Where is the Self in Treatment of Mental Disorders?
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
Grohol, J. (2018). Where is the Self in Treatment of Mental Disorders?. Psych Central. Retrieved on September 29, 2020, from https://psychcentral.com/blog/where-is-the-self-in-treatment-of-mental-disorders/