Centuries ago someone became intent on separating the “mind” construct from that of human anatomical structure. Humans were believed to have this thing associated to them called the spirit which did not occupy a physical place in the human body, but rather was related to it metaphysically. Eventually, through serendipity (or accidents and disease) it was noted that if the brain were to sustain structural damage, often so did the person’s spirit or mind; what we now call ‘personality’ as well as sensory and motor function changes/deficits could occur. So then it was determined that the essence of what we speak of when we use the word “I” inhabits the brain. Soon, others (again, often through accident or disease) became able to map particular human responses, emotions, and sensations to certain areas of the brain. The current understanding is that there is a predilection of certain brain structures to be associated with the central processing of a particular human function, but that this function can be diffusely localized throughout the brain.
Psychiatric illness used to be subdivided into organic brain disease and other mental disorders. Not all problems related to human cognition were thought to be able to be localized to a defect in a particular brain structure or group of structures. For example, a disease like Alzheimer’s dementia was considered an organic brain disease because it causes biological changes in the brain that can be observed macro- and microscopically at autopsy. On the other hand, disorders like depression were by conventional techniques not able to be pinpointed to any particular place or sets of places in the brain; these were the “other”, i.e. non-organic, mental illnesses. With continuously evolving brain imaging techniques, there have been increasingly new biochemical or anatomical related structures or pathways identified that have been found to be associated specifically with the majority of mental disorders. Now the different diseases affecting human cognition are subdivided preferably into classes of acquired or intrinsic aetiology, affecting motor function, affecting sensory function, and related to intellect or cognition, etc. In essence, there is no longer a question of whether any mental illness is related to physical brain substance or not; a physically-related change is implied.
Okay, again back to the “for better or for worse...”. So a person falls in love and he/she makes a commitment to someone else to be a partner to their person. Simple. Right, but what is a person, who is the “person” you marry? If your partner is well and healthy then that person is their physical body and their intellect and everything they express and sense. If that person, say, had a leg amputation, he’s still your partner. If he had a bilateral leg amputation, he’d still be your partner. He could lose gall bladder, arms, a segment of bowel or liver, thyroid, spleen, kidney, bladder, or lung and he’d still be the person you married. You would know this as soon as he communicated with you and you recognised their expressed thoughts as their own.
Now, consider a person who enters a comatose consciousness state suddenly due to either accident or disease. Their partner will have a memory of what this person was like physically, without any medical attachments, and, more importantly, of their “personality”. You can’t suddenly stop loving a person, or even just stop recalling suddenly what they were like. Often the partner will visit the comatose version of their partner for some time until he either succumbs to illness or regains consciousness. Why do they do this? Is it because they love them? Probably to a degree (like I said, you don’t suddenly stop loving a person), but I would argue it has more to do with the fact that you also have a recent memory of their functional personality. You loved the person physically and cognitively, yes, but you still recognise the living body under the hospital clothes, dressings, tubes, wires, etc. as your spouse because you fall in love really with the intellect, the ‘personhood’, the mind of someone. And you are aware, or at least believe, that under all these physically palpable things lies the “person” you knew.
You could call the above scenario an example of an acquired injury affecting brain function. What of “intrinsic” mental illness, then? Let’s consider as an example depression. Okay, so you meet your partner and you fall in love with their personality, what they say and think, and (at least accept) what they look like. Gradually (these things are often gradual) your partner starts to change. Physically he may remain the same or he may change also, but more markedly his mood and thoughts change. The mental illness affects his ability to concentrate, to attend to things, to enjoy things he previously found pleasurable, etc. You notice these things every time you interact with him. He may become irritable or unable to be roused into anything that requires enthusiasm. His expressive behaviour changes as do his cognitions. Maybe you know something about depression, maybe you don’t but you still love him. You recognize this person is going through a low mood stage in their life because everyone has had these at least transiently. You empathize, maybe even sympathize. You notice he’s changed in the way he interacts with you and it is much less desirable or pleasant to what he used to be. You put up with it for a week, two, a month, a year maybe, and then what? Assuming the person makes no dramatic improvement in their mental illness, such as what some medications can bring about, you with time forget that memory you had of the person you fell in love with. Maybe you can remember what they were like a week ago, maybe a few years ago, but with more and more experience with their “depressed self” you start to evaluate the person as they are and have been. Then guess what happens? You just can’t do it anymore. The love, the relationship, and the person has changed so much you can no longer relate to this person and love them like you once did. You fall out of love and either emotionally or physically move on.
What happened to “in sickness and in health...”? Acquired brain injury is a disease but endogenous depression isn’t? It is hard to love in the context of any ailment because it literally changes EVERYTHING! We used to think disease affected one person, but we’ve gradually come to realize that one person bears the sick body, but the disease affects a whole family unit. Having a romantic relationship (and even kinship) in the context of mental illness presents a particularly challenging scenario. No one can tell you who to love and for how long and in what circumstances, but I hoped with this discussion to raise only one point: mental illness is a disease state also. Judge the mentally ill as you would an amputee or a cancer patient.
Say you know about a person's diagnosis from the time you met. What happens when they use it as an excuse for "bad" behaviours? Some of them I can write off as legit byproducts if you like of their illness, but some I am sure are simply being used for convenience. I feel like a real bitch sometimes calling them on it, but I can't help but feel they are trying to take advantage. Is this wrong??
ReplyDeleteOne way to think of it is to consider the "sick role" or "victim role" some people may adopt (either consciously or subconsciously) when they are subject to a chronic illness or long-term trauma. Sometimes people will behave in maladaptive ways and they may say, or we may imply, that they do so because of their illness. Are they wrong in doing this? Yes and no. Sometimes they may behave "badly", as you point out, as a direct consequence of their illness - and no, it isn't their fault in doing so. Sometimes a person may behave badly and use their illness to take advantage of your goodwill towards them - in which case, yes, that is clearly malicious.
ReplyDeleteOne way that to help identy those who are being genuine in their 'bad behaviour' is that when you confront them about their behaviour, the person who is doing so subconsciously will often be apologetic and try to change. The other person who is using their illness as an excuse, will often argue back with you, tell you you're bad for judging them, will make no effort to try to change or at least control the damage, etc. Are you wrong in distrusting a person with a mental illness who misbehaves? No. It would be wrong to do so without at first trying to explore the issue further.
The other point to raise is the difficulty in differentiating a person with a personality disorder and those who just simply have a bad personality. I might discuss this further later on.