Over the last few weeks, I have been entrenched in a novel, More or Less Maddy, written by Lisa Genova. In this work, Genova describes a young woman whose life becomes entangled with bipolar disorder. Maddy, the protagonist, struggles to define who she is after the condition latches onto her, magnifying highs and depression that vanquish her. With the assistance of a newfound love of comedy, she embarks on a quest of self-discovery. As Genova writes:
“So it’s not just that her diagnosis is scary and unacceptable. If she not only has bipolar but also is bipolar, then she herself is scary and unacceptable. And she can’t bear being scary and unacceptable to the people she loves.”
Mental health crises and the diagnosis of a mental health condition like bipolar disorder can mark a major alteration to a person’s identity. In my own experience, I can sort of divide myself into a “before” and “after” my first psychiatric hospitalization. Like Maddy, I struggled with a sense that a switch flipped after I and those around me learned of my diagnosis. Where was the line between sadness and depression? Nervousness and anxiety? Confusion and psychosis? Happiness and mania? For a time, I felt that I had lost the right to some of my basic emotions lest all my reactions be pathologized.
My recovery involved reclaiming my perspectives as valid and reconfiguring my outlook on who I am. I often see a similar process echoed in my clients, both as individuals and as they negotiate relationships with family members who may struggle to make sense of their experiences.
Identity and Mood
Most serious mental health conditions have their onset between adolescence and young adulthood, a time when we are exploring who we are both on our own and in relationships. We engage in a sort of dance as we figure out what matters to us and how we see ourselves. Yet, mental illness can force this process to detour. For this reason, identity confusion is common among individuals of all ages living with mental illness (Inder et al., 2008).
“Her diagnosis has changed the way her mother sees her, or rather doesn’t.”
Often, we derive our sense of self at least in part through our relationships. Yet, when a person develops a mental health condition, those relationships are frequently affected. Others might withdraw or treat the person differently. This can be devastating.
In the case of mood disorders like bipolar disorder and depression, there is a special kind of trouble. Our moods color every aspect of our experiences. When a person is at times exuberant, productive, and impulsive, yet at other times eclipsed by depression and inactivity it’s natural to start to wonder which mood truly encapsulates them.
Self-as-Context
From the perspective of Acceptance and Commitment Therapy (ACT), the answer would be that both moods define them. A person is more than their moods or behavior. We are the entities behind our eyes.
In ACT, this is called “self-as-context” or the observing self. It’s the idea that a person is more than any label or role could encompass. Rooting ourselves in the present moment and our values is key to psychological health, particularly for people living with a diagnosis of a mental health condition.
Closing
More or Less Maddy describes some often overlooked aspects of living with a mental health condition, particularly as it relates to one’s self. Integrating the diagnosis of any health condition, particularly mental health conditions, into our identities is complex. Yet, a person is more than any diagnosis.
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