A lot of treatment for mental health concerns is focused on the disorder. Medications for the symptoms, cognitive-behavioral therapy for the irrational thoughts. Professionals always asking “How’re you doing?” “How’s the week been?” “How’s your depressive mood this week?” They look at your eye contact, monitor your lithium levels.
The focus for most treatment professionals is on a patient’s symptoms and the alleviation of symptoms. Few professionals delve into how a disorder — like bipolar disorder or clinical depression — changes our identity. Everything we know about ourselves.
Everything we thought we knew about ourselves.
That’s why this recent piece in the NYT Magazine by Linda Logan exploring this issue is so interesting and timely.
Our identities as unique individuals with well-worn and familiar roles in life — mother, confidante, partner, employee — are quickly stripped away when a new label takes over: patient. Inpatient. Psychiatric inpatient. In all of society, there is almost no worse label that could be applied.
The illness then takes precedent. Everything about you fades away. It’s all about treating the symptoms, bringing them “under control” — usually through a combination of medication and structured activities in an inpatient setting. It’s an unsettling and uniquely dehumanizing experience. In our society, I suspect only prisoners experience worse.
Linda tells the long and sad story of her grappling with her disorder — bipolar disorder — while a mother to three children and struggling to complete her doctoral studies in geography:
The last time I saw my old self, I was 27 years old and living in Boston. I was doing well in graduate school, had a tight circle of friends and was a prolific creative writer. Married to my high-school sweetheart, I had just had my first child. Back then, my best times were twirling my baby girl under the gloaming sky on a Florida beach and flopping on the bed with my husband — feet propped against the wall — and talking. The future seemed wide open.
Linda writes, “I would try to talk to my doctors about my vanishing self, but they didn’t have much to say on the subject.”
While some medications affected my mood, others — especially mood stabilizers — turned my formerly agile mind into mush, leaving me so stupefied that if my brain could have drooled, it would have. Word retrieval was difficult and slow. It was as if the door to whatever part of the brain that housed creativity had locked. Clarity of thought, memory and concentration had all left me. I was slowly fading away.
Going back again and trying to regain your identity as a unique person with a number of roles in life can be just as hard.
Philip Yanos, an associate professor of psychology at John Jay College of Criminal Justice, in New York, studies the ways that a sense of self is affected by mental illness. […] Yanos told me that reshaping your identity from “patient” to “person” takes time. For me, going from patient to person wasn’t so arduous. Once I understood I was not vermicelli, part of my personhood was restored. But reconstructing my self took longer.
Mental health professionals across all professions — psychiatry, psychology, social work, etc. — should be more aware that this loss of self identity is a very real component of some people’s mental illness and subsequent treatment. It should be addressed as a regular component of mental health treatment, especially when the loss is acutely felt.
Because across all of healthcare, we are quick to dehumanize patients and focus only on the treatment of symptoms. Maybe it’s a way some professionals seek to keep their patients at arm’s length — not to become too emotionally connected to them. But in doing so, it also sends a (perhaps unintentional) message to the patient — you are only a constellation of symptoms to me. That’s all we’ll focus on, that’s all we’ll treat.
As professionals and clinicians, we can do better. We should do better to not turn someone in emotional pain into a simple diagnosis or label. If we think of Linda as simply “Oh, the bipolar woman in room 213,” we’ve lost our humanity and our focus.
Linda is now 60, and has lived a life full of color and heartbreak. Her story is worth checking out below.
Read the full article: The Problem With How We Treat Bipolar Disorder
5 comments
I actually finished reading Linda’s article a few minutes before stumbling over this one. More than simply a heartbreaking tale of survival, she provides a template for how and to what extent the core of our very being — each one’s sense of self — is set loose, erased and ultimately lost to us when suffering severe psychopathology. I felt a palpable sense of having lost something after reading the last few paragraphs.
I believe what Linda describes happens to a lesser extent for everyone at times in our lives — an existential moment in which boundaries blur, life seems completely bereft of meaning and the will to continue struggling seems a distant and empty memory.
Yet there is hope. There are a number of studies under way that seek to predict risk factors for anxiety, depression, PTSD, alcoholism and suicide. The studies in which I have most interest involve speaking to adolescents and their families, with adolescence being largely accepted as the second most powerful time for the development of self.
Clinicians would likely benefit from being less concerned about symptom management and therapeutic outcomes, and with placing a greater emphasis on the whole person in treatment.
While not related to the above story in the NY Times, I ask what about patients who get falsely labeled Bipolar who are in fact something completely otherwise, and the psychotropics do in fact cause much more harm or at least disruption?
Mood swings are NOT just about bipolar! Boy, have I seen that first hand in my travels.
I had read Linda Logan’s heart-breaking article in the New York Times on how doctors treat the symptoms of mental health disorders without taking the time or care to make a meaningful connection with the patient’s feelings, thoughts and sense of self, which often are in jeopardy because of the drugs that are administered. Thank you for bringing this article to your readers’ attention. I have very high regard for PsychCentral.
This rang very true to me. But regarding chronic illness- the onset of life changing symptoms, the diagnosis, the categorizing for treatment paradigms, the loss of everything i ever was up to that point… i became the rheumatoid arthritic. People see my crippled hands 20 years later and my creative gait and they think they know me. I became untethered to my known self, truly adrift in the unknown ether. It became so unsettling that i anchored myself into a new existence. I still mourn the old one like a dead child but I nurture what I have amidst the loss.
Linda’s article in the New York Times was indeed very timely and like others above, I too felt very touched by it.