Driving Somewhere BeautifulSubmitted by Icarus Project on Mon, 02/11/2013 - 1:35pm
By Mike Snelle
A friend once told me that the only sensible way to tell whether a philosopher is worth reading or not is to look at a photograph of their face. Wittgenstein yes, Heidegger no -that kind of thing. Karl Popper had a lovely face. Google him if you don’t believe me. He didn’t have Wittgenstein’s intense stare or Nietzsche’s ridiculous moustache. Popper looked more like a kind old grandfather from a children’s story, wise and generous and thoughtful. He had the sort of face I am intuitively inclined to trust.
Popper was an influential philosopher of science. He claimed that one of the key tenets of science is that any theory, to be considered scientific, must be inherently falsifiable. He was not saying that ideas which fall outside of this test are not interesting, or valuable, or part of what it means to have a rich and complex understanding of the universe. He was just saying that those ideas are not scientific. A belief in God, for example, is not falsifiable, so too theories about an afterlife. These are matters of faith and, according to Popper, fall outside the scope of scientific enquiry.
In 1973 the academic journal Science published an article called On Being Sane in Insane Places. It documented the findings of an experiment by psychologist David Rosenhan designed to test the validity of psychiatric diagnosis. The first part of Rosenhan’s study involved eight ‘sane’ people feigning auditory hallucinations to see if they could get committed into psychiatric institutions. What is interesting about the experiment is not the ease with which the participants successfully feigned mental illness, but the difficulty they had, once inside the system, of proving themselves sane. Although none of the participants showed any further symptoms it took up to 52 days for them to be released, and even then only then when they accepted diagnosis of irreversible lifelong conditions such as schizophrenia. So what? That’s pretty much what I thought until I got diagnosed with bipolar.
I had a two year long psychotic episode as a teenager. It was terrifying. School became impossible and I left, a week after my fifteenth birthday, with no qualifications. Although I have had no subsequent break with reality I have, for the past 17 years, experienced episodes of debilitating depression alongside moods so good that my thoughts crackled with electricity and made my skin prickle with excitement. I am tempted to write about how it feels to be on a mental high, how the grace and fluidity of my own thoughts gives me an erection. I’m tempted to write it down because it’s a feeling so good that even the memory of it allows me a tiny fraction of the experience. But my involvement with the mental health system didn’t arise because of the highs.
The best explanation I have ever heard of suicidal depression is by the writer David Foster Wallace. “The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.”
During a particularly brutal and extended bout of depression I phoned the Samaritans. As good a service as they offer it’s still an excruciating and pride swallowing experience to realise that your desperation has exceeded your dignity. On a particularly dark night I was grateful to a generous stranger for picking up the phone. I called in the hope that this most fragile thread of human connection would be enough to stop me from killing myself. And it was. I decided then to seek help.
And so I found myself at first the GP and then, via an assessment with a psychiatric nurse, in the office of a consultant psychiatrist. She had massive hands. Not just big but huge -the sort of hands that could crush apples, or tear a phone book in two. It had taken 6 weeks to get an ‘emergency referral’ but only took 45 minutes for her to diagnose me with bipolar disorder and prescribe me with the mood stabiliser Lamotrigine. I’d be lying if I said I hadn’t expected it. I’d read Kay Redfield Jamison and had knew the relevant sections of the Diagnostic and Statistical Manual of Mental Disorders (DSM) by heart.
I had always resisted pressure to seek medical help for what I saw as my uniqueness. I preferred to believe that my moods were an essential and perhaps defining characteristic of my personality. My depressive phases were emotionally painful but I believed they allowed me a privileged access to a kind of truth too difficult for most people to bear. My heightened moods were the best of me, concentrated and distilled into a point so fine it could pierce the membrane separating me from the outside world and allow me to connect with the universe in ways that felt almost supernatural.
The psychiatrist with the gargantuan hands told me, within the space of a few minutes, both that medication would ‘make me a different person’ and that ‘medication will not make you a different person’. I was perplexed and began to ask her some questions. Before long I found myself expressing my anxieties about accepting a diagnosis. What if my mood swings were due to a traumatic childhood with an emotionally turbulent mother? Was it still accurate to diagnose me with a serious mental illness or was I merely reacting normally to a prolonged period of childhood trauma? Could I get better? Was it possible that one day the diagnosis would no longer fit? And anyway, how did these mood stabilizers even work?
Her explanation was that bipolar is like diabetes. There is a genetic predisposition that may or may not be triggered by environmental factors (emotional abuse and too much sugar respectively) but that once triggered it is a lifelong diagnosis that needs to be treated medically. She said that similarly to a diabetic it is possible to make lifestyle changes to help minimize the episodes and manage the symptoms, but that the illness was something to learn to live with rather than hope to be free from. Mostly managing the symptoms involves avoiding the triggers. This is all very convincing until you realise that the triggers are most of the experiences that involve participating fully in human life.
When I expressed concern and doubt about accepting a lifetime of avoiding stressful or emotionally charged environments and experiences she replied that this was a normal response of someone with bipolar disorder. And when I suggested that in time I thought I would be able to change and grow and get past the diagnosis she said that a rejection of the facts was a common symptom of the illness. It seems that once a diagnosis is made, any normal human response can be interpreted as a symptom of the illness.
The problem runs deep. Accepting a psychiatric diagnosis seems to rob you of the validity of your own thoughts. They become symptoms of an illness, which is exactly the fear that prevented me from seeking support in the first place. Because that’s what anyone who is struggling really wants, understanding and compassion and support. At least that’s what I had always assumed until, on getting a diagnosis, I looked on some forums for fellow bipolar sufferers. It seems that a diagnosis is not only a licence for the medical profession to invalidate genuine thoughts and concerns, it’s also an opportunity for those diagnosed to excuse their behaviour under the guise of mental illness. ‘My wife doesn’t understand why I lose my temper, or hate her friends, or occasionally smack her about. She doesn’t understand my illness.’ I’m exaggerating, but you get the picture.
I believe that anything which denies someone the possibility of genuine and lasting change robs them of an essential and important part of what it means to be a human being. By change here I don’t mean simply medicating away their behavioural symptoms. I mean engaging with an emotional and intellectual process which allows them to grow as a person, a consequence of which maybe a deep and self-sustaining change away from unhealthy patterns of behaviour.
Similarly any explanation that reduces a person’s autonomy and free will is by nature dehumanising. It might initially seem to be a convenient and reassuring interpretation that the times I have acted in angry, hurtful or unkind ways it was not really me at all; it was an illness acting upon me. It has certainly sometimes felt that way –as if I were not in control of my thoughts and actions. Ultimately however, there is something unsatisfying about this explanation. I want to be held accountable for my actions and thoughts, even those I wish I did not have and struggle to control. I think it’s a key component of being able to have meaningful human relationships based on mutual respect and equality. I believe it’s possible to change unwanted behaviour and even thought patterns by understanding the underlying distress which causes them.
My point here is that once diagnosed, there is no legitimate thought or concern I could have which could not be interpreted as a symptom of the diagnosis. This is dehumanizing. But more than that, if Popper is to be believed, and he had a trustworthy face, it’s not even scientific.
Participants in the Rosenhan experiment took notes whilst at the psychiatric hospitals. This was documented by medical staff as ‘writing behaviour’ and deemed ‘pathological’. Once the decision was made that they were suffering from a mental illness there was nothing they could do or say to reverse the decision. It was not falsifiable. The only way they could get released was by accepting the diagnosis.
One interesting aside that came out of Rosenhan’s experiment was that although none of the staff recognised that the participants were sane, a quarter of the patients voiced suspicions that they were. It seems that the mentally ill are better at recognising their own than the specialists who treat them.
Back in the psychiatrist’s office the doctor explained to me that there had been numerous studies that proved that bipolar disorder has a genetic element. It is possible for trauma to be the trigger, she said, but not the cause. Usually where there is one family member with bipolar there are others, whether diagnosed or not. And anyway there are plenty of people who had happy upbringings who develop the illness.
Perhaps I’m ill informed. I’m certainly not an expert. But I find that this kind of reductive argument is usually an oversimplification. Take for instance, the idea that CT scans show that the brain of someone with bipolar is functioning differently on a neurochemical level than someone who doesn’t have it. This seems at first to be irrefutable evidence of the fact that bipolar is caused by a physical phenomenon, perhaps a lack of some chemical or other in the brain, and hence should be treated by adjusting the level of that chemical using medication. But this argument requires a whole universe of assumptions, none of which are falsifiable. For instance, reducing mind states to brain states does nothing to illuminate the causal relation between the two. To say that the tendency towards extreme emotional states runs in families and that this is evidence of a genetic component to bipolar is to ignore a more obvious explanation.
It is well documented that those who have experienced trauma act out that trauma on the people around them. Abuse begets abuse. There are wildly varying statistics about the percentage of the prison population who have been abused, sexually or otherwise. Some studies record up to 83% of inmates having been abused as children. Those damaged children then go on to develop their own distorted ways of interacting, and end up in prison, or in the case of bipolar sufferers, unable to regulate their own moods in a way that is healthy. Of course it runs in families. Trauma always does, sometimes passed down countless generations, each struggling to cope with the emotional inheritance left by the last.
A child whose parent cannot regulate their own needs and emotions (perhaps because of their own traumatic childhood) and as a result fails to create a safe and stable environment in which that child can develop healthily, will themselves struggle to self-regulate their feelings as adults. It is often cited that when one sibling suffers from bipolar there is a far higher likelihood that the others will too. It’s hardly a surprise when they grew up in the same house.
But what of those people who had stable happy upbringings and still end up developing the symptoms and being diagnosed? The psychiatrist posed the question as if it were a trump card -with a relish that made me wonder if I hadn’t accidently strayed into hostile territory. It didn’t feel like a clinician’s emotionally detached explanation. It made me wonder why people choose to become psychiatrists, what personal reasons they might have, and how much self-worth might be wrapped up in their belief in the system.
How about this? Just as some people can sing in tune better than others, or have better physical coordination, some people are more sensitive than others. And some of those people find the world a difficult place even if they had idyllic childhoods. Turn on the news. Walk down a city street. There is terrible inequality, an inhumane value system which promotes wealth, fame and power as the ultimate human achievements. There is the relentless advertising on billboards, television, magazines and the internet which tells us a thousand times a day that to buy more is to be more. There is the worldwide economic crisis caused by a society which idolises the rich and fuelled by a belief that money and power are the ultimate symbols of personal meaning and value. And all this in a world where people are starving and children die every day because they don’t have clean water, or food, or medicine.
Most of us manage to largely be blind or desensitized to the constant evidence of terrible injustice and deep rooted systemic irrationality. We do this by being selfish, by concentrating on our own lives, our own needs and frustrations and desires. We do it by participating in the very system that perpetrates and perpetuates the violence.
Maybe this all sounds a bit self-righteous and earnest. Please don’t think I am suggesting I am one of these sensitive people. I’m not. I sell expensive things that nobody needs to rich people for a living. I’m merely proposing that it’s not all that far- fetched to imagine that there might be some people for whom being in the world at all might be a traumatic experience. And that this trauma might cause deep and serious psychological conflict and result in extreme emotional states. And just as depression could be caused by recognising the injustice and irrationality of the world, alongside the feeling of powerlessness to change it, so too might ‘manic’ states be caused in those people by recognising all that is rich and good and beautiful in human life and feeling connected to it. Even psychosis could be understood as an individual’s struggle to cope with a world that seems out of control by inventing their own reality which is at least a madness of their own creation. As R.D. Laing put it ‘Insanity –a perfectly rational adjustment to an insane world.’
I am not downplaying the deep distress of the mentally ill, nor the very real dangers for individuals who go untreated. I am suggesting that a system which focuses on only the symptoms whilst leaving the causes untouched will never provide the necessary means for real growth and long lasting change. It is not dissimilar to the way our society treats those people who break its laws. We punish the crime by imprisoning the perpetrator without ever attempting to treat or even uncover the cause, and then we act surprised when they are released and reoffend. Similarly by treating the mentally distressed only by medicating away their symptoms we do not allow or facilitate the opportunity for meaningful change. It is no surprise that the majority relapse, often with tragic consequences, when they discontinue medication.
I have no doubt that there is an important role for psychiatry and medication to play in treating those who suffer from psychological distress in whatever form it takes. Likewise I do not question the need to temporarily incarcerate those who perpetrate crimes in order to prevent them causing harm to others. However this should only be one part of a wider, more comprehensive and ultimately compassionate way of treating people.
Following the diagnosis by my apple crushing psychiatrist I bought a book about living with bipolar. I bought it hurriedly and with a stab of shame that reminded me of getting caught masturbating over the lingerie section of the Littlewoods catalogue as a thirteen year old. I failed to notice that it was intended for the partners of those with bipolar. It contained lists of common signs that your partner may be in either a manic or depressive phase. The manic list included ‘wanting to take a really long drive just to see something beautiful.’ There is something terribly sad about a diagnosis which treats being willing to travel to see something beautiful as a symptom. Thank fuck for Karl Popper and his lovely face.