Thursday, September 29, 2011

Insight and Intelligence

In the past three days, I've been three times to the office of my new psychologist. He runs a large practice (I think at one point he said there are forty-odd people who spend some time in his offices each week), but I have primarily been interacting with the owner and director of the practice. Today I met with Barry (let's call him Barry) and my mother to interpret the results of the battery of tests I took yesterday. Aside from the obvious ("You're really depressed!"), there were a few things I've been thinking about since I left his office.

Barry commented that the tests showed I was both very intelligent and very insightful. I've heard this from multiple therapists and psychologists before, and where it once made me feel proud and hopeful, now it's mostly just annoying. I talked about it with my mother as I drove her to the airport: what good does it do to know that I'm bright and insightful, if I'm still miserable? What good is it to be bright and insightful?

Well, the insight I know rationally is a positive good: I don't, for instance, make the same kinds of mistakes that I made three or four years ago. Because I'm observant of my moods and behaviors, and report them fairly accurately to the professionals whom I see for treatment, I've been able to curtail some behaviors and thought patterns that caused me pain in the past. But insight has not been enough: there is no amount of insight-based or skills-based therapy that will cure me of bipolar disorder.

So I get tired and frustrated when I hear psychologists become excited over how intelligent! and insightful! I am. I'm sure I'm a more pleasant patient to see than one who is dull-witted, combative, and incapable of recognizing harmful patterns in behavior, but it's not much comfort to me in the moment when I'm experiencing a depression that I know, rationally, is chemically and biologically based but which still feels as though it's rooted in circumstances and in my character and personality.

Tuesday, September 27, 2011


I intend to use this blog both as a vehicle for self-exploration and as a platform for serious discussion of the intersection of psychology and philosophy as approaches to living with mental illness. I am twenty-one years old, a college student (by the skin of my teeth), and bipolar. I do not have a mild or particularly manageable case of bipolar - I have had many episodes, episodes of depression, of hypomania, and also mixed episodes with symptoms both of depression and of elevated mood. These episodes have frequently been disabling, and have interrupted my life in serious ways. I am not fond of this illness, and frequently wish that I did not have to live with it, but I am past the point of denial. Now it's just a matter of learning to live with this disorder - and oh, how easy that sounds when put into words, but how hard it is in practice!

I am currently three days out of a ten-day hospitalization for bipolar depression. To be blunt, I tried to jump off of a bridge. My depression has been somewhat alleviated by the medications I was prescribed while inpatient, but has not gone away; if my previous depressions are anything to judge by, my current episode may last for several months. Because of the severity of this episode, my graduation from college is going to be delayed by another year: by the time I graduate, I will have been an undergraduate for seven years, since I was sixteen years old. It is frustrating beyond words to see my friends graduate, get good jobs, even marry. But I have made myself a private promise: even if my disorder is sometimes limiting, I am determined not to let it become disabling.

I am bright and driven, and to my chagrin I have come to recognize that is not enough. For many years I was noncompliant with my medications, but the results of my unauthorized med holidays have been predictable, though not always rapid: a return of symptoms, symptoms which when untreated are disabling. I am now treatment compliant, but unfortunately that is not enough to ward off a return of symptoms, either - because my diagnosis is so new (a year and a half ago) I have not yet found, with my psychiatrist, the ideal combination of medications to keep me asymptomatic and free of onerous side effects. I have tried many, many medications, but I am blessed to live at a time of rapidly expanding treatment options for patients with mood disorders. Thirty years ago I might have been stuck with lithium, which gives me terrible, weeks-long headaches and awful nausea. Now, luckily, lithium is not my only option. But the plethora of choices poses difficulties all its own.

Much of my undergraduate education has involved a careful study of Western philosophy, not to mention literature. Many philosophers promise that their style of thinking, sometimes formulated as a system, sometimes expressed in aphorisms, can produce true happiness, can alleviate wretchedness, can provide real consolation. I love philosophy dearly, and it was very difficult for me to come to terms with the fact that there is a biologic - dare I say mechanical - underpinning to the grief and anguish which my disorder has often caused me. It is so tempting to say that if I only embraced Stoicism (or undertook Pascal's Wager) I would be able to conquer my bouts of depression through willpower alone. But I cannot. And I am left wondering what philosophy is for, if it is insufficient for human wretchedness?

These are the things I intend to write about: my own experience with mental illness; my own struggles with philosophy; the intersection of my disorder, my treatment, and my philosophy; and my attempts to live a life unafraid of stigma. I hope to reach out to others writing about similar topics, whether they be peers who also have psychiatric diagnoses, amateur philosophers, clinicians, or anyone else interested in the mind and its diseases.

Wish me luck!