When you have a mental illness it is not you, you just have it

[Tobin S.]

Likewise, when you are diagnosed as having a mental illness you are not diagnosed with the illness, you are diagnosed as having the illness. Here's what I mean.

A lot of people who have a mental illness say that they are the illness. "I am bipolar," or, "I am borderline," or, "I am OCD," or, "I am schizoaffective." No, you are not those things! You simply have an illness. The illness is not you and it is not your defining characteristic. The right way to say it and think about it is: "I have bipolar disorder," or, "I have borderline personality disorder," or, "I have OCD," or, "I have schizoaffective disorder," or whatever the illness might be, but it is certainly not you.

I also hear a lot of people say that they were diagnosed with bipolar disorder, or that they were diagnosed with schizophrenia, or whatever the illness might be. This is more a matter of semantics than the first issue, but I think it still leads to an improper way of discussing mental illnesses. It is correct to say that you have been diagnosed as having a mental illness. For example, I've been diagnosed as having schizoaffective disorder, I wasn't diagnosed with it.

[HereSince1628]

1. I don't believe that. Because of the biopsychosociological context

it is pretty damn difficult to say that I am NOT something and that the problem with me is some Dx.
I am my Dx. More accurately, I am some DX that has or hasn't been identified.

It's GREAT to blame some conditions, but it is _MY_ behavior is what makes people dump their associations with me. It is ME that costs me my jobs, friends, therapists, etc.

"ME" might have my thinking all in a mess, but 'Me' must live with the consequences because NO ONE, not even the Mental HEalth establishment is capable of the endurance needed to buck up the levees that contain the flood.

[Tobin S.]

2. What are you when your symptoms are under control?

What are you when you take the illness away? THAT'S the real you, not some illness that you identify with. Yes, you do have to live with the consequenses of your illness, and you can't control how other people treat you. But you also must know that you are not in control of your illness- you didn't choose to have it. Using your logic, you are blaming yourself for having an illness that you did nothing to acquire. It's like someone blaming him or herself for being the victim of a crime.

[HereSince1628]

3. Interesting you wrote this challenge even as I was headed back to inpatient crisis intervention...

And that should be some indication that the thoughts written below don't work perfectly in practice.

For me it must be admitted that there is a tight symbiosis, between me and my mental illness. So tight that the community around me cannot see where I end and my mental illness begins. Indeed I've had it for so long that I feel merged together with it. Yet I think that perspective on mental illness plays back and forth between two views. One side of the swing contains distinct identities of Me, the host, contaminated by a discrete agent, my mental illness, the alien parasite needing to be expunged. The other side of the swing is occupied by a complex entity in which the alien thing is easier to see as self than non self.

The first case provides for an 'us vs them' orientation, and that's a popular view for many illnesses...we must fight the cancer, we must subdue the symptoms of the cold, etc. Such an understanding seeks to gain victory over the alien through psycho medical campaigns that result in better more effective interventions, including pharmaceutical 'magic bullets'. If a person suffers from a psychological condition that responds to medication, this viewpoint is reinforced, probably strongly reinforced. If it works the medication must be addressing some target(s) so my problem must be those targets, which can readily be perceived as 'not me' or at least the 'not healthy me.'

The second case, which I think is more appropriate to problems like my borderline and schizoid/avoidant tendencies has the unsettling point of view that when we meet the enemy "The Enemy" is a well integrated part of OURSELF. Imagine mental illness as a mind-worm, a potentially pernicious loop of thinking that can influence/control behavior. It cannot exist without us, and it exists only because we created it to solve a problem we perceived as being very real in our past. We nurtured it and gave it tenure because once it was a protector. But, now the thought that was once useful finds itself functioning beyond the context of its origin, and it has become inappropriate or down right harmful. But it's still a part of us, an old loyal friend.

While we can think of a thought and a mind and a behaving body as if separate things, they are truly one. The location where we end and our thought pattern begins seems very unclear to me, if it exists at all. In this vision my (our) mental illness engages our being as integrally as do our mitochondria (which arguably originated as alien bacterial-like symbionts). Attacking symbiotic mind-worms is problematic, because I/we/the host, isn't fighting a foreign attacker, but a still dedicated member of our mental security forces. Destroying the mindworm just opens the host to lesions no longer shielded by the symbiotic alien thing. The host, is then vulnerable to insults normally foiled by the now missing symbiotic mindworm. Fear of that lesion means keeping the old protector is a good thing. Resistance to retiring the now pathogenic old soldier is strong as are the memories of its previous good service and is strengthened by events that continue to call on its service.

So, to your Q about what I am when my conditions are under control is that I see my self in terms of the second model. The cognitive functions (mindworms) that influence my perceptions, that in turn serve as cognitive motivators for my behavior are sitting vigilantly. Conducting internal and external surveillance. Outwardly, my appearance could be quite normative, depending upon the duration of the absence of detected triggering threats, I could perform quite well (BTW I earned a PhD, gained University tenure and participated in international research before my final crash and burn). But I'd still be, and I think I still am, integrated with my mental worms, and the potential for the old mindworms to trip behavioral motivators can still be present. In the intervals when I'm normative I really would and do appear normal, but this could actually mean I've simply not encountered a cognitive motivator within a appropriate psychosocial circumstance to initiate the mentalworm in to what could be called a mentally Quixotic defense.

So when I have no symptoms I must move through my life like a mental minesweeper with simple rules: Detect "potentially explosive" circumstances, Avoid triggers, Take thoughts on a different path (distraction), Diffuse my thoughts when other avoidance and distraction fail, and Radically Accept that this is my life.

[Tobin S.]

4. I had no idea that you were headed back to the hospital,

I may be challenging you to a certain extent, but I'm not trying to tear you down, and I did not question your intelligence.

I'm merely questioning why some mentally ill people think that they are their illnesses. Your illness is a part of you, but it is not your total self. It's a diseased part of you that can a lot of times be controlled. Sometimes it can't. For the last 7 years I've lived symptom free, for the most part, with an illness that causes psychosis. I still have a hard time once a year, usually for a couple of weeks to a month in the winter, but it's nothing like what I used to experience.

I do not greet people like, "Hello, I'm schizoaffective disorder. Pleased to meet you." And I'm sure you don't greet people like, "Hello, I'm borderline personality disorder and depression. Pleased to meet you." See what I'm saying? Hello, my name is Tobin and I'm a multi-faceted person.

A mental illness can take over your self. It can also be controlled and reduced to something that you can live with. If you don't believe me, then take a look in the lounge sometime at my trucking threads. I've gone from being nearly completely disabled due to mental illness to owning a business (my own truck) and being able to handle all of the difficulties that come with that.

If you don't think your mental illness can be reigned in and controlled, I hope you are pleasantly surprised. I wish you well.

[HereSince1628]

5. I think we actually agree--mental illness isn't the whole story

on a person. I've met a few bona fide mentally ill folks and their illness is hardly their whole story. Most of them would be seen as pretty typical folks. And although it's a small number, I honestly think most of the mentally ill that I've met will be able to ultimately live lives as they choose, not as their illness dictates.

At the same time, I've come to realize I have a very persistent problem. People say once an alcoholic always an alcoholic. I don't know beyond pamphlets I've read if its true that alcohol dependence is a propensity that never goes away, either. But if a reformed alcoholic treats him/herself as if the alcoholism never goes away, and stays away from the EtOH, then they can live free of the effects of the binge drinking and cloudy thinking. Alcoholics may be sober but 12 step programs suggest that they must always be vigilant and use discipline around EtOH. I've read and I've been told pretty much the same story for my borderline.

My propensity to fall back on certain paths of thinking will likely always be there. Additionally, the feelings that life's ups and downs evoke in me that are characteristic for BPD and which cry out for the wayward thinking may never really completely go away. In fact, it's very likely that they'll pop up again and again...What I want, and need to be different, is how I act on those feelings, and how I manage the process of having those feelings run their course. I certainly don't need to make exaggerated body movements during my bleatings to emergency room staff about how bad life seems because I absolutely am certain that I don't want alarmed police or hospital security pushing the envelop on dislocating my shoulders anymore. At present my executive functioning is not doing the managing of my reactions to my feelings very well--as evidenced by the last few days back in the fishbowl. So, for now, like the recovering alcoholic I know I must be vigilant of my own tendencies...

Many of us (the mentally ill)--I fervently hope MOST ALL and that includes me--will again find a way to live meaningful, and rewarding lives outside of the binds of the mental illnesses against which we struggle to be free. I'm not knocking what works for anyone in that respect, whether its alternative ways of thinking or medications.

I'm not knocking points of view that help either. But, I do think that think there is a spectrum of thinking and feeling among the mentally ill and their caregivers about how to individuate mental illness and that spectrum goes from this alien 'thing' inside me/you to 'this is just how my/your gears work.'

I wouldn't knock a person who uses "Hi, I'm John and I'm alcoholic" as a tool and I wouldn't knock a person who said "Hi, I'm John and I'm schizotypal" as a statement of non-denial. Self-awareness and self-concern seem like really big milestones along the path back to normative life.

Good luck, keep the rig between the lines.

[Tobin S.]

6. Good deal, HereSince1628

:hug:

Keep us updated and let us know how the next stay in the hospital is if you are headed that way.