Saturday, April 27, 2013

Where Did the Self Go?

In tomorrow's New York Times Magazine, you can read an article by Linda Logan, 
"The Problem With How We Treat Bipolar Disorder."  Ms. Logan writes, in a tender and tragic way, about her own struggle with a severe, treatment-resistant mood disorder, and how her psychiatrists attended to her symptoms, but not to what she calls her loss of self.  

Ms. Logan writes:

How much insult to the self is done by the symptoms of the disorder and how much by the drugs used to treat it? Paradoxically, psychotropic drugs can induce anxiety, nervousness, impaired judgment, mania, hypomania, hallucinations, feelings of depersonalization, psychosis and suicidal thoughts, while being used to treat the same symptoms. Before getting to the hospital, my daily moods ranged from bad to worse, each state accompanied by a profound depth of feeling. The first drug I was given was amitriptyline (Elavil), which, in the process of reducing my despair, blunted all my other emotions. I no longer felt anything. It was like going from satellite TV to one lousy channel.
While some medications affected my mood, others — especially mood stabilizers — turned my formerly agile mind into mush, leaving me so stupefied that if my brain could have drooled, it would have. Word retrieval was difficult and slow. It was as if the door to whatever part of the brain that housed creativity had locked. Clarity of thought, memory and concentration had all left me. I was slowly fading away. 

I would try to talk to my doctors about my vanishing self, but they didn’t have much to say on the subject. Instead they focused on whether I could make eye contact or how much expression I showed in my face. They monitored my lithium and cortisol levels; they took an M.R.I. of my head. I received an EKG, was exposed to full-spectrum lighting and kept awake all night for sleep-deprivation therapy. Nurses jotted down their observations; my scribbled lines in art therapy were inspected. Everything was scrutinized — except the transformation of my self and my experience of its loss. 

She describes hospitalizations lasting for months, trials with many, many medications, psychotherapy, support groups, desperate episodes of mania and psychosis, and the toll this took on her as a person, as a mother, as a wife, and as a professional.  Even as a psychiatrist, I found her story tragic, though by the end, we do have the sense that she has gotten so much better and so much more functional.  And sadly, while Ms. Logan longs for a treatment paradigm that addresses not only the illness, but the loss of self, aside from acknowledging that both the illness and the treatment can strip you of who you are, and working towards getting yourself back is a worthwhile goal, I'm not sure I have much to add.  As always, I'd love to hear your thoughts.