Mental illness. Why does that term create unease in so many people? By what justice is a diagnosis of cancer met with an outpouring of sympathy and support, while a breakdown or admission of a psychiatric condition is too frequently met with silence, distance or even rejection? What is it about the connection between mind and body that threatens the spirit? And where in madness does the soul of the mentally ill person lie?
Dramatic questions? Yes, perhaps, but these are the kinds of thoughts that burdened my own recovering mind following a severe manic psychosis, committal to a psychiatric ward and, ultimately, diagnosis with bipolar disorder. They are questions that I have not even begun to resolve and would like to explore further from a social perspective and within the context of faith. The following essay constitutes my initial reflections on the subject.
Mental illness is more prevalent than one might imagine. It is estimated that roughly one third of the population will suffer from a psychological disorder at some point in their lives. The most common are anxiety and substance abuse disorders (including alcoholism) followed by mood disorders. In my experience, in the aftermath of my breakdown, being informed that I had bipolar disorder seemed very clinical and comforting. I wasn’t crazy after all, I was sick. But when I managed to secure from my nurse a booklet about this condition, I discovered with shock and dismay that bipolar disorder was also known as manic depression. God help me, I couldn’t have that! Yet as I read the descriptions, case studies and personal accounts of other bipolar individuals I found a haunting self-recognition in their tales. I had been fighting the emotional ups and downs of a mental and emotional roller coaster for years, not knowing it had a name, let alone a treatment.
The road to full recovery and stabilization would continue for me long after I returned home from the hospital, even though I responded well to medication and have never experienced another serious episode. But bipolar was, for me, not the whole story. It could not write away the persistent internal unease and discomfort I felt about my identity, the lifetime of gender insecurity that had seemed, to me, to drive me headlong into madness in the first place. So five years later I have added another notch to my DSM IV Axis I bedpost (the DSM being the diagnostic bible of the American Psychiatric Association). I have also been diagnosed with Gender Identity Disorder and have started the process of reassignment from female to male.
When I look back now, over a year into hormonal transition, I can see a foggy, troubled terrain that stretched all the way back into my teens. For the first time in close to 30 years I have a sense of mental clarity and emotional stability I had no idea I was lacking. I always knew something, somehow, was wrong but I reasoned it was me personally, some weakness of character or lack of conviction rather than a combination of medically based conditions that, if not curable, could be treated.
However, once I was back in the real world following my hospitalization, I found myself confronting a series of external misconceptions about mental illness while I struggled to make sense of my own internal reaction. I met the stream of thought carried on from Thomas Szasz, R. D. Laing and others who argued that “mental illness” was a misnomer, a reflection of society’s lack of acceptance for difference, even illuminating insight, rather than a medical condition. The argument that the disease model has no applicability to the mind was appealing to me as tried to rescue my fragile sense of self, after all the thought of having a “sick mind” is very disturbing. But at the same time I was clearly aware that the medication I was taking was placing a healthy distance between my self and the acute symptoms of my illness, the horrifying experience of systematically losing control of my ability to maintain a grasp on reality. Certainly madness had held some amazing moments, but I really had no desire to ever go back there again.
Then I found myself up against those who accepted the condition but not the treatment. Fear of psychiatric medication and “shrinks” had kept me from seeking help for a severe, possibly psychotic depression three years prior to my manic episode. In fact, in mania, it had again kept me from agreeing to seek help when the effort of staying focused long enough to read the label on a can of soup had become almost unbearable. I resisted the pressure of madness for a month until a violent, fear driven confrontation between my spouse and myself culminated in a call to 911 that brought the police, an ambulance and a humiliating journey to the hospital. Accepting the potential of a lifetime on mood stabilizers was difficult enough without well meaning friends and relatives suggesting herbal remedies and dietary changes or eastern philosophical insights guaranteed to free me from the demon psych meds. In the hospital, as I was recovering I saw enough people admitted with relapses after going off their medications to realize that if the drugs worked I had to stick with them. I found myself having to argue that there was no more shame associated with having a biochemical imbalance in the brain than with having diabetes or any other chemical imbalance.
This is not, by the way, to imply that a holistic approach to mental illness is not valuable. The psychiatric profession tends to be too focused on medication and what works wonders for one person can be ineffectual or disastrous for another. Healthy diet, adequate exercise and regular sleep patterns are equally important. As is being informed and proactive regarding your treatment or that of someone close to you. But medication and constructive therapy that is having a positive effect should never be undermined. Unfortunately when you acknowledge having a mental illness, suddenly everyone including perfect strangers come forth to offer their opinions about how you should manage your mind’s health.
Another phenomenon I soon encountered was the tendency many have to glamorize mental illness. Yes, many gifted people have or may have had mental illnesses. However, alcoholism, destructive behaviors and suicide too often mar their lives. The Hollywood presentation of mental illness is in stark contrast to the reality we see on the streets of our cities, where homelessness, rising HIV infection rates and drug and alcohol problems are taking their toll on a considerable number of people with serious mental illness. Another image, one you see less frequently not because it doesn’t exist but because it is not obvious, is the face of mental illness that looks like that of anyone else with a productive satisfying life. Mine is, I pray, one of those faces.
Following my release from the hospital I was left to the care of my general practitioner and all of the community-based supports I had been promised were seemingly non-existent. Of course I had a place to live and a supportive family but a great deal of damage had been done. And many people in my life disappeared. Others, like my father from whom I likely inherited this mood disorder, preferred to respond with denial. And I still had the weight of the unresolved gender anxiety haunting me. Peer support was the first step on the road to healing. I found a group through a crisis line and soon I was facilitating regular meetings. To talk to others who had learned to live well with their conditions and meet others who were slowly losing the battle, helped me to come to understand and set goals for myself. But most importantly, the group was a refuge from the stigma, a place to laugh, cry and commiserate about the reality of life with a serious mental illness.
If I could manage to construct a place in society as a person with a psychiatric condition or “consumer” of mental health services to be politically correct, I had a much harder time within my church and in the context of my own personal faith. I have yet to entirely resolve the conflicts that I have encountered. Despite a parade of colorful candidates for a contemporary diagnosis of mental illness in the pages of the Old Testament in particular, Christian churches do not always offer refuge or support for those with psychological problems today. Historically in Western society, the madness of psychotic mental illness, the seizures of epilepsy or the delirium caused by a host of illnesses or infections were viewed as evidence of demonic possession or the practice of witchcraft. As a medical understanding came to replace a superstitious one, hospitals, workhouses and asylums were built to accommodate the more dramatically ill. Early psychological assessments of abnormal behavior then took a step back from the medical model and turned their focus to either internal and personal causes or learned and conditioned responses to the environment. Thus the roots of these conditions tended to be assigned to the individual’s character or upbringing. Only recently have scientists and physicians made significant headway in unraveling the genetic and chemical factors underlying many mental illnesses and this biomedical approach is far from being widely accepted throughout the psychological discipline. In fairness, psychoanalytic and behavioral methodologies do have considerable treatment value, but our rapidly increasing understanding of the brain will no doubt continue to impact the way that psychopathology is addressed.
Against this background, it is perhaps not surprising that churches (speaking in broad generalizations of course) tend to still have trouble with conditions of a decidedly psychological or psychiatric nature. They don’t know how to respond to someone who has suffered a nervous breakdown, who battles depression or commits suicide and far too often they respond by ignoring or rejecting that person and even his or her family. So many of my Christian friends were incapable of seeing a mental illness as anything beyond spiritual weakness. They could witness to the effect of the Twelve Step philosophy, which has, in truth, rescued many lives from addiction. But a moral-existential approach cannot fully address the medical factors involved in disorders that we now acknowledge to have a solid neuro-biological basis such as clinical depression, obsessive-compulsive disorder, schizophrenia and numerous other conditions, including many substance abuse problems. It has saddened me to sit through sermons where there has been the implication of shame or sin attached to either being ill or seeking treatment or, most painfully and tragically, to a life that has ended in suicide. It almost seems that mental illness challenges the comforting notion that the mind is somehow inseparable from the soul. If the mind is sick then surely the soul is too?
I suppose that the ability to conceive of my brain as part of my body is one of the first lessons I had to learn for myself on my road to spiritual healing and the salvaging and recreation of a sense of my own soul. The diagnosis of bipolar disorder with acute psychotic mania had been a blow to the very foundations of my spiritual faith. As a child I had had a profound vision or near death type experience that had convinced me beyond doubt and reason, that God existed. That conviction in its own unique context, stayed with me through my Catholic upbringing and on through studies in science and philosophy. Even when I had trouble with Jesus and the trappings of Christianity I knew God existed and that was enough to sustain me. During mania God became an electrifying presence not only in my head, but also in every fiber of my being. I had awesome visions, a sensation of oneness with the universe and eventually an exhausted sense that I had had quite enough of God in my head, thank you.
In recovery, as I read up on bipolar disorder and psychosis, I had the terrifying realization that my precious childhood experience was possibly nothing more than what was clinically described as a “pre-psychotic” experience. After all I had always been susceptible to weird sensations and experiences, even under the influence of aspirin for heaven’s sake. The thought was devastating. Being in a post manic, anti-psychotic induced depression did nothing to help and suddenly I found myself alone in a universe without God. How could I be certain that all the prophets and saints were not simply madmen, not divinely inspired in their madness but suffering from biological quirks of the brain? Or was it possible that they could have been both?
I turned at first to astrophysics to build a new place for God in my material universe. I delved into eastern philosophy and quantum physics. I returned to church but ran philosophical debates with the pastor in my head all the way through the sermons. Very frequently I arrived home from church angry and bitter. But God never left me as I sought to rebuild the rational and spiritual sides of my being to a functional level at least. In retrospect I was still healing mentally and I was yet to come to understand the nature of my gender concerns, face my son’s struggle with an anxiety disorder, endure the break up of my marriage and embark on the difficult path of transition. So, it is hardly surprising there are still many spiritual bits and pieces left over from my breakdown that I am only beginning to contemplate now.
The faith I have reconstructed and continue to explore is, in large part, an intellectual one. But my sense of God and his presence in my life continues to be intuitive, to exist in a place without words. And although I always considered myself to be a Christian, and have worked for and been deeply involved with churches and Christian organizations, I am only just beginning to come to an understanding of Jesus. I can begin to see the spiritual trauma that not only my breakdown, but also the years of unregulated mood instability, created in my life. I want to put the pain behind me while preserving the visions to which I have been privileged. But that is not a straightforward task.
If the church can fall short in its understanding of mental illness, the mental health profession tends to undervalue the spirituality of the person who has been ill. It is difficult, especially in a delusional disorder because religion so frequently forms the template for psychosis. When I was on the psychiatric ward I noticed everyone had a Bible on hand, even if they had never read it. I was editing the violent imagery out of Psalms. And the requisite Jesus (who was also a multi-millionaire) held court in the lunchroom every day. If delusions tend to draw their content or imagery from the culture and traditions of the person experiencing them, it only stands to reason that Western religious themes or personas would be so common. And I suppose it is no wonder that psychiatrists look for a reduction of religious talk as a sign of improvement. But faith is an important component of recovery and survival in the aftermath of a serious bout of mental illness, as it seems to be with other physical illnesses. However the stigma and shame associated with these conditions, and the unique stress that living with mental illness can put not only the consumer, but also his or her friends and family, can leave considerable spiritual trauma that is rarely addressed.
In some small way I feel that I was given a brief opportunity to experience the madness that many battle for years, if not entire lifetimes, and yet I have been blessed with a good response to minimal medication and the commitment to be well and healthy. I am lucky to have two beautiful children, both with special needs, for whom I knew I had to get better. I have also, after much effort and again good fortune, found a psychiatrist and therapist who provide me ongoing support not only in my gender reassignment, but also in my general mental health and the management of my mood disorder. Now I want to be able to take the insight I have as a consumer and as a caregiver and put it to good use. I am studying psychology and working with adults with a variety of disabilities including serious mental illness and beginning to move in a direction that will address that goal and allow me to honor and celebrate being well.
However, on the personal side, there is still the matter of that same madness, the journey through the valley of darkness, the vision quest-like experience of manic psychosis that I am only now beginning to explore through reading and reflection and perhaps someday in writing. Or maybe it will remain wordless, I don’t know. For a long time I had to leave the internal experience of my breakdown in a conscious limbo, while I concentrated on healing my life. But I do suspect that terrain lies as a bridge between the anxious, superstitious girl I once was and the middle aged single male parent I have become. Looking back at it with distance and perspective may allow me to come to terms with some of the lingering sensations of shame and guilt that still haunt me. But first I have to trust that there is a way to live successfully with mental illness and yet rediscover the magic of spirituality that I once knew.