On Mental Illness as a Being in the World

The more I learn about mental illness the more I realize how difficult it is to categorize, understand, and diagnose it. It’s not like the flu where one encounters the same symptoms in 99.9% of cases. In mental illness, two people with the same diagnosis might have different symptoms and, of the symptoms that are the same, the details will certainly be completely different.

My own psychosis is physically painful – it feels as though I’m being electrocuted. I’ve never met anyone else who is physically tortured by their illness. Others with psychosis experience totally different things. When I first started hearing voices, it was an indecipherable murmuring – like when I was little and my parents were talking in hushed voices outside my door. I knew the voices were saying things about me, but they were just out of ear shot. I don’t hear them all the time anymore, I only hear them under specific circumstances. And, when I do hear them they’re dark and threatening – they’re angry with me and want to hurt me. Others might hold entire conversations with the voices in their head. Others have a pseudo-kind of voice: thoughts narrated in their head in someone else’s voice.

This is what makes the world of mental illness so murky – every symptom so individualized – no one has all of the symptoms, usually just a few, and not the same few symptoms all the time. Mental illness progresses, but not necessarily in predictable ways.

More to the point, there’s a lack of objective tests to determine what’s going on and how to treat it. It sometimes doesn’t feel like an illness at all. I walk into my psychiatrist’s office and explain to him how I feel and how my illness has been expressing itself and he makes an educated guess on how to treat me. If I go into my primary care physician’s office and explain to him the symptoms of diabetes, he doesn’t make an educated guess on how to diagnose and treat me. He gets a blood test done – an objective measurement of how my pancreas is working so he knows how to treat me.

And that’s the key difference: knowing.

What does it mean to know? What does it mean to know a person versus knowing where to find the best deal on used computers? Dig deep enough and you might realize there is no such thing as objective truth, but we’re not going that deep.

My PCP knows if I have diabetes – there’s a number printed out on a piece of paper and it’ll either be within the normal range or outside of it. I either have diabetes or I don’t. It doesn’t matter if I eat nothing but fruits and vegetables and avoid red meat. It doesn’t matter if I have five candy bars for supper every night. The blood test doesn’t lie and the doctor is essentially a technician reading a number off of a printout and prescribing the necessary medication or treatment.

To know in a psychiatric sense is much more miasmatic. Here we discover just how little we truly know about the brain and how it functions. Dr. Carlson can’t do a blood test, can’t listen to my heart, or check my throat. He can’t take an x-ray or run any kind of objective test to tell if I have a mental illness, let alone what kind. Instead, I sit across from him for forty-five minutes at a time and try to express how I’m feeling and what I’m experiencing.

Without an objective test, without a tool to see or listen or poke or prod the mentally ill are left to our mastery of language in getting the treatment we need. We’re left to our own awareness of our minds – what’s normal and what’s not, what’s natural and what’s foreign – something which mental illness often obscures from us. We’re left to a forty-five minute discussion in which a doctor tries to translate the plebeian expressions of a patient (who’s going through some pretty terrible things) into a treatment plan. The whole arrangement has got me thinking, maybe there’s a disconnect here.

What if mental illness isn’t really an illness in the conventional sense of the word? What if mental illness is just a different way of being-in-the-world?

If you’ve ever read any Sartre, that phrase “being-in-the-world” should be setting off all kinds of bells. Heidegger called it “dasein”. My Oxford Dictionary of Philosophy defines being-in-the-world (dasein) as “affective relationships with surrounding people and objects.” You can think of affective as being emotions or a way of communicating feeling with the world. Being-in-the-world can also be taken literally and still be understood. You don’t necessarily have to dive down the philosophical rabbit hole of trying to define what “being” actually means – it’s just useful to consider things from a different perspective sometimes. You can think of it as your presence, your perception, or your relationship with the world as you experience it.

And I think that’s a nice way to sum up mental illness, because all mental illness really is is a different way of relating to the world. It’s a different configuration of the brain. I used to think of my brain as this diseased, rotten thing – I pictured it looking like the lungs of the lifelong smoker they showed us in health class in high school – blackened, sickly, and dying. Then I read about how people with mental illnesses like mine simply have their brain arranged in a different way – we have more connections with the primitive parts of our brain and fewer connections with the more evolved parts of our brain than other people have.

What a lovely way to think about my brain. It’s certainly comforting to me. Instead of seeing this diseased brain I’m ashamed of, I see a unique brain, a brain offering a different perspective on how to approach life and solve problems.

Certain cultures see the benefit of this alternative configuration of the brain, particularly the Australian Aborigines. To an Aborigine, someone like me ought to be a shaman…someone who gives council. My unique brain offers a different way of thinking, a connection to a different being-in-the-world so-called “normal” brains don’t have.

It doesn’t mean I’m going to throw away my pills and my routine and my CBT training. My treatment is still crucial – I still take my pills, I still see my therapist one week and my psychiatrist the next, I still take walks every day, I still take my bi-hourly breaks – I still do everything I need to do to stay healthy. Mental illness as a different way of being-in-the-world doesn’t mean I don’t have to treat it, it just means I get some relief from thinking of myself as diseased and broken.

Because I’m not broken. I’m not diseased. I’m still a complete person. I’m still as deserving of love and respect and compassion as anyone else. I think people are too often caught up in the stigma of mental illness, that subconscious fear they’ll “catch” whatever I have if they’re around me for too long. In those instances, when someone shrinks back from me, it’s a great comfort to know it’s not so much an illness (in the “I have diabetes” sense of the term) as it is just a different way of thinking. I have a unique brain, with a unique way of processing information. And that’s valuable. It takes all kinds of people to make a culture, it takes all kinds of different perspectives to adequately think our way through the serious problems we’re faced with.

Many of the most valuable contributors to culture have/had a mental illness. Maya Angelou, Albert Einstein, Vincent Van Gogh, Buzz Aldrin, Thomas Edison, amount countless others have used their unique ways of being-in-the-world to revolutionize the art world or help us better understand how the universe is constructed. Would they have been able to make the contributions they did without their unique ways of being-in-the-world? I don’t know. It’s easy to separate someone from their cancer diagnosis, to consider someone outside of their diabetes. It’s much more difficult to separate me from schizoaffective disorder. Mental illness is such a personal thing, affecting the very core of who you are. It will separate you from society, isolate you, change how you interact with reality. But where would we be without these different beings-in-the-world? How much worse off would we be if we all thought the same way and interacted with the world in the same way?

And this makes me feel like I’m a valuable member of society. I’m needed, I’m essential. Because if there weren’t people like me, who thought like me, we would be worse off, we would be weaker. It’s just such a shame we don’t seem to want to acknowledge that. Stigma busting isn’t just valuable for improving the lives of the mentally ill. It’s also valuable for making everyone stronger with a diversity of thinking, because of the variety of beings-in-the-world me and my fellow mentally ill offer.

Mental illness so often makes you feel powerless. We take our relationship with our minds much more personally than we do our relationship with our left kidney. We can get along just fine without our left kidney. But without our brain, who are we? Who are we if we have a diseased brain? Thinking about mental illness as a different way of being is a comfort to me. I don’t picture a blackened, sickly, dying brain anymore. I picture my brain as a unique and valuable addition to all of the rest of the brains out there. Nature favors diversity and the mentally ill certainly help provide that diversity.

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