We have been told mental illness is a "no fault" illness, much like diabetes. Indeed it is. But one can clearly assign blame to a person with diabetes who continues on a high sugar diet and won't take his insulin as prescribed. Can the same be said for someone with bipolar who equally tempts fate? Absolutely.
But when we are severely depressed, we lack the cognitive skills, motivation, and energy to help ourselves. And in mania we are too far gone to be acting in our best interests.
So when does fault kick in? Over the past eight or nine months, we have been exploring that ill-defined and highly subjective area where illness meets personality. The distinction lies between "state" and "trait." Episodes - depression, mania, anxiety - tend to be a departure from our personality (or temperament). But we can also have depressive or exuberant or anxious temperaments. Did I mention this gets complicated?
I got started on this inquiry several years back when I noticed that those who appeared stuck in their recovery tended to be the ones with unresolved personality issues. We all have them, and therein lies the rub. In many cases, our illness may be the least of our problems. Personality is ingrained and therein lies the difficulty - there are no quick fixes.
In a recent sharepost, I reported on how I had to force myself to imitate being an extravert in order to break free from the destructive isolation-depressive vortex I kept getting sucked into.
In another recent sharepost, I briefly introduced a new element to the state/trait equation - character. Robert Cloninger of Washington University (St Louis) cites Immanuel Kant in support of the proposition that character is "what people make of themselves intentionally."
Our character, says Dr Cloninger, is what allows the higher areas of the brain to transcend the lower parts of the brain and achieve healing.
Much easier said than done, of course, and therein lies the rub: We're pushing not one but two rocks uphill. Illness and personality. We find ourselves overwhelmed, going nowhere. Stuck.
Character is what helps get us unstuck. When we succeed, we congratulate ourselves. But what about our inevitable failures? Does that mean we lack character? That we are at fault?
Last year, the NY Times Magazine profiled Shane Battier of the Houston Rockets. Battier is not one of the better known NBA players, but does the intangible things that improve his team's performance. The article talked about the difference between outcome and process. We can't control the outcome - that is in the hands of the gods. But we have a measure of control over process.
If Battier is skillfully doing the things he needs to be doing (the process), the other team's star shooter should be having a less than stellar night (the outcome). The opposing shooter will be making hurried shots, off-balance, often with a hand in his face. But maybe the ball keeps going in the basket, anyway.
We can never guarantee a favorable outcome. It may never happen, despite our best efforts. But one thing we can say for certain: Without our best effort - call it fanatical devotion to the process - there is no chance, absolutely none, of a favorable outcome. If you tried and succeeded, you have every right to pat yourself on the back. If you tried and failed, you can hold your head up high. Tomorrow is another day.
Published On: June 19, 2010
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