Me... Or My Disease?

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Recently I was reading some feedback comments on Natasha Tracy's Bipolar Burble Blog. The idea was put forward by one sufferer with bipolar disorder that it is important to understand that the turbulent behaviour of individuals with the condition comes from the disease and not from the individual who suffers from it. Unfortunately my manner of questioning the usefulness of this attitude caused some offence to the individual in question. I realised in retrospect that the best way to discuss such difficult topics without giving offence tends to be to speak of personal experiences. So I thought I would use that exchange as inspiration to give a very personal and detailed account of my viewpoint here.

I've experienced bipolar psychosis. To clarify my take on the “Is it me or is it my disease?" question, I'd like to look at two examples of my behaviour in a hospital emergency room while experiencing a psychotic episode.

One of my delusions at the time was that an apocalyptic transformation of human society was taking place and that, in this new world which was coming into being, things were acceptable which would not have been acceptable before. I thought it was O.K. for me to grope the bottoms of nurses. It took a couple of experiments before I recognised that I might be mistaken. One nurse responded angrily, another broke down in tears.

Was this me? Or was it my disease? I wasn't to blame for my behaviour, because, had I not been confused by psychosis, I would not have behaved in that way. I had no desire to cause offence or distress. It was the delusion that my behaviour would not cause such feelings which made it seem acceptable to me at the time. But where did the impetus for the behaviour come from? It came from my desire to grope women's bottoms, something which had nothing to do with my psychosis. I wanted to grope women's bottoms then. I want to grope women's bottoms now. I have two reasons for not doing so :

1. Such behaviour would lead to me being excluded from civilised society.

2. It would be liable to cause distress the women involved.

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One of the symptoms of the manic phase of bipolar disorder is a loss of inhibitions. When we lose our inhibitions, and thus our tendency to censor our expression of our feelings, what is revealed is, arguably, more our real self than the sanitised version we present when we are concerned about making a good impression.

Something else I did during this wild evening in the emergency ward was to point at a fellow patient and shout : “You're not my father!"

Was that me? Or my disease? Once again, I would not have done this if I had not been psychotic. I had no desire to confound or frighten some poor fellow patient. In my confused state he looked like someone I knew, someone from whom I felt a desperate need to declare my independence. (Not my actual father I should point out.)

My disease was the source of my confusion. But the message of defiance, misdirected as it was, was very much my own.

Stability in the personality comes from integration of all of its aspects. If we accept all aspects of our psyche as a part of who we are, then wholeness is possible. If we view some aspect of our thought, feeling or behaviour are something alien and/or hostile which we must contain, fight against or attempt to expunge, then it will tend to become more severe.

Let's look at a hypothetical situation now. One of the major problems we may have if we are suffering from some form of psychological condition such as bipolar disorder or conventional depression is the pressure which may be put upon our relationship with a loved one. No doubt I was a source of distress not just to nurses but to friends and members of my family when I was ill. But I've never been married or had a comparable kind of relationship. What if I had?

When we are suffering it is natural for our attention to centre upon ourselves. If we are depressed or manic we will be selfish. This is inescapable. We may fight against it. We may try to force ourselves to recognise the needs of others. But our heart won't be in it. Maybe we will feel guilty about putting an emotional drain on our partner. If we do, it will make us more depressed or it will add to our mania. The essence of mania is escape. Our situation seems intolerable, so rather than facing it our mind races away into wild dreams or spending sprees or sexual escapades, anything to avoid facing what would otherwise seem to be our reality. I say “seem" because often what is so unthinkable is unthinkable only because we have not yet discovered a comfortable way to think about it. Our problems are not necessarily objective problems.

“I know I'm treating you terribly," we might say, “but it isn't me, it's the disease. I love you."

What is love? It's a form of communication characterised by openness, honesty, spontaneity and generosity. Often what we think of as love is something else - attachment, commitment or sexual attraction. Attachment is when we desire the presence of a person or a thing. When we pick someone to be our partner, we make a commitment to be supportive of them and to try to keep our love for them alive. Love exists when it can. It requires the qualities listed above. If we have to hide something from our partner - be less than open - then that compromises the love between us. The same is true if we lie to a partner, if we fall into patterns of rigidly formulaic interaction or if we are selfish.

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If we feel the need to say “I love you" then love at that point is at best tenuous between us. Since love is a form of communication, both parties can tell if it is happening or not. A more honest approach might be to say : “I want to be with you" or “I want love to occur between us".

One of the barriers to love between someone who is suffering from depression and the person who cares for them is the feeling on the part of both parties that they need to be fair.

We all have desires and needs. If those desires and needs are not met it can cause feelings of frustration. This is irrespective of why those desires and needs have not been met. First we feel disappointed or angry, and only after that do we ask ourselves whether we are being reasonable to feel this way. If we come to the conclusion that we are not being reasonable, all the worse for us, because then we have two layers of bad feeling - one the frustration and on top of that the sense that we don't even have a justification for that feeling of frustration.

The loved one of a person suffering from depression can't possibly give them all that they need. And it is unreasonable to expect it. But the unreasonableness of such an expectation only makes it that much harder to bare. This can become a negative feedback loop. The depressed person places a burden on their partner. They know this is unfair to their partner. So they feel guilty. The guilt makes them more depressed. The more depressed they are the more of a burden they put on their partner, which leads to more guilt, and so on.

But feelings are only feelings. Once we have established that they do not conform to what is reasonable, we can see them as a quality of being and not as a message. What hurts is the implication that we are at fault. If we understand that the other party is just “letting off steam", i.e. giving vent to the frustration of their position, rather than taking what they say as a criticism to be taken on board, even if that is the verbal form it takes, then we can come closer together. It is the log jam of “shoulds" that blocks the passage of love in this kind of situation.

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If we were to insist that the bad feelings and the behaviour they impelled us towards were “our disease, not us" then we would not be able to come to an understanding of the dynamics that generate them or those which could ease them.

And if I told myself my desire to fondle strange women's bottoms was a symptom of a chemical imbalance in my brain rather than an intrinsic part of my sensual nature, then I might live in fear of an unpredictable fit of glute groping rather than being able to look back with amusement at my moment of madness.

Frederick March as Mr. Hyde