Identify?

Once when I was in hospital, a doctor (or nurse, or someone, I don’t recall exactly, I was ill) asked whether I “identify” with my bipolar diagnosis.  Later that week someone else said “I can see your diagnosis is something you  really identify with.”

I have really mixed feelings about what it means to “identify” with a diagnosis.  I know that psychiatry is not an exact science, so there is guess-work and a subjective sense of what fits where, and how.  So yes, in a sense, I do identify with the diagnosis of bipolar.  I recognise in myself the highs and lows, the behaviours, thoughts and attitudes that come with them.  Textbook.  And the acknowledgement of this, of my recognition, brings some positive results with it: more helpful prescriptions, a framework for treatment, and (the usefulness of this is underestimated) a logic within which others can read me.

On another hand, even if psychiatry is aiming at a pinata in the dark and hoping for a lucky strike, I’m not sure a diagnosis should be something you “identify” or “don’t identify” with.  Certainly, I can say when something doesn’t feel right to me.  If someone diagnoses me with an illness whose symptoms I cannot recognise in myself, I can definitely make the case for this not being my diagnosis.  This will hopefully lead to the results I mentioned above, re: treatment.

But some people don’t “identify” with their diagnosis- nor do they necessarily identify with any.  The pressure to hammer square symptoms into the round holes of diagnoses can lead to counterproductive outcomes.  For example: over-diagnosis of some conditions because some of the symptoms fit for many people and there’s nowhere else to put them; diagnosing people with an illness of which they have only one or two symptoms; abandoning hope for some people, assuming that their lack of place within the rigid structures available means that they have no illness at all (and that because of this, the symptoms of the now-non-illness need not be taken seriously anymore).  Not everyone “identifies” with a diagnosis, but that doesn’t mean nothing is wrong.

In addition, while I understand that psychiatry is inexact and sometimes a blunt tool for a fine operation, I think if you are going to use something as medical-sounding as “diagnoses”, you can’t afford to put that much emphasis on “identification.”  Nobody “identifies” as having a physical health condition.  And no, physical and mental health conditions are not the same- despite what people say, they are often not even similar- but if you are using the same language, giving the same weight to the same words, you need to have something behind those words.  Something that doesn’t just depend on whether someone “feels” like you might be right.

I know I have written before about how I “have” rather than “am” bipolar.  It might not seem like an important distinction, but the point I was making at that time was that recognising the signs and symptoms of an illness within yourself, doesn’t mean that these define you.  They may be important and have a big effect on shaping who you are, but this doesn’t mean that they are all you are.  The diagnosis, the illness, isn’t necessarily intrinsic.  But something not being an identity in and of itself, doesn’t mean that it isn’t tangible in real terms.  For example, I don’t think of myself as “identifying” as a lesbian.  I just am one.  It’s not something I picked and chose to call mine, like being a goth or an emo or a banana or whatever.  It’s something I consider intrinsic and ingrained, which would exist regardless of my own understanding of it (whether cultural or personal).  In the same way, I don’t think bipolar is something I “identify” with.  It’s something I think explains a lot of my symptoms, and for me it is a useful framework to work within.  However, this exactly the reason that I don’t think of it as something I identify with.  I have it, or I don’t.  The diagnosis is useful to me, or it isn’t.  The language of identification doesn’t belong in medicine of any kind.  Not from the same people who, when you “identify” as mentally healthy, take this to be a symptom of your illness.  No.  You can’t identify your way in or out of a problem.

 

Happiness(es)

“It’s OK to say you were happy,” M says.  “I don’t expect you to have been miserable all the time before me.  It’s OK to say you were happy with other women.”

It’s a sudden, strange realisation that she’s right.  It’s very unlikely that I was horribly unhappy, all of the time, in every single one of the half-a-lifetime of relationships before I met her three years ago.  In a buried sort of way, I think remembering the small, happy moments always feels like a betrayal.  When you’re with someone, you’re fully with her, and it’s easy to minimise the good points about anyone else.  It’s the way children behave with their friends: anyone your “very best friend” doesn’t like (even if you do like them) can easily become the absolute worst, in a bid to validate the “very best friendship.”

Hearing, from M, that it doesn’t have to be this way is refreshing, because it allows for a third space.  It’s common for people to say “I wasn’t really in love before; I just thought I was.”  This is said so often and by so many people that it takes on the role of cliche, of myth.  It validates the love you’re in now, by invalidating the love(s) you were in before.  Knowing that M didn’t need this kind of negative validation- that she felt OK, secure, with us- was so reassuring.  It means neither of us need ever lie about our pasts.

I’ve realised that it doesn’t have to be like that.  I love who I’m with.  I am fully immersed in that- in the rightness of that.  I really believe that nothing before has come close to being this good (through my fault, through the fault of others, through no-one’s fault at all).  I have never been so peaceful.  That doesn’t mean I have never been happy before, or that the happiness before was false, or that I never felt any love, of any kind, for anyone else.  One thing (or person) being the best doesn’t mean that every other thing (or person) was the worst.

The brief moments in which I realised this were a swift re-writing of history, a highlighting of the rights amidst the wrongs.  The unhappiness and the horrible moments were not, and cannot be, erased.  I don’t want tinted sunglasses.  But I realised that this history- of rights as well as wrongs, of fun as well as misery- makes me appreciate our present (and future) all the more.  There is less satisfaction in contrasting the negative with the positive, than there is in contrasting the OK with the amazing.

 

A Memory (c.2004)

That day, I had a sudden, nervous, sick feeling towards the end of period 5 (History).  I had to leave because of the nausea and (hidden) the sudden, unexpected shaking of my hands.

When G told me she was leaving, I could have said this to her: that I had been feeling nervous all day, which was completely unusual before one of our sessions.  I could have expressed surprise.  At that moment, several choices were open to me and what I chose to say, when she told me she was leaving, was “oh.  OK.”

She tried to discuss it further, talk around my feelings about it, but I didn’t want to.  When she pushed too much I said “well, what do you want me to do?  Cry about it?”  At that moment, I actually saw hurt on her face.  Although I wanted to be clear that I wasn’t remotely bothered by her departure, I definitely didn’t want her to feel bad.  I felt guilty- but I was a teenager.  The stone had been cast, I could not take it back.  It was far too late to make amends.

As I write this, I suddenly remember the other conversation, two weeks or so prior.

She: So, I suppose what I want to say about what I said before, is that maybe I said it wrong, because I knew I was leaving…

As I write this I remember, clearly, what she said “before.”

She had told me that she was thinking about my “needs as an individual” and wondered whether I might be more comfortable seeing a black therapist.  I remember, clearly, my outrage at the time.  In retrospect, I can almost understand what she meant (or I hope this is what she meant): that, given my predominantly white school, it might be good to have someone “of colour”, outside of my family, to relate to?  Or was she just fobbing me off?

A couple of years before, I had a black counsellor for a few sessions.  “It’s hard to be mixed race,” she told me with all the authority of knowledge, but none of the honesty of experience.

I reacted to G the same way I reacted (on the inside) to the black therapist, though I respected G enough, and had been seeing her long enough, to at least partially explain my reaction.  What would be the point, I asked, in trying to “match my colour”?  Did she plan on looking for a specifically mixed race person for me to see, or would she just settle on any non-white?  Although I didn’t say this, I was quite upset because G was Irish- like my grandfather- and yet seemed to think I would feel more of an affinity with any black person, over a white person who shared my roots.  G backed off quite quickly after my outrage was expressed, saying it “wasn’t what she meant” but the feeling of being unsettled, the vague rage, was already there.

It’s funny, because this was going to be a brief piece about the way in which I chose- or chose not- to say goodbye to someone.  In the memory I had, I had skimmed the surface, overlooked the genuine and justified outrage I felt towards G as she said goodbye.  I had minimalised my anger, my real experience, and turned the situation into one that makes me feel bad.

It’s odd, the way memory works.

“Indecision”

I still remember clearly my own struggles when I was perceived to have BPD (EUPD).  How hard it was to get people to listen and how often, when they did listen, they simply put whatever I said into a box that was already neatly awaiting my words.  I am aware that people who have, or are perceived as having, PD are routinely given this same treatment.  I am aware of this because of the experiences of my friends on-and-offline, and also because of my interactions with professionals, as a professional.  It’s amazing what people will say to you when they have no idea who’s listening.

So, from multiple angles of experience, here is another thing I have noticed about the ways in which people with PD are often viewed.

Professionals often think that one of the markers of PD (and, to a lesser extent, of mood disorders) is wanting to change care providers (whether care-coordinators, therapists or entire care teams) frequently.  This is seen as evidence of the fickleness unfairly attributed to people with BPD; or as evidence of a wilful desire to destabilise the team dynamic of professionals involved in their care; or of ambivalence, uncertainty, and the inability to make important life decisions.  Or this old chestnut- it’s a sign of being manipulative.  Of course.

Here’s another way of thinking about it.  In what other situations are we expected to put up with a service that is inadequate or, for whatever reason, simply unsuitable for us?  I’m planning to change my mobile phone service provider when my contract is up this winter.  In the grand scheme of things, my data allowance is of minimal importance (even to me).  Yet it is accepted- even expected- that if I experience even the least dissatisfaction with the service after several times of trying to “make it work” (if that!)- then I should change it.

Given this widespread acceptance of people changing services when a service doesn’t suit them, why does a similar understanding not then apply to people experiencing severe and enduring distress?  Surely, by contrast with me finding my phone company unsuitable, it is much more crucial for a person needing help to ensure (within the limits of what is available) that the service is appropriate.  Changing care-coordinators isn’t always an expression of “liking” or “disliking” someone (come on, let’s not take things so personally!) but a matter of finding someone it’s comfortable- or the least uncomfortable- to be supported by.  Granted, this can be frustrating for care providers when needs/ wants have to be accommodated by overstretched teams of overstressed people.  That’s understandable.  I empathise.  But that is absolutely not the fault of the person seeking help that it appropriate and suitable for them.

I also understand that, as within any group of people, with or without any kind of “disorder”, there will always be those (extremely few) who “play the system”; those who actually are indecisive, and those who can be straight-up disruptive.  But associating these behaviours or attitudes solely to those with a diagnosis of PD, based on your subjective experience of what you perceive to be their “manipulation/ splitting/ indecision”, is unhelpful, discriminatory and often inaccurate.

Further, people who have experienced trauma (which many people with a PD diagnosis have) may experience issues with trust towards those in a position of either “authority” or “care.”  Considering that trauma quite often involves the abuse of authority by someone who is supposed to care, it isn’t actually difficult to comprehend that someone who has experienced trauma might display a confused (and confusing) attitude to those that they perceive to be in a similar position.  So yes, the desire to change care providers might be symptomatic of trauma (with or without a diagnosis of personality disorder)- but not because the traumatised person has some perverse desire to manipulate, cause chaos or upset people.

When I notice these negative attitudes towards people with PD, I try to challenge them.  When I notice a negative myth about PD affecting my own views, I stop myself in my tracks and correct it.  It’s impossible to offer positive and meaningful support to someone you have already second-guessed as being obstructive, manipulative, or unwilling to work with the (limited, sometimes inadequate) resources that you have.

Resources

Recently, I was speaking with someone about what it’s like to know you’re not doing the things you feel you “should.”  We discussed the feeling that another version of you (an old one?  A future one?) is looking at you and judging you in your current state, thinking “what are you doing?”  I mentioned my own experience of unemployment, the ways that it impacted upon my self-perception.  I explained that although it’s hard, sometimes you have to remind yourself that you’re doing the best you can with the resources that you have.

As we thought about that idea, she told me it can be even more daunting to think about it that way.  Within the context of not doing what you feel you should, it’s a struggle to see what your best should even look like.  You start to doubt yourself.  Example: I usually cook proper meals.  At a low point (mentally, emotionally and financially) all I had was dried pasta and a jar of pesto.  And because I wasn’t feeling great, I didn’t even use those things.  So in a sense, I was not “doing my best” even within the confines of limited resources.  I wasn’t using those resources at all, but instead wasting them.  She told me it can be stressful to think about how you have so many resources but struggle to use them.  I had to agree.

What I realised then, at the exact same time as it came out of my mouth, is this: even if you have the material resources (that pesto in the jar, that pasta on the counter), your inner resources might not match them. You might have many things available to you: people to talk to, a safe environment, food on the table (or in this case, in the cupboards).  But if you lack the inner resources- motivation, confidence, self-belief- then these material, external resources, quickly start to seem useless.  At the same time that this is happening, you may begin getting upset with yourself, for having all this stuff and yet not making use of it.

Yet, in the same way that depression can strike a billionaire, with more material resources than most, you can lack the resources inside yourself to make use of the external resources the way you feel you should.  That word again.  Should.  The truth is that what you “should” do is your best.  What I am coming to believe more and more, is that more people are doing their best, every single day, with the resources- both inner and outer- that they have.

Connections

Next week will be my last two days of work.  I work at 2 services, as a mental health worker; in one, I have already had my final day, last Thursday.  In the second- the one that I started at in 2015- the 25th will be my last day.

2 services.  16 people in each.  32 people.  32 people I will, most probably, never see again.

In 2 years, seeing people nearly every day, you get to know them.  Despite all kinds of ideas about detachment and boundaries and so on, they get to know you pretty well too.  Maybe not about the ins-and-outs of your life, maybe not about your family, maybe not about your favourite pub.  What they do see is probably something that cuts through all those things, straight to the chase: your style of being.  What I mean by that is that every individual has a series of styles: a style of talking; a style of moving; a style of expressing; a style of interacting and connecting.  If you are a fairly transparent person, then the style of being people (at work) see is most probably the style closest to the one you use when you are out-of-context, in the world, in your life.  When I said that I was leaving, people I have been supporting told me things about myself that I hadn’t noticed, about the way that I interact and the way I behave.  I was surprised, but I shouldn’t have been.  Why should insight be only one way?

It’s strange to be leaving.  This time last month, working in those two services had worn me down to the point where even the one month’s notice I had to give seemed like too much to work through.  And yet, on Thursday, I found myself in tears.  16 down, 16 to go.  Excluding coincidence, like I said, that totals 32 people I may never see again.  32 people whose names I will try to run through in my head so I don’t forget them.  Some whose names I might anyway, one day, forget.  Who will also forget mine.

I wrote each person a personalised goodbye message.  Some were easier than others, some more thoughtful than others.  One person told me she will stick hers to her noticeboard.

One week from today, I will be out of both services, for good.  Something I have been wanting for a long time… something I have been vaguely dreading for a while.  Off into the unknown- but everything’s unknown until you know it.

Role Models

I’ve written about my feeling as a young person that gay and lesbian people don’t exist after 30.  I’ve written about how I thought I had nothing to say about race… but was wrong.  What I haven’t talked about is something you could say falls between the two.

I was thinking a couple of days ago that, at least as far as examples from my personal life go, I have no idea what I will look like when I’m old.  This is because the oldest mixed-race person I know is just 41.  The girls and women I saw on TV shows in my early teens seem to have vanished (although, to be fair to the BBC etc., I rarely watch TV).  While there are many examples of what white (and black) people might look like aged, there are not so many images of mixed-race people past the age of about 45.  Will my hair go white or gray?  Will my curls loosen?  Will my skin wrinkle, or will I go dark under the eyes?  These are mysteries I have yet to solve.  Search results for “older mixed race actresses” include such gems as “28 Celebrities You Probably Didn’t Know Were Mixed Race” and “50 Hottest Biracial Celebrities.”  Not quite the information I was after.

I understand that part of this is because mixed-race people were slow to enter the cultural lexicon.  For example, in the USA, black and white “biracial” people are often referred to as “black”.  In the UK, mixed-race people and relationships have been around for hundreds of years (Olaudah Equiano married a white British woman in the 1700s, and here is a more recent example, from WW2).  But these relationships and the resulting children were not always in the public eye, and were simply not as common as white/white, black/black, Asian/Asian relationships.  So it’s not always a matter of erasure or stigmatisation… in a sense, we were just “late to the party.”

When I started primary school in 1992, I was one of very few mixed-race kids.  And I lived in a very multicultural area of London.  There were definitely black kids and definitely white kids, and just the one Asian kid, but barely anyone who shared my heritage.  At the same school now, the number of mixed-race kids is huge.  It makes me feel proud, unnerved, and responsible, that for some of these children, I might be the oldest mixed-race person they have ever met!

As a child, I wasn’t (usually) unhappy about my skin colour and I was proud of my heritage.  But looking back, every time I did feel uncomfortable with my race, it was due in part to not feeling like I had examples of people who looked “like me.”  I can even remember, quite clearly, the first time I noticed that a black woman was beautiful- and it was pretty late in my childhood.  The images I was bombarded with were almost never of non-white, beautiful people, so it didn’t register with me that I could be someone beautiful.  When people said my skin was light, or other things that aligned me with “whiteness”, I often felt proud- not just because “whiteness” seemed the thing to aspire to (even the mixed-race models in teen magazines tended to be as light-skinned as possible) but because white people grew older.  White people seemed to have futures, in terms of appearance, that I could not imagine for myself.

One of the main (and stupid) reasons given to discourage mixed-race romantic relationships, was that “the children will be confused.  It’s not fair on them.”  I was lucky- I wasn’t that confused.  “Mixing races”, like mixing paints, seemed to me to have pretty obvious results (that included more interesting dinner options and a wider selection of songs).  But let’s be honest- confusion is definitely made a lot easier when your image is not repeated, and repeated, and repeated, like everyone else’s.

Times have changed.  CBeebies (BBC for little kids) is full of images of all kinds of people, with all kinds of accents and appearances.  Mixed-race people appear on all kinds of TV shows and usually their race isn’t even mentioned because it isn’t a big deal and doesn’t add anything to the story.  We are one of the UK’s fastest-growing populations… we are everywhere (if the news is to be believed- cheers, Google).

Maybe the older mixed-race people are around after all and I haven’t noticed because they slipped in and became part of the story while no-one was looking.  Maybe if I count the white-haired heads, I’ll find some that are my shade.  But for a long time this seemed impossible, and since we all know now that representation is important, I don’t think I can say that I haven’t been affected by that fact.

It’s cool, though.  I’ll get older and find out for myself.  And I’ll let you know.