achieve the same coherence of self-structure that the patient previously took for granted?

. . . To switch unpredictably into highs and lows that are not in your control, when you have no clear sense of stable, differentiated identity to start with, leaves you without a critical anchor in a very treacherous storm.^[115]

To the manic-depressive, experience is polarized, the oppositions undercutting (deconstructing, as it were) each other. Because mood swings interfere with both cognition and memory, patients are left with little consistent evidence out of which to integrate disparate experiences of self. The euthymic self seems transparent compared to the vivid manic ups and depressive downs.^[116]

Manic-depression showed Woolf how subject and object interact to make meaning; it did so by periodically revoking meaning, by polarizing subject-object relations. Although euthymic manic-depressives can look back over a mood-disordered episode and see how wrong they were to make deeply gloomy or grandiose assessments of the value of life, patients who are in the midst of an episode find it difficult, if not impossible, to gain self-insight, since they typically over-identify with the world they see. A magically expanded world of miraculous meaning is allied with an exalted experience of the manic self perceiving that world, while a degraded, empty self either sees the world as being as barren as itself or, if objects are idealized, a world too good for the likes of the depressive. Fiction allowed Woolf to examine the pieces separately before she put them back together in a pattern of her own choosing.

But what pattern was right? As they move repeatedly from ill to well, manic-depressives tend to "seal over" memories of episodes of acute illness;^[117] undesirable or even "alien" experiences or behaviors are easily denied or fitted forcibly into an explanatory model that filters out the radical divergences of self and world that once were so compelling. The patient's attempts to protect a vulnerable self-identity may result in an intolerance for ambiguity or novelty^[118] —a temptation Woolf herself seems to have resisted successfully by acknowledging the value of the divergence itself:

But it is always a question whether I wish to avoid these glooms. In part they are the result of getting away by oneself, & have a psychological interest which the usual state of working & enjoying lacks. These 9 weeks give one a plunge into deep waters; which is a little alarming, but full of interest. All the rest of the year one's (I daresay rightly) curbing & controlling this odd immeasurable soul. When it expands, though one is frightened & bored & gloomy, it is as I say to myself,

awfully queer. There is an edge to it which I feel [is] of great importance, once in a way. One goes down into the well & nothing protects one from the assault of truth. . . .

I wished to add some remarks to this, on the mystical side of this solitude; how it is not oneself but something in the universe that one's left with. It is this that is frightening & exciting in the midst of my profound gloom, depression, boredom, whatever it is. . . . Life is, soberly & accurately, the oddest affair; has in it the essence of reality. I used to feel this as a child—couldn't step across a puddle once I remember, for thinking, how strange—what am I? (Diary 3: 112–13)

Woolf gained her perspective on depression by contrasting it to her manic episodes and by comparing both to the process of creative writing, which involves a similar alternation of creative construction with critical revision:

I tried to analyse my depression: how my brain is jaded with the conflict within of two types of thought, the critical, the creative; how I am harassed by the strife & jar & uncertainty without. This morning the inside of my head feels cool & smooth instead of strained & turbulent. (Diary 4: 103)

She found it very difficult to write fiction (as opposed to critical reviews) when she was depressed:

Its odd how being ill even like this splits one up into several different people. Here's my brain now quite bright, but purely critical. It can read; it can understand; but if I ask it to write a book it merely gasps. How does one write a book? I cant conceive. It's infinitely modest therefore,—my brain at this moment. (Letters 3: 388)

But she also realized that hypomania's energized and inventive fluency was not enough to produce lasting fiction. And so she noted, preparing to return to her writing after three weeks of headache and depression:

now I must press together; get into the mood & start again. I want to raise up the magic world all round me, & live strongly & quietly there for 6 weeks. The difficulty is the usual one—how to adjust the two worlds. It is no good getting violently excited: one must combine. (Diary 4: 202)

Depression, the critical, counterbalanced hypomania, the creative. Depression concentrated and contracted the gregarious Woolf who had felt scattered, buoyant, unheedful of anything outside of her own subjective world. What Woolf needed, therefore, was a subjective-objective view that

integrated the critical and the creative. She knew that only a flexible self-neither a depressive, rigid one nor a manic, scattered one—was capable of artistic fusion. Elucidating this view became a central concern in her novels.

None of Woolf's doctors could satisfactorily explain how the sane and the insane Virginias were related, because they did not even recognize clearly the symptomatic changes: in their eyes, her illness merely produced an incoherence or self-indulgence that was best left unexamined. Indeed, one of Savage's colleagues, Thomas Clifford Allbutt, recommended against much analysis or discussion of mental illness with clients: "we must beware of putting notions into the patient's head; . . . we must avoid giving the child, or the childish adult, the 'formula for his defects,' lest he act up to the character."^[119] When Dr. Sainsbury prescribed "Equanimity—practise equanimity Mrs Woolf" (Diary 2: 189), Virginia considered the advice superfluous. In her diary, she continued to probe madness: "what use is there in denying a depression which is irrational?" (Diary 2: 232). That is a good question, but her doctors were not prepared to ask it. Leonard was curious, but until Virginia was past thirty years old he was unable to see a pattern in her symptoms. By then she had begun exploring symptoms in her fictional characters.

Woolf's knowledge of her illness was nonmedical, the result of an acute sensitivity to what she felt, not of scientific analysis. She particularized the problem of her illness in terms of discovering or creating a sense of self in spite of, but also recognizing the validity of, the multiplicity of her experiences. In her diaries and letters she evidenced her awareness that mood shifts caused her to act against her normal desires and perceptions. To Dora Sanger she apologized for previous hostility:

Your letter to Leonard makes me very angry with myself. How can I have been such a fool as to spoil those days with "merciless chaff"? It must have been some idiotic mood—probably nervousness—on my part. I do hope you will forgive me and believe in the sincerity of my affection. (Letters 4: 135)

It was with this subjective experience of the multiplicity of manic-depressive illness that she worked. "After being ill and suffering every form and variety of nightmare and extravagant intensity of perception" (Letters 4: 231), Woolf questioned her "terrible irregularities," her "spasms of one emotion after another" (Letters 5: 29). But instead of discounting the "mad" feelings as incoherent and irrelevant (as Savage had done), or imposing a phallocentric Freudian explanation, she turned the issue around and questioned

all mental states—normal or abnormal, in herself and in others—and the unexamined assumptions about their integrity:

and then there's the whole question, which interested me, again too much for the books [Night and Day] sake, I daresay, of the things one doesn't say; what effect does that have? and how far do our feelings take their colour from the dive underground? I mean, what is the reality of any feeling?—and all this is further complicated by the form, which must sit tight, and perhaps in Night and Day, sits too tight; as it was too loose in The Voyage Out. (Letters 2: 400)^[120]

The experience of mood swings challenges our fundamental belief in the authenticity of identity and the reality of emotion, for the dividing line between well and ill feelings is surprisingly tenuous. Many manic-depressives know by experience that a seemingly normal depressive reaction (to bad news, the loss of a loved one, a marital squabble) can sometimes deepen into a major episode of psychotic proportions, or that a feeling of well-being, or happiness and creativity, can sometimes escalate into hypomania or mania:

Many common emotions range across several mood states, spanning euthymia, depression, and hypomania. For example, irritability and anger can be a part of normal human existence or alternately can be symptoms of both depression and hypomania. Tiredness, sadness, and lethargy can be due to normal circumstances, medical causes, or clinical depression. Feeling good, being productive and enthusiastic, and working hard can be either normal or pathognomonic of hypomania. These overlapping emotions can be confusing and arouse anxiety in many patients, who may then question their own judgment.^[121]

The relationship between ill and well emotion was made further significant for Woolf because her father, Leslie, treated his own mood swings as if they were legitimate responses to real conditions. He demanded from his family consistent support and care when anxieties struck him, for he did not question the reality of those "bad thoughts," or any of his feelings, though he knew they were at variance with his convictions at other times. Carried away by the conviction of a mood, he angered and alienated loved ones, which only exacerbated his already shaky self-esteem when depressed. When well, he did not look beyond his expanded self-confidence to examine critically what he had previously felt: he left his exhausted family and vigorously climbed alpine mountains. Woolf admitted her divided feelings by noting that "all interesting people are egoists, perhaps; but it is not in itself desirable" (Diary 1: 152) to impose one's subjective world on

others. She admired her father's mind even as she hated his seemingly infantile dependency. Clearly, she chose a different path from his: to think about her mental states, to scale inner mountains rather than outer. Even as early as January of 1915, after two years of recurrent and severe bipolar episodes, Woolf realized that there was a qualitative difference between "sane" feelings and "insane" ones: "I thought how happy I was, without any of the excitements which, once, seemed to me to constitute happiness" (Diary 1: 20). An essential element of "natural happiness," as opposed to "intense happiness," she noted in 1925, was that she felt "stabilised once more about the spinal cord" (Diary 3: 73, 43). Such discriminations helped her realize that if feelings can be fictional, then self is not a given (not given by birth, or by mother, or guaranteed by exaggerated support from a coerced family) but a creation—and, at that, not the old egocentered self of traditional novelists. A "modern" self, especially the self of a feminist and a manic-depressive, must be continually created and re-created and reevaluated. The power to give birth to herself lay solely in her own hands.

In order to "authorize" herself, Woolf continually probed this connection between normal and abnormal mentality, letting each one inform the other, questioning not only emotion but the self—sane or insane, what was it? Rocked back and forth between subjective omnipotence and depersonalized impotence, she wondered whether self was merely an illusion, a phantom shadow shaped like a human being:

How much I dictate to other people! How often too I'm silent, judging it useless to speak. I said [to Katherine Mansfield] how my own character seemed to cut out a shape like a shadow in front of me. (Diary 2: 61)

What she sought in her fiction, therefore, was a marriage of these two modes of perception, manic and depressive, the ability to imagine wedded to a lucid recognition of reality, an epiphanic moment when her inner being and the outer world cooperated with each other, each ratifying the existence and the worth of the other, so that self became more than a walking shadow or an inflated ego; it became both real and invented, like a work of art: "I thought, driving through Richmond last night, something very profound about the synthesis of my being: how only writing composes it: how nothing makes a whole unless I am writing" (Diary 4: 161); "[I] write rather to stabilise myself " (Diary 3: 287). Perhaps she was thinking here of Katherine Mansfield: "'Nothing of any worth can come of

a disunited being', [Mansfield] wrote. One must have health in one's self" (Granite and Rainbow 75). Woolf too saw the connection between art and mentality, but, as I will argue in the next chapter, she questioned the value of achieving closure and certitude in either.