Choice and Identity in Mental Illness.

I don’t like to say that mental illness is like physical illness, or disease. When I think of ill people, I see patients in hospitals lying in beds, wired up, the truth of their bodily condition beeping out of machines, externalised and publicised for any trained ear. Doctors do not particularly need to know them to know their beeps, and hospital patients themselves are completely passive under ticking clock faces. Their beats, their breaths, their tumours, their scars, do as they will.

The comparison of mental illness and physical illness has become familiar. Don’t tell people who are depressed to ‘cheer up’ because you wouldn’t tell someone with cancer to just ‘get better’, the vital property shared of the two being that the illness makes them completely incapable of doing that. What’s happened and continues to happen within them is completely beyond their control. It isn’t a choice.

But a person struggling with mental illness is far more complex than that and, in my view, the mentally ill deserve better. They know fresh, hidden wisdom about wellbeing like untouched snow and they exercise it in ways we couldn’t understand. When depressed people cheer up they bring some new colours back with them. We can’t deny that cheering up, in the sense of long-term stable recovery, is exactly what we want depressed people to do. I am aware that it is one of the most difficult things you can ever have to embark on, it’s a long, hard, monstrous journey. From my own experience, I would describe it as learning to really not think about a crocodile when someone tells you not to think about a crocodile. It’s so natural, your mind serves the image up to you like a keen child with a crayon drawing, but you have to simultaneously recognise the thought itself but also force it to pass through you completely unacknowledged. But once you have a way out of mental illness, you have something that unaffected people can never understand. I don’t believe many things make you ‘ready for anything’, but I believe recovering from acute mental illness does.

For these reasons, I’m growing concerned about where the emphasis is being placed on the issue of mental health these days. As much as I am on board completely with fighting against the stigma of mental health, I don’t think this is to necessarily mean welcoming unrestrictedly our diagnoses into our identities. What we class as our identities, are parts of ourselves which have substantial effects on ourselves and our lives, but which we did not choose. Being a woman, being black, being gay, being Norwegian, being shy, etc. We certainly do not expect people to get better from these things. And this is my somewhat controversial concern; as mental illness more and more becomes something we are encouraged to integrate into our identities, the emphasis is no longer so much on getting better.

I’m not arguing that we choose to be mentally ill. We don’t, but at the same time we’re staring at the same blurred line between nature and nurture. The mentally ill are not completely robbed of choice. Given their capabilities and their circumstances, they can make choices – some of which are wiser, some of which are not. To make the wise choice every time is impossible. But to be honest if you’re factoring in your mental illness as a fundamental and unchanging part of the subject of you, preceding any choice being executed, it’s going to be harder to make choices which affect and hopefully challenge your symptoms.

Chronic mental illnesses such schizophrenia in which the aim is more symptom control rather than complete cure, personality disorders, and instances of illnesses such as bipolar with a significant genetic component, are complicated cases. I certainly think being at peace with having these conditions and not being ashamed of your own tailored way of dealing with the world is absolutely crucial to well-being. The fact that some individuals dealing with mental illness suffer from insensitive stares from strangers, impatience and misunderstanding from their peers and parents who suspect you of ‘faking’ and are embarrassed in the belief that the general term ‘nutter’ describes you, all exemplify the stigma still present.

But research suggests that if we allocate a ‘sick role’ to the mentally ill, we can impede their progress in recovery (from this short paper if you can get access) by erasing the influence of the willpower and choices of patients. If we digest our mental illnesses into our conception of ourselves completely, and we interpret our own behaviour through the lens of the DSM diagnosistic criteria of an illness, we lose not only our chances of recovery but a sense of ourselves. Cancer is completely indiscriminate but mental illness isn’t. Each patient’s experience with even the same mental illness is personal to them.

I know we don’t listen to each other much these days, but all the worthwhile people believe that you’re suffering. We truly hear that you’re suffering. I believe that you’re hurting. I watch in horror as mentally ill loved ones suffer in invisible intangible ways which don’t translate well into words, living in a haunted house and reaching out to scientists. I believe that you don’t need to feel like this, that there’s something wrong here, and that there’s nothing wrong with that.

And most importantly, I believe that you is important, that you are relentlessly interesting and insightful, and that you will continue to be when you recover.

2 thoughts on “Choice and Identity in Mental Illness.

  1. Love this post! Reducing stigma while also emphasizing that most common mental disorders are curable/treatable is so important. Since I’ve started to recover, I’ve noticed a lot of people online who talk about their problems with depression, anxiety, phobias, etc as if these are permanent neurological conditions and they react to peoples attempts to give practical advice for their symptoms as if it were some sort of ableist attack. It’s like they don’t realize that it’s possible to support mentally ill people without colluding with them

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    • Thank you for sharing this. I think you know exactly where I’m coming from. I started thinking these things when I saw so many of my friends who were diagnosed with depression/anxiety etc, even eating disorders, embrace those diagnoses so much that I felt they were standing in their own way of recovery. I found myself having to watch what I said to them so much that I started to feel like I was only ever colluding with them by being their friend and so the friendship started to fray. I wish them all the very best in their recovery but I think we need to start looking critically at some parts of this mental health culture young people are in.

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