I stayed up late the last few nights reading Jeffrey Eugenides’ The Marriage Plot, engrossed in large part by the subplot involving Leonard Bankhead, who suffers from bipolar disorder and what might be called a typically complicated relationship with both his manic phases and his medication.
The book is set in the early 1980s, which gives Leonard few viable options for pharmaceutical treatment. Now doctors often prescribe anticonvulsants such as Tegretol and Depakote, and atypical antipsychotics, but back then lithium was more or less the only choice.
Leonard began to experience depressions early in high school but wasn’t diagnosed or treated until his freshman year of college, when he began taking a low dose of lithium apparently without incident.
But as college graduation nears, he begins to chafe at the idea of taking the medication at all, which sets him on a terrible merry-go-round of breakdowns, high doses to get him back on track, side effects from the high doses and then rebellions against the side effects, followed by more breakdowns.
Having emerged from a three-week hospitalization and narrowly managing to graduate college, Leonard embarks on a months-long battle of pull and tug with his doctors over dosages.
The amounts they insist on make him sluggish, give him a telltale metallic taste in his mouth, slow his lightening-quick thinking and drag on his insatiable libido. The challenge, of course, is telling how much all these side effects represent a change from his baseline and how much they simply represent an evening out from the peaks of his manic phases.
His doctors insist it is the latter; Leonard thinks they are overly cautious, uncomfortable with having him veer just a bit into hypomania. And so he embarks on an experiment in self-dosing, one that will be familiar to many people who have taken medication and think their doctors are insufficiently sensitive to side effects. He decides to manage his own doses, cutting his pills in half, then in fourths and eighths.
Almost against my will, I found myself cheering him on, so sympathetically did Eugenides describe the side effects. Tellingly, Leonard gets good feedback, at first, from his experiment in self-dosing. His girlfriend is thrilled by his bold, thin, energetic, witty, sexually adventurous new (old?) self. When he proposes marriage, she accepts.
I knew this run couldn’t end well, and yet I hoped it would. In some ways, it was easy to trick myself, since so far we had seen the allure of Leonard’s hypomania and even the seductiveness of his high school depressions, but hadn’t experienced his hospitalization from his perspective, or yet seen how scary full-blown mania can be.
Then, Leonard, truly manic, runs away while on his honeymoon in Monte Carlo. He promptly crashes, and ends up stuck on suicide watch at his new wife’s parents’ house in New Jersey.
At the book’s end, he has abandoned his bride and escaped to a remote cabin in his home state of Oregon. We don’t know his state of mind, we don’t know if he is taking medication. All we know, presumably, is that he regrets his short marriage deeply.
But, for a young man who is short on options, including, even, which medication to take to control his highs and lows, one feels that by leaving he has, at least, allowed himself just a bit more freedom.