Personal Accounts: I Did Not Lose My Mind, but My Brain Had Stopped Working
Weʼve done a fundamental disservice to the treatment and acceptance of illnesses of the brain by calling them illnesses of the mind. Toward the end of the 19th century we began to refer to these “afflictions” as mental disorders. Although the term “psychiatric” has more recently been favored in clinical settings, the word “mental” stuck. It stuck in our popular culture, it stuck in our treatment models, and it stuck in how those of us living with these disorders still identify ourselves.
The word “mental” is defined as “of or relating to the mind” and “carried out by or taking place in the mind” and “relating to or suffering from disorders or illnesses of the mind.” These descriptions are a minefield for possible misinterpretation, evident in cultural references. Consider the phrases “sheʼs lost her mind” or “heʼs mental.” The message is that mental illness is a disorder of the mind, and the phrase “carried out by or taking place in the mind” adds a disturbing dimension, as if the mind were producing the disorder. And when somethingʼs all in the mind, itʼs assumed to be somehow less real. The implication is that people with mental illness have created these illnesses, that their experience is not real, and that their minds are diseased.
I have bipolar disorder type I. I experienced my first major depressive episode at age 19, and for nine years after that I struggled privately through almost annual bouts of depression. As the years progressed, the highs between depressive episodes also increased. By 2006, at age 28 I had a full breakdown characterized by a mixed state of mania and depression plus acute insomnia. This lasted for six weeks, and I was hospitalized three times.
My breakdown began on the heels of a music tour in Europe. I was drinking heavily, and the change in time zone combined with a chaotic performance schedule and limited sleep induced a bout of hypomania. After I returned home, that high energy changed to agitation, and a thick fog encroached on my brain. I lost control of my ability to process and synthesize information. My thoughts began to cycle very rapidly, and I was unable to control these loops of negative ideation. I could no longer sleep for even an hour or make decisions. I began to get lost driving in my neighborhood.
I needed to prepare for another trip but stared blankly at my suitcase, having no idea how to pack. In a healthy brain all the subtle calculations happen automatically, but I could no longer weigh the factors. What season was it? What temperature would it be? How many clothes do you wear during two weeks? How long is two weeks? Is one shirt better than another? How does one arrange clothes into a suitcase? My clothes were dirty, but I couldnʼt figure out how the washing machine worked. What did those knobs do, and which way should I turn them?
This is how those days unraveled. I had to write down what time Iʼd fed the dog because ten minutes later I would have no idea whether I had. But part of me remained a horrified witness to what was unfolding in my brain. Even when I had lost my grip on reality in many respects, I was having moments of clarity about what was no longer functioning correctly.
Years later, when I read Jill Bolte Taylorʼs account of having a massive stroke, I found her descriptions very familiar. As a brain scientist she had an intellectual level of awareness of what was occurring as she lost much of the functioning of her left brain during the event. Likewise, I was often acutely aware of my inability to process information or make decisions.
During my hospitalization, the social workers and staff who spoke to the witness part of me had a profound effect on my wish to recover. One social worker told me a story of his near-death experience in a motorcycle accident and his awareness of his consciousness separating from his body. This story resonated deeply with what I was experiencing—there seemed to be a thread of consciousness much stronger and older than the current illness that gripped me. I began to say to the staff, “Can we practice having a normal conversation?” The more someone spoke to the witness part of me, the more that consciousness in me was strengthened.
Sometimes I would be overcome with sadness at the disparity between my consciousness of the situation and my brainʼs total inability to function. I remember standing in front of a microwave oven and having no idea how to open it. I kept trying to interpret the symbols on the outside panel, but they were impenetrable. I pushed all of them, and nothing happened. Only later did I realize that I simply had to pull the handle. I was completely conscious of my inability to perform this basic task, but my brain was unable to solve the problem.
Months later when I had finally stabilized my brain on medication, I immediately began looking for ways to understand what had occurred. I wanted to know what to call the part of me that had remained witness to my breakdown. Was it called the self? Was it called the soul, the heart? To me it was consciousness, but how do we define that? I gravitated toward Buddhist teachings. In Buddhism the mind is known as the seat of consciousness. And consciousness, when it is given a correlate in the physical body, is located in the heart area. Buddhism contains a highly developed science of the mind. It offers practical methods for mental training. It cultivates awareness of how we perceive and determine sensory and emotional experience. What resonates with me is that Buddhists believe that the mind by nature is pure. All practice is an effort to return to that mental state of clarity and emptiness. These principles can be used regardless of oneʼs spiritual orientation.
Redefining my relationship to my own mind has been paramount in my recovery. Medication, lifestyle change, and six years of therapy and psychiatric treatment have played a pivotal role. But what has fueled my rehabilitation has been this paradigm shift in which I have come to see the mind as pure and inherently healthy. With the mind as my ally, as the seat of a healthy consciousness, I feel greater agency in my management of this illness.
Iʼve been fortunate. So far Iʼve had a fairly treatable psychiatric illness. Iʼve had access to free health care. I had a baseline of years of good physical and emotional health to work toward again postbreakdown. I have a supportive family and a strong network of friends. I make a living as an artist and have found great solace in creative expression.
Not every psychiatric illness is mild enough to leave the witness part of the consciousness intact. My three weeks on the inpatient unit gave me plenty of firsthand experience of the degrees of psychosis among my fellow patients. It was also painfully clear how chronic these illnesses are; many of the people I spoke with had been cycling through hospitals for many years. Also prevalent were the deep wounds of trauma in many of these patients and the continued abuse of alcohol and drugs.
I do not think that I represent the majority in any sense when I describe my own experience of illness. But I believe these core principles Iʼve become aware of can be applied to the recovery process for a wide range of psychiatric illnesses. Cultivating a feeling among persons with mental illness that at their core they are well might serve as an incentive to change their lifestyle. If youʼre running a race and someone tells you that youʼll never finish it, you simply donʼt see any reason to endure. But if someone says, “Iʼve already seen that you are by nature a very strong runner and that you will reach your goal despite this knee injury,” the incentive to persevere is strengthened. Now imagine telling someone not only that he or she is inherently a great runner but also that you can provide access to some physical and mental training methods that have been successful for thousands of years.
For those of us with psychiatric illness, believing we have a chronic “mental” disorder that will affect the rest of our lives is counterproductive. We are living with an illness of the brain. There are a host of physiological and environmental causes and conditions that give rise to psychiatric illnesses. But by nature our minds are pure. Each small gesture toward strengthening that inner witness gives us greater agency in our recovery. We can view psychiatric illness as a mental disorder, or we can view it as an illness of the brain, with the mind being our best ally in illness management—our choice can make all the difference in recovery.
