Marbles: Mania, Depression, Michelangelo & Me is a graphic memoir written and drawn by Ellen Forney. It is a brilliant depiction, from the inside, of the experience of being diagnosed, treated for and dealing with the symptoms of BiPolar Disorder. I do want to take a moment and say that while I liked “comic books” as a kid, my current love of “graphic novels” and now “graphic memoirs” can be blamed directly on Joe Roberts, who pointed me to “Watchmen”, “Sandman” and “V for Vendetta”.
I highly recommend this graphic memoir to anyone who is struggling with this problem, who knows anyone struggling with this problem, those treating people dealing with depression and mania or folks that like a good story. This review will be reading and viewing this through my psychotherapist’s eyes.
Marbles is a memoir specific to Ellen’s diagnosis of Type 1 Bipolar Disorder. She starts as she is diagnosed and continues through her finding of relative balance and stability. She carries us through many interactions with her psychiatrist, her family and friends, her symptoms of mania and depression and fears about medications and their possibly changing her creativity.
I want to tell you about some of the things I loved about this book.
At numerous points during the story, Ellen portrays her sessions with her psychiatrist, Karen. I include the beginning of the first of these below. I do appreciate the psychiatrist going through the diagnosis straight from the DSM. I think this can demystify the diagnosis. I have done this numerous times. Ellen’s deflated feeling when categorized is something I need to be more sensitive about with folks I am working with in the future. Ellen has to choose what to share with Karen, omits important stuff at times, is relieved when she can escape answering certain questions (and avoid that choice of whether to be honest). She does sometimes call Karen on when she says things that don’t add up. I have often told people I am training or supervising that being a psychotherapist sanctions our behaving inappropriately, asking intrusive, impertinent questions and commenting on the behaviors of the people we are conversing with. I like to remember that when we do not get a straight answer, that may be what our client needs to do at that moment. I have never seen these therapist/patient interactions better portrayed than here.
Medications are central to this story. The psychiatrist focuses on this but not exclusively. To her credit, she is never reported to have uttered the phrase “you have a chemical imbalance”. Ellen does a great job depicting her ambivalence toward medications, even when they seem to be helping. Weighing the pros and cons of side effects is shown. Figuring out the meds is shown to be trial and error. This can be agonizing and is shown as such. Her story about not being able to have an orgasm after starting Tegretol is quite funny. Ellen goes into great detail about the different meds and the hoped for pros, possible side effects and her own personal experiences while taking them. Again, this shows what I have seen many times. Ellen’s experiences with side effects are portrayed in a fair amount of detail.
Her story about her medications fits quite well into the story that Joanna Moncrieff tells about the history of psychiatric medications in her book, The Myth of the Chemical Cure. Moncrieff critiques the idea that psychiatric meds have specific actions that act on a specific brain/chemical disease (the Disease-Centered Model). Ellen’s detailed descriptions of her experiences of the medications make more sense seen through the lens of Moncrieff’s Drug-Centered Model. The basic idea is that the drug’s effects interfere with symptoms without having anything to do with the actual causes of the symptoms. I plan to write in some detail about Moncrieff’s work on this. If you are interested, stay tuned.
Ellen’s artistic depictions of her experiences of depression and mania give me the feeling of, at least, getting some of what it was like. Her relationships with her symptoms are fascinating. Once she has been diagnosed, her experiences take on new meanings. Her vigilance in trying to know if some experience means she is ready for a high or a low is important. Some of her portrayals are heart wrenching.
Ellen and her psychiatrist do emphasize important things besides medications. This includes support from family and friends, self monitoring, activities (swimming and yoga for Ellen) and being actively involved in her own treatment. For me, Ellen represents the ideal client. She researches her diagnosis, actively engages in weighing the pros and cons of her experiences (symptoms?), she tries things she doesn’t really want to do at the suggestion of Karen, perseveres and is appreciative. She tries things on her own that she “shouldn’t” be doing, then evaluates their effects. I do hope those reading her book see the importance of all of these pieces rather than this being the story of a woman who found the right combination of medications.
Ellen does not directly say anything about placebo effects of the medications. The last example of her work that I will share here captures this so well that I wanted to include it:
The Michelangelo part of the book is important, examining the connections between madness and creativity. The story she tells has nuance and is likely to be helpful to others in making sense of these questions.
One caveat regarding Marbles is that I am unaware of any psychiatrist that actually does any form of psychotherapy anymore. While Ellen does not say so explicitly, her session must be more than med checks. All I know about these days that psychiatrists do 15 minute med checks and the use of the only tool they know, and they seem to use it to pound that nail relentlessly. I am sure there are exceptions and I wish I had some stories to share about them.
Marbles works on so many levels. Informative; honest; funny; heart-wrenching; artistically engaging; creative. I would use it as a primary text if I were teaching a psychotherapy class. Have you read it?