The Problem of Identity

Patient Expert

If you have bipolar friends on Facebook, you may have noticed multiple postings of an article in yesterday's New York Times Magazine by Linda Logan, The Problem with How We Treat Bipolar Disorder.

Linda was a married mother of three, in her mid-thirties, with a promising career in academia. Then, in 1989, after years of swimming against the current, she checked into a psychiatric hospital.

"The moment the psych-unit doors locked behind me," she writes, "I was stripped of my identity as wife, mother, teacher and writer and transformed into patient, room number and diagnosis."

Our personal identity is the nub of the issue. We are fearful that, in the name of treatment, our doctors will take our sense of self away from us. Lobotomies are out of favor, but what about "selfectomies"? What if, in the name of stability, we lose all sense of who we really are? You know the story - overmedicated into the kind of zombie states our doctors mistake for recovery.

But there is a counter-story to this. This is the opening sentence to Linda's article: "The last time I saw my old self, I was 27 years old and living in Boston." Linda was experiencing depression. Truly, there is no force in nature like depression to rob you of your identity.

Then, she reports, "a newcomer arrived. I seemed to have split into three: my shellshocked self, my depressed self and a brazen hypomanic self. We could practically hear the new girl sizing us up, cackling."

Many of you in the HealthCentral community have written very eloquently on the identity issue - hit from one side by depression and mania and anxiety and psychosis, the other by the very people who presume to treat us.

Who the hell are we? In my book, Living Well with Depression and Bipolar Disorder, I describe the experience of meeting myself for the first time. I actually liked what I saw. In my more recent memoir, Raccoons Respect My Piss, But Watch out for Skunks, I explore the issue in much greater depth. Depressed and crazy is who I am. But how much? You see, I don't want to be normal. I don't want to be like everyone else. But I don't want to be too depressed, either, or too crazy. Then I'm not myself.

Just right crazy, just right depression - is that too much to ask? Wait there's more. I also want to be functional. I want to be able to get things done, fulfill my obligations, keep my promises, walk into a room without driving everyone toward the exits. Not only that, I want to do it all with a sense of contentment and control.

Tall order. Here is the money paragraph from Linda's article:

Philip Yanos, an associate professor of psychology at John Jay College of Criminal Justice, in New York, studies the ways that a sense of self is affected by mental illness. He told me that when his work was under grant review, it was initially met with skepticism. Some thought that what he calls "illness identity," which manifests in some patients as overidentifying with their mental disorder, was a topic of lesser importance in the face of other serious symptoms that patients experience, like cognitive impairment and thoughts of suicide.

Can there be a happy ending? "During the 20-odd years since my hospitalizations," Linda writes, "many parts of my old self have been straggling home. But not everything made the return trip." Nevertheless: "This June, I'm turning 60. I'm having a small party to celebrate my ingathering of selves. My old self was first to R.S.V.P."