Wednesday, August 10, 2011

The Personality of Mental Illness

On Monday’s Colbert Report, the guest was Nassir Ghaemi, who has written a book called “A First-Rate Madness: Uncovering the Links between Leadership and Mental Illness.” In the interview he explained that certain mental illnesses can have positive effects, such as mania contributing to intense creativity and depression being associated with greater empathy. I was thrilled to hear such an idea uttered on television, because it represents an almost unheard of push towards mainstream recognition of views similar to my own on mental abnormality, psychiatric medication, and over-diagnosis of mental illness.

I feel that Americans are far too quick to see themselves as afflicted by mental states and psychological tendencies, when they might be better served by identifying themselves as being simply influenced by those things. It suggests a terrible pessimism, and a pessimism that ironically is grounded in a preoccupation with happiness. It seems to me that people look on their own abnormalities through a negative filter, noticing only the extent to which it impedes a sense of pleasure and one’s capability for thorough social assimilation.

I’m certainly willing to acknowledge that there are mental afflictions that seriously threaten a person’s life or well-being, and to which medication may be a reasonable response, but I believe that in the vast majority of cases, the impulse towards diagnosis and treatment is based on an unanalyzed desire for normality, and that this ignores the possibility of negative effects from artificially altering one’s own brain chemistry. The essence of my view is that it is extremely difficult to disembed who you are from how your mind works. My personal feeling is that no matter how serious a diagnosis I could secure for any damaging tendencies or dark thoughts that I experienced, I would never appeal to medication or even to elaborate therapies as a means of contending with them. My worry is that by making a top priority of removing the abnormality, people effectively risk using a machete to remove a tumor. Something is likely to be lost that you weren’t aiming for. Is it worthwhile to induce changes in your personality for the sake of improving your sense of comfort? Some may well say yes, but I imagine that most people to whom the question is relevant simply don’t think about it.

For my part, I think that being prone to what one could call depression is part of who I am. By definition, I guess that means that I’m not a happy person, and that I don’t have much hope of being one unless I experience some very significant changes. I can be content with that, however, because I highly value other things apart from happiness. I also believe that without my depression, I likely would not be nearly as principled a person as I am, or precisely as Ghaemi points out, as empathetic. The worst of my depression can sap my motivation, but the best of it gives me a clearer picture of what a kinder loving world would look like. I can’t fathom the idea of reverse-engineering a part of my brain so as to be able to operate more easily and more regularly in pursuit of much less significant goals.

Perhaps this commentary will be viewed as unfair because I am generalizing my ordinary experience of downcast moods and deleterious attributes, and pronouncing upon mental illness, which may be quite different, and inconceivable to me. But who, apart from a psychologist is to say that I’m not mentally ill? And even if one psychologist denies that description, I expect I’d be able to find another willing to levy a diagnosis. A great portion of the problem with this subject, to my mind, is that there is no clarity as to where the dividing line lies. I’ve always thought of the selective diagnosis of bipolar disorder as rather unfair. Defined in its most general possible terms as the vacillation between exhilarating highs and debilitating lows, manic depression just strikes me as a symptom of being alive. There are no doubt some people who barely experience those highs and lows at all, and others who are unambiguously bipolar and feel utterly out of control because of the strength and frequency of the phases, but there must be vast swaths of the population who exist somewhere in the middle ground, where those phases occur and have a recognizable effect, but don’t necessarily dominant the individual’s personality. Clinically, some of those people will end up with a diagnosis of the illness, and others will not. I surmise that that must harm the self-perception of individuals who end up on both sides of the arbitrary divide. Those who are denied a diagnosis are left with the impression that what they experience is a set of personal features that are under their control, which they can alter or overturn by their own efforts. The ones that are identified as bipolar, on the other hand, are made to think that they are sick and that their own efforts are futile without external treatment.

As I see it, the truth is both that all of us and none of us are in control of our own minds. Our own behavior can reinforce itself or contradict itself, and reason can isolate problems that need to change even within our own thinking, but our activity and our brain chemistry also have innumerable external influences, which similarly affect realization, reinforcement, and reversal. The nexus of internal and external influences provides the potential for constant change. Sometimes that change may be regressive, and sometimes it may be insubstantial, but under ordinary circumstances it can at least be assumed that it is gradual. And that fact affords people the possibility of measured change, in contrast to the option of cutting off the source of discomfort and sacrificing whatever may go with it.

Mental illness is a frightening topic. But what is far more frightening to me is the notion that such large numbers of Americans are more concerned with being normal than they are with being themselves. Mental illness and personality traits may sometimes be the same features in different degrees, and they may be inextricably linked together. I think there is too much guess work and too much alarmism involved for it to be worth playing with the fabric of one’s mind, but I am decidedly in the minority within a culture that so values the kind of happiness that is best obtained by blending in and accommodating the circumstances rather than changing them. In that context, it will be a long time before enough people change their views to reach the breaking point wherein, as Ghaemi says, we are able to, “in a matter-of-fact way, accept that some abnormality is actually quite good.”


Anonymous said...

Maybe you might find it interesting to know that, as someone with an accurate diagnosis of Bipolar Disorder, I am very much resigned to the reality that I will never know "normal." And, that is not the goal of my treatment. The hope is to prevent a premature death, attain some level of stability, and not to harm anyone in any way. From my vantage point, you seem not to be writing about mental illness, not about any serious psychiatric condition. I feel like I just read about the variations and fluctuations of any given person's base line. Normal for you may be more melancholy and contemplative than someone who tends to be, just as an example, vivacious and impulsive. Neither rise to the level of being a psychiatric disorder. Diseases such as Bipolar Disorder are quite debilitating and dangerous. Treatment is not about becoming normal, as you put it.

Edward Carney said...

Anonymous, I agree with you on every point except for your last sentence. And in that case of course I'm not saying that I don't believe you about the goal of your treatment; but I don't think resignation to abnormality is universal among people who struggle with mental illness. Even if people do discount the idea of becoming "normal," I'm sure that many of them at least aspire to become "more normal." Lest we get bogged down in semantics, I think we can agree that normality itself might be characterized as a state of being relatively stable and free of harmful impulses.

I agree with you about the distinction between your disorder and the mental states of people with divergent baselines. I agree with you, but I can just about guarantee that given some time I could find psychologists that don't. A major point of my post was that the dividing line between "normal" and "afflicted" is often arbitrary, and that to a certain extent it has to be.

I hope you understand that my post was mostly about the danger of over-diagnosis, and that I did use that term. As such, the idea of trying to become normal applies more to people whose mental states already fall far closer to that designation than your accurately-diagnosed ones.