Monday, March 10, 2014
Mental Illness, the Identity Thief
by Grace Boey
I felt a Funeral, in my Brain,
And Mourners to and fro
Kept treading - treating - till it seemed
That Sense was breaking through -
And when they all were seated,
A Service, like a Drum -
Kept beating - beating - till I thought
My mind was going numb -
And then I heard them lift a Box
And creak across my Soul
With those same Boots of Lead, again,
Then Space - began to toll,
As all the Heavens were a Bell,
And Being, but an Ear,
And I, and Silence, some strange Race,
Wrecked, solitary, here -
And then a Plank in Reason broke,
And I dropped down, and down -
And hit a World, at every plunge,
And Finished knowing - then -
* * *
In the poem, I felt a Funeral, in my Brain, Emily Dickinson watches a part of herself die as she sinks into insanity. The fragmentation and loss of the Self that Dickinson describes is a common theme amongst victims of mental illness. By their very nature, conditions like schizophrenia, depression and bipolar disorder have profound impact on one's personality, behaviour and beliefs. Mental illness can rear its head and usurp one's identity at any time; what happens next can be confusing and frightening, for victims as well as their loved ones.
Transformation of the self
A good place to start examining the loss of identity in mental illness is depression. This is something that many of us will experience in some form, if only briefly and temporarily, at least once in our lives. In addition to simply feeling low, those who are depressed lose interest in pursuing activities they usually enjoy, and struggle with feelings of negative self-worth. I remember watching one of my own close friends slip into depression as a young adult. She was usually a cheerful, kind and bubbly girl. But as her first semester in college progressed, she became increasingly reclusive, pessimistic and irritable. She stopped playing sports as she 'no longer felt like running around', and gained weight as she slept all day.
After witnessing and worrying about her continuous decline for a few months, I suggested she see a psychiatrist. She did. After a few months of being treated with therapy and antidepressants, my friend made a good recovery. She has sinced bounced back to being more or less her old self. The last time we met, she thanked me for pushing her to get treatment. "I felt so crappy - I had never felt so bad about myself in my life. I didn't know what was happening," she said. "I thought that maybe I was just changing, my personality was changing, and it was normal. But it wasn't. I feel like myself again."
Fortunately, my friend made a clean recovery, and hasn't had a relapse since her brush with depression five years ago. But for many others, the effects of mental illness are much more sticky - the 'old self' that used to exist is not fully recoverable. In a New York Times article, Linda Logan describes her long-drawn battle with mental illness. She writes, "During the 20-odd years since my hospitalizations, many parts of my old self have been straggling home. But not everything made the return trip. While I no longer jump from moving cars on the way to parties, I still find social events uncomfortable. And, although I don't have to battle to stay awake during the day, I still don't have full days - I'm only functional mornings to midafternoons. I haven't been able to return to teaching. How many employers would welcome a request for a cot, a soft pillow and half the day off?"
In another personal account, psychiatrist Karen Hochman recalls how paranoid schizophrenia completely transformed her brother Mark, as he descended into delusion and irrationality. "It was following my mother's death that I believe Mark experienced his first psychotic break. I coped with my grief in my way, which was always with the support of and conection to others. Mark, in his characteristic way, bore his grief on his own. His choices for himself had always differed from mine for myself, but during the years immediately following my mother’s death, his ideas, choices, and actions became increasingly incomprehensible to me. His discourse became vague. At the same time, his poorly articulated ideas became of increasing importance in his definition of himself." Six years after his mother's death, Mark hung himself from a maple tree.
Discourse of 'old' and 'real' selves, of course, presupposes the existence of a healthy or authentic self that is separable from the sick one. For victims whose symptoms manifest from young, the notion of such a self in opposition to the sick self might not make sense at all. In the two-part documentary, The Secret Life of the Manic Depressive, Stephen Fry describes how he experienced symptoms of bipolar disorder from an early age. Fry began acting out as a young boy, and was expelled from school for bad behaviour at the age of 15. At 17, he was arrested and served jail time for credit card theft.
What might Stephen Fry be like today if not for his manic depression? Lacking any reference point, it's impossible to say. His troubled adolescence is typical of those who are later diagnosed with bipolar disorder - for such people, mental illness swoops in and takes over one's identity before it even gets the chance to develop. Before they seek help, if they do, these people know no other way of being than the one that mental illness has given them.
Losing social identities
In life, we often find ourselves in the social roles we play. The multiplicity of these roles gives mental illness yet more avenues to wreak havoc on our identity. When struggling to keep up with the demands of everyday life, many victims of mental illness come to identify with labels like 'bad friend', 'bad lover', or 'bad employee'.
For a long time, I myself struggled with being a 'bad student'. Like Fry, I began to experience symptoms of bipolar disorder from a young age, which affected my behaviour performance in school. I was a bright, hardworking child when I entered primary school at 7, and landed myself in a special programme for gifted students. But my performance in school started slipping at around the age of 9 or 10 as my mental life became increasingly troubled. I lost all interest in my academics, and with increasing frequency I was sent out of class or reprimanded for failing to do my homework. By the time I was thirteen, I was a bona fide bad student - I squandered my opportunity in the top girl's school in my country, probably spent more hours in detention than in class, and was effectively kicked out at the age of 14. I continued to underperform and face disciplinary problems right up to my GCSE A-Levels.
Luckily for me, the hardworking young girl who once took pride in her studies somehow emerged again in college, after disappearing for a decade. I remember how confused I was when my one of my professors praised me for being a 'good student' in freshman year - I couldn't believe I was getting positive feedback from an authority figure in school. I thought to myself, he's got to be sarcastic. Me? Good student? It wasn't until then that I realized how much of my poor self-esteem stemmed from identifying as a bad one. Despite working hard and eventually getting straight As, I constantly expected to fail after each test. To this day, I still suffer from a fear of academic authority figures. I still struggle not to engage in self-sabotaging academic behaviour. I still don't really think of myself as a good girl.
Since seeking help for manic depression, in addition to learning what it means to be a good student, I'm also learning what it means to be a better friend, sister and daughter. But perhaps the most heartbreaking way in which mental illness can harm one's identity is through the role of parenthood. Logan describes the transformation of her identity as a loving parent into one who slept all day, and didn't see much of her children. Before the onset of her depression, she was “twirling [her] baby girl under the gloaming sky on a Florida beach and flopping on the bed with [her] husband.” After the onset of her depression, she struggled with taking care of her kids, slept for long stretches at a time, and was in and out of psychiatric units; all of this affected her sense of competency as a mother. When she was out of the hospital, she hired a full-time housekeeper - while Logan was “appreciative of her help, [she] felt as if [her] role had been usurped.”
Sadly, mental illness can steal one's parenthood before it has even begun. Many with mental illness choose to remain childless - either because they are doubtful of their ability to be a good caregiver, or as a recognition of the reality that mental illness is genetically transmitted. Curtis Hartmann, a lawyer and writer with bipolar disorder, writes that "this, unquestionably, has been the cruelty hardest to bear: no children to love for a man who loves to love."
In search of a sustainable sense of identity
Shifts in identity and personality means it is a constant struggle for many of the mentally troubled to reconcile the actions of their 'sick' self with their healthy self. Mental illness causes people to do things that are reckless or irrational - things that they later regret, or that are harmful to those around them. Who's this talking - me or my illness? If someone with psychosis experienced the desire to hop off a building, under the delusion that he could fly, he'd likely distance himself from this desire later, saying it was his illness talking and not him. Yet, not all behaviours and mental states are so clearly divorced from physical reality. It's often difficult for victims - and those around them - to recognize whether behaviour is attributable to the diminished capacity that illness brings.
There are many technical discussions to be had about mental illness, diminished capacity, blameworthiness, and identity. Such questions are undoubtably important, particularly for questions of legal culpability. But what good is the diagnosis of clinical depression when one has damaged a relationship beyond repair?
To cope with everyday life, many of those with mental illness simply come to accept their disorder and its effects as "part of the rich tapestry of life", as so eloquently put by one of the interviewees in Stephen Fry's documentary. Some even come to identify with their illnesses in positive ways: when asked, all of the subjects that Fry interviewed said they would not opt out of their bipolarity if given the chance. Manic depression is a way of life that comes with its own richness and perspective.
One may endlessly ponder the philosophical implications of sickness on the authentic self, and wonder what 'would have been' if not for this and that. But the brute reality is, mental illness saddles one with a set of limitations from which one's identity is forced to develop. The mentally ill cannot choose their condition, and although there are steps they can take to seek help and shape their own identities, they must accept that there are many things that will continue to remain beyond control.
Then again, isn't that so for all of us?
Image by Ana Kova.
Posted by Grace Boey at 12:10 AM | Permalink