On being mentally unwell - part 1

This is the first post in a two part series about mental health. For more context, see this post. For the second post, see here.

This is the more personal post.

A library of minds

I would like to invite you to a special library. It is related to Borges’ Library of Babel, but it is not as well-known. This one contains, not every possible book written with a combination of characters belonging to a certain set, as does Borges’, but books describing all the possible types of minds.

For each possible mental state this library contains a corresponding book, the contents of which describe that state in some way. If you feel a single book is insufficient to capture the complexity of a mind you can imagine each mind to be represented by a potentially infinite series of books, all contained in the Library (technically, if the number of possible mental states is countable, this is unnecessary - we could simply represent each distinct mind state by an integer, but for the sake of the analogy we allow for more descriptive representations, e.g. stories in English).

Every person that ever has, or ever will, live has a wing in this athenaeum, including you and I; all the states that our minds have ever been in are in our personal wing. Since we spend much of our lives sleeping, many of the books correspond to states of sleep - or at least the human ones do, which are the only types of minds we will consider here, due to a lack of familiarity on my part with non-human minds.

Tragically, some non-trivial number of the books in the Library correspond to mental states immersed either in that intense, persistent, and all-encompassing despair that is called depression; or that unreasonable fear called anxiety; or both (these should not be confused with books that may merely evoke such states in the reader; e.g. literature steeped in 20th century existentialism, or historical books outlining the various horrible things people have done to each - those kinds of books can be found in perfectly ordinary and finite libraries).

In addition to books, the library is filled with visitors of various kinds. Those ones, over there, call themselves ‘therapists’ - they have a habit of carefully (some more than others) opening the books, reading them, and then making little scribbles in them, altering them slightly; like a cross between an archivist, a bookbinder, and a conservator. One wonders whether they always know what they are doing - the owners of the books sometimes find this process too uncomfortable, or do not appreciate the alterations; and then the therapists are asked to leave. Sometimes they are replaced by different and hopefully more skilled ones.

A common form of visitor is people interested in reading their own minds; since they are then in the mental state of reading their own mental state, which is that mental state where they reading it, and so on ad nauseam, some recursion is involved. It is best not too think too hard about this; suffice it to say that the books can contain copies of themselves.

Anxiety

I have spent a great deal of time in the Library myself. The evidence is there, in my wing - it contains more than the average number of books that describe a pensive mind ruminating on its own workings and failings. As a result my wing in the Library of Minds is not the happiest place; and while it is far from the unhappiest, I have a vested interest in improving it. I have recently dusted some long neglected shelves, and improved the lighting a bit - the mood is less somber, more welcoming. Perhaps I will get around to adding a few potted plants at some point.

Not a few of the books in this wing are characterised by anxiety. My anxiety ranges from mild to paralysing - the closer it comes to the paralysing side of the spectrum, the more it manifests as bodily discomfort. This ranges from a tight feeling in my stomach or shoulders, to an oppression on my chest that is useful fuel for intrusive thoughts of the type familiar to the hypochondriac, and therefore the source of more anxiety.

When the anxiety reaches a fever pitch, it often, but thankfully not for quite some time now, develops into a full blown panic attack, which renders me as capable of rational thought as a sea sponge (my apologies to any rational sea sponges reading this).

Sensory integration issues

Like many people, two common triggers of my anxiety are crowds and loud noises; to the extent that the influence of the latter on my anxiety has a neurological basis I have become resigned to the fact that there is not much that can be done ‘cure’ wise until our technology has progressed much further - my main coping mechanism is avoidance (for the former also, if truth be told). Since the uncomfortable truth is that the world is not heading in the direction of smaller aggregations of people or less noise, I unfortunately recognise this as a maladaptation that I need to manage to avoid becoming a complete hermit. So far I believe I am managing this fairly well, even if I have not quite banished excessive social anxiety from my life. Ironically, writing, which is a predominantly solitary activity, has been helpful in this respect - I like to imagine that the sentences I write find their way to the Library, where they console some of their less happy brethren, or grant them a new perspective.

I believe some sort of sensory overload is involved with much of my anxiety - I become extremely flustered by loud noises, which destroys my ability to think, which I find very distressing. It has occurred to me that perhaps the relation between my sense of ‘self’ and my internal verbal dialogue is more developed than average; or maybe less developed, and simply more prone to disturbance by certain types of sensory stimulus (e.g. sound); and this manifests as a jarring sense of impending doom when my internal, rational dialogue cannot be heard (by whom you ask? by my homunculus of course). The underlying physical mechanism is likely something conceptually simple, like a problem with the way my mind processes sound, quite distinct from any sense of ‘self’ I may have.

Social anxiety

I also struggle with social anxiety, in various contexts. The thought of dealing with officials, fulfilling bureaucratic tasks, or simply being in public, often fills me with dread; I am afraid that I will humiliate myself, or be punished in some way. This is an oddly self-referential form of anxiety, and these books are shelved near to the OCD books - they have a funny shape, and if you open them you’ll see that the book starts over at the end; you can never finish the book, since there are always more pages, with the same damned text every time.

I have tried talking to these books, explaining to them that they’re being very unreasonable, and in fact quite illogical; this has not yet yielded great success, so I gather they are as immune to logic and reason as the most stubborn bureaucrat or official.

A form that my anxiety has manifested in crowds is the remarkable transformation of the faces of passing strangers, who are surely more likely to be supremely uninterested in me than anything else, into faces with clear malevolent intent; and at such times I am overcome with the paranoid conviction both that they judge me to be morally defective, and that they harbour ill-will towards me.

A Freudian purist (do such people exist?) might say I am projecting malevolence onto these strangers as a defence mechanism (I cannot imagine against what); I am more likely to say that the part of my neural circuitry that is wired to seek danger has become overactive, and that its pattern matching is yielding a high rate of false positives, which is feeding into a positive feedback loop. The end effect may be the same as that conceived of by the imaginary Freudian - whether that means the Freudian point of is equivalent to the one couched in non-psychological terms is a thorny philosophical problem that I often muse upon; it is unclear to me whether this is therapeutically helpful, but I am leaning towards the negative.

Therapy and healing as creative endeavours

In the picture I have drawn above, therapy, medication, and similar endeavours are attempts to carefully rewrite our mental books, so that they no longer correspond to such dysfunctional states; and a therapist is someone who guides you to do so, who invites us to reconfigure some of the troublesome features of our minds, insofar as such a thing is possible. When it seems that it is not possible we may be invited to assume a fresh perspective; and to assume a novel perspective is, of course, also to be in a different state.

To deal with my dysfunctions I have had to steel myself to open the covers of certain books in the Library, and strive to decipher the language in which they are written (it is a script both foreign and comfortingly familiar). I have had to trace the trajectory of my life’s stories, which are in a book in a different library (accessible through interlibrary loans) - its chapters narrate my birth, development, triumphs, losses, and humiliations. I have struggled to find the golden thread that links the two tomes; to unravel the chaos of my experiences as chronicled by a constantly misremembered past; and eventually, occasionally, I have been able to say confidently ‘aha! yes of course, this is why I resent [X]’ or ‘this defence mechanism is maladaptive, and has its origin in [Y]’, or even just ‘experience [Z] was fucked up, and it’s ok to talk about it’.

Reconciling the various tomes of the mind

In addition to the tomes describing our mental states, and those chronicling our life stories, there are others relevant to our analogy (it turns out that our minds have a large imaginary literature); these contain the less immediately relatable, but no less true, story of the biochemical events corresponding to a particular state of mind. Reading these books are harder, and it is doubtful if you will ever be able to legibly map the voltages, molecular binding events, firing of neurons, and all the other panoply of the nervous system to the experience of being you; of being in love, in pain, of wanting to die because of loneliness and rejection, of being satisfied by a delicious meal. And if you did, it is unclear what you would gain (but if you did the pharmaceutical industry would very much like to talk to you).

I have, over the years, entrusted my neural biochemistry to some nice people who give me pills they tell me will help. By and large they seem to; it’s difficult to tell sometimes, and I need to have some faith in study designs, statistics, and the people who designed these pills to convince myself to take them. But on the balance they seem to have done more good than harm.

A primary side effect of the pills, that has as yet not been eradicated, is a mild sadness that I must take pills to have a ‘normal’, or less pathological, emotional life - and the nagging feeling that this means I am a defective human being.

Fortunately my current biochemical tinkerer enjoys talking with me more than is the norm for people of her profession; I have benefited greatly from our conversations, where she often points out some plot detail of certain of my books that I somehow overlooked. She also introduced me to a friendly horse, who does not seem very interested in reading, but is nonetheless quite pleasant.

Refusing despair

Concomitant with my anxiety has been a sense of shame and inadequacy at my inability to be as others are, or to function at the level I feel I should. At its most extreme, usually coinciding with periods of social withdrawal, I have entertained self-destructive thoughts. I think it is difficult for outsiders to severe depression to understand that the thought of not existing can be a relief - it is one of those facts that society at large does not often acknowledge, because it is uncomfortable and gives the lie to many of our more saccharine illusions.

This type of obsession is not good, and likely a sign that you are in need of help. If you regularly or strongly feel like this, please go see a mental health professional, or confide in a sane person you trust, who has your best interest at heart. I know this can be difficult, especially if, like me, you have harboured paranoid feelings about the motivations of others. In my case this seems to be due to some dysfunctional childhood dynamics rather than a more strictly biological dysfunction, for which I am grateful. I have seen the hell of the severely paranoid and delusional, and it is something that will break your heart.

I am pleased to report that after what you may construe as either a challenging analysis of a specific set of books in the Library, or a major break through in therapy in the last few years, my experience of severe, crippling anxiety and depression has markedly decreased in frequency and duration. I haven’t been deeply depressed in ages. The anxiety has been dulled, and I sometimes manage to interrogate it; sometimes even to tell it go away.

My partner and I are considering having children. I like to believe that choosing to bring people into the world is a chord in a hopeful melody which has value in itself, as does life; and that the nature of that value is such that it can only be expressed by living it.

If you too struggle with your mental health (and the odds are you do) I encourage you to visit the library of minds. Open the various books corresponding to your mind, and read.