One of the ever-present and ubiquitous challenges that faces everyone, not just philosophers, psychologists and psychiatrists, but all people, is the problem of the Other. Human are social animals, we form and maintain relationships with other humans, and we try to engage with other humans from a position of knowledge rather than ignorance; we try to make sense of others. Intersubjectivity is what Derrida calls an 'undecidable'. It lies between 'subjectivity' and 'objectivity' – one could argue that these two terms both have intersubjectivity as their ground in the sense that the 'objective' arises from a shared consensus among different parties and the 'subject' also is born from relationships with other people, from others' view of the self. The problems of intersubjectivity and Otherness have been a central concern of philosophers at least since Hegel, with contributions made by Husserl, Sartre and Levinas among others. In this post, I am going to just tackle one aspect of the problem, the notion of essential character or personality.
The common-sense view of the world adopted by most people is that individuals possess essential, enduring and unchanging personality traits. I seek to understand others and, if I am a little more enlightened, I seek to understand myself. If I describe a person to a third party, or seek to explain myself to another, I use adjectives. I might say someone is "generous" or "miserly", "sophisticated" or "naive", "introverted" or "extroverted". Whenever I do so, I am assigning essential qualities to that person. Psychology and psychiatry also assume the presence of enduring personality traits, of natural kinds of person. A patient may be 'diagnosed' Borderline or Avoidant or Narcissistic, autistic or bipolar or schizophrenic. Again the tendency is to assume that people have essential characters or natures.
Whenever we describe a person, we are almost inevitably making a moral judgment. If I say someone is "selfish", for instance, I am assigning a negative label to that person. Almost all labels are either positive or negative although a descriptor like "cynical" can seem negative to someone and positive to another. The current discourse in psychiatry is founded on the idea that people can be divided into different categories, where every category is considered a different sort of deviation from the norm. What constitutes normality however? Who gets to define it? We can only presume psychiatrists are the norm. Every diagnosis is a moral judgment, an Authoring of the patient.
I have a problem with this essentialist view of the human personality. The problem is that a person may present differently at different times and in different situations, and that an observer's own biases, prejudices and preconceptions may influence his or her judgement of another.
Last year, for instance, I had lunch with my brother and his attitude was angry, even hostile. If he had been a stranger I had never met before, I might have thought that he is a naturally angry person. Knowing him well I had first thought he might be angry with me, and then found out from him that he had that morning visited a friend dying of cancer in a hospice. He said to me something like, "It's all so fucking unfair!" The lesson one can draw from this is that a person's apparent personality can be affected by events and experiences in his or her immediate past and that to assess a person's character we need to factor in what has happened in his or her life, both recently and more further back. To understand another we require information: we need to know what has happened to him or her.
Sometimes a person can depart from his 'normal' personality for longer than a day, sometimes it can last months. In 2007, I was profoundly unwell. I believed that the world was controlled by a conspiracy of closet homosexuals who might kill me if I exposed them. I also believed that a listening device had been planted in my glasses and that everything I said was being monitored. This episode lasted from just before I became a patient of the mental health service until around the end of the year. say around eight months. I didn't talk about either delusion. I remember back in 2007, my mother and I travelled to Wanganui from Auckland to visit my aunt and we were followed by a truck: I though the truck-driver might be an agent of the homosexual conspiracy and that he might run us off the road. When we arrived at Wanganui, a small city of just over 42,000 people that I had never visited before, I decided that it was an enclave of enlightened heterosexuals who had fled there to escape all the closet homosexuals that made up the bulk of the population in New Zealand and around the world. In the years since, I would often toy with the possibility of moving to Wanganui.
It may seem like I am digressing but the point of this story is that for most of 2007 I was possessed by an extraordinarily powerful paranoid delusion – but those treating weren't aware of it. I even believed that patients of the Mental Health Service were basically intelligent heterosexuals who had cracked the secret of the homosexual conspiracy; I thought the system was an instrument of the homosexual conspiracy intended to silence or neutralise potential whistle-blowers. I sometimes thought that their strategy was to turn straight kids gay, to bring them into the conspiracy. Towards the end of the year I was a day-patient at an up-market respite facility called Mind Matters; I believed it to be a recruiting ground for homosexuals and when I first started going there thought I would be sacrificed. Without understanding how ill I was, the cause of my illness or the nature of my core delusion, those treating me may well have thought my behaviour was characteristic. I remember one young woman at Mind Matters saying to her colleagues, "You remember the DSM IV? Borderline Personality Disorder?" I piped up from the couch, saying that I had diagnosed myself some time ago as having Avoidant Personality Disorder.
On one occasion, I remember my corrupt and mendacious psychiatrist, Tony Fernando, telling me that delusions were, by definition, fixed. I can't remember when he said this, but I think it must have been either in 2009 or 2010. He couldn't have known with certainty what my core delusion was because I never spoke about it until 2013 but perhaps had intuited it. Consider – if delusions are always fixed, by definition, then if a patients says, once, that he thinks the Queen is a reptilian shapeshifter, it will go in his or her record as an inflexible belief. Psychiatrists never ask, "Do you still believe so-and-so?" The notion that delusions are inevitably fixed is just one more bit of bullshit that let psychiatrists get away with murder. The delusion that the world was ruled by a conspiracy of closet homosexuals featured strongly in the psychosis I experienced in 2007, very intermittently in the psychosis I experienced for almost all of 2009 and evaporated entirely over the Southern summer of 2009 and 2010, at the same as the delusion that I had a listening device in my glasses went away for good. Having Obama and Jon Stewart as imaginary friends proved to me that this neither belief could be true. That was seven years ago now and neither delusion ever returned.
What I am hoping to show is the difficulty assessing a person's personality when a person exhibits different behaviours and different characteristics at different times. Personality is not fixed. If there is such a thing as essential personality, different aspects of it manifest themselves at different times.
The other difficulty associated with understanding another's character is that personality is situational. When one enters into a dialogue with another, one constantly monitors the other's body language and what the other explicitly and implicitly says. If one tries to avoid or minimise tension with others, if one wants to be liked, one monitors one's own speech in a way that reduces the possibility of conflict. When a patient is in a consolation with a psychiatrist, the patient is continuously assessing the psychiatrist's micro-expressions and drawing conclusions from what they say and don't say. Psychiatrists think they can maintain an 'objective' perspective by saying as little as possible but this doesn't work.
I thought I would now, as I did in the previous post, tell a few stories that reveal my way of observing and making sense of those treating me. I'll put these recollections in chronological order.
As I've said before, I sensed or intuited that at the end of 2008 or the beginning of 2009 my arsehole of a psychiatrist had either put in my record that I'd come out to him as gay or put something damning in my report that suggested I was gay. The psychosis I experienced for all of that year (with a gap of semi-wellness in late August and September after I'd been permitted to discontinue rispiridone) began in January 2009. Upon my mother's suggestion, I had decided to study information technology at AUT and, despite my psychosis, gave it a go. At an appointment with Tony before semester began, I told Tony my plans. My relationship with Tony was conflicted: I sensed that he was an arsehole but because he had complete power over my life I kept trying to believe that he was good. At this appointment, I told him that I hoped that by studying IT I could "make a difference": what I meant was that I believed that professions like IT were full of closet homosexuals and that if a heterosexual broke into their ranks this would be a kind of civil rights victory. I didn't actually say this out of course. When I told Tony this, that I wanted to "make a difference" the cunt smirked. I knew that my statement could be taken in exactly the opposite way than I intended, and sensed that he would, but there was nothing I could do about it. I believe Tony knew exactly the cause and nature of my illness, and that he took pleasure in fucking with me.
Later in 2009 he asked me, in a deliberately offhand manner, with my parents in the room, if I "stood up for myself" or was "a people pleaser". I had no idea what he meant but, because I was scared of him, I opted for "people pleaser". Again he smirked. He could put this on my record. One of the older theories of schizophrenia is that occurs if a sufferer is trapped in a double-bind, when a sufferer has only two options, both of which are bad: for me it was the choice between being a cat and a dog. Tony was deliberately putting me in just such a double-bind.
Towards the end of 2009, on Mt Hobson, I heard a voice suggesting that the way out of my madness was to "accept consensus reality". The episode involving Jon and Jess happened immediately after. For the next three years, I just lived with the fact that people in the Service thought I was gay: it made me uncomfortable but didn't make me ill. I never made a secret of the fact that I was pursuing a girl in 2011 (Jess of course), never gave anyone any reason to think that I was gay. Perhaps people thought I was gay but simply didn't want to come out.
In the first half of 2010 I wrote an article about Schizophrenia which I tried to get published in North and South. It wasn't well written; moreover, I described my experience of psychosis without once referring to sexuality. I gave a copy to Tony and he went through it as though it was an undergraduate essay, ticking every paragraph. It is one of the deep shames of my life that I sort of got on with Tony for several years. But then I had no choice.
Between 2007 and 2012, my key worker was a woman called Kate Whelan. From 2010 onwards she would organise a coffee group for 'clients' of the Mental Health System. A girl called Rose was a regular attendee. One day I asked Kate about Rose and she told me that Rose had brushed off the coffee group that day to spend time with a female friend instead. Kate kind of shuddered or shook herself. (The nuances of body language can be hard to put into words.) Now, the reason I asked about Rose was because I thought she was incredibly hot. But Kate, being a totally straight woman, was incapable of seeing that. She thought I was asking about Rose in relation to Rose's sexuality. Which was stupid because Rose, a committed Christian, was quite evidently straight – I know this because in one of the coffee groups she had talked about joining a dating service provided by her church. The fact that Kate could think Rose (and me as well) sexually muddled is evidence of the rottenness of the system. No one is safe from suspicion.
In early 2013, in the interval between my letter about lead being published and my formal reentry into the Mental Health Service just before Easter, I became 'unwell' again as I described in the post "What Happened in 2013". I saw Kate again briefly when I needed help getting a benefit from WINZ. I had become paranoid again. At a cafe just after my appointment I launched into a spiel about the women I had loved in the past. Kate asked me, "Don't you want to be part of a community?" She obviously meant the gay community but there was no way for me to reply, to tell her that she had me completely backwards. At a coffee group very shortly after I told her about how my friend Jess had spent eight months in hospital the previous year. Kate said, "I hope she came out with something." I felt like killing Kate for saying that. It beggars belief. Why would people in the Mental Health Service think young men are cured when they start fucking each other up the arse, and young women are cured when they start going down on each other?
I'll tell one more anecdote. After my last Independent Review, the judgment had contained the sentence, "He said rather poignantly that if he knew the cause of his illness he would argue his case better." This is a complete lie: I never said that. I knew why I had become ill – it was simply impossible to talk about in that setting. I had my most recent appointment with my current psychiatrist Jen Murphy a fortnight or a month ago. She asked me how much I drank, presumably to see if she can put it in my record that I'm an alcoholic (I'm not). When I saw Jen recently, though, I had decided to finally explicitly explain why I had become ill in the first place. I told her that my parent's divorce when I was seven had created a vulnerability (at which she laughed dismissively), that I had been living in a flat of twenty people and that a rumour had gone around my flat that I was gay. When I said this Jen nervously reached for a glass of water. It was a 'tell' as revealing as the moment Kellyanne Conway flicked her hair when introducing the world to the concept of 'alternative facts'. I had killed two birds with one stone. First I had made it explicit that the whole reason for my illness was being thought gay when I'm not. Second I had indirectly pointed out that my flatmates were all (or almost all) straight, completely counter to the impression I think the psychiatrists and health workers had formed of the Big House.
I admit in this post I have strayed off the subject. The point I am trying to make though is that communication is always a two way street. Psychiatrists think that they're objective, think that they can accurately read and describe their patients, but they are not objective at all. Biasses and preconceptions dominate the relationships. In fact, I think most psychiatrists actually lack inter-personal skills. Patients read their psychiatrists as much as psychiatrists read their patients and can alter themselves to fit the doctor's interpretation. The condition 'schizophrenia' is created in psychiatric consultation rooms.
I'll tell one more story, just to show how 'sick' I was in the period before I was allowed to discontinue Rispiridone. One night I went into my back garden. I thought I was Jesus and that the garden was Gethsemane. I thought a tree in the backyard was one of the suicide trees from Dante's Inferno. I thought that I was Jesus and my role was to save young people from killing themselves; like Jesus before the Crucifixion, I said to the voices, "Choose someone else!" I went back inside and lay on the couch. I asked the voices, "Am I Jesus or am I in hell?" The voices replied, "What's the difference?"
I saw on TV1 news last night that Prince William, Prince Harry and Lady Gaga have joined voices to promote mental health awareness, a campaign called Heads Together. William was encouraging people with mental health issues to seek help; he also said he would like mental illness to be treated in the same way as physical illness. I think he's wrong on both counts. The Mental Health System here in New Zealand and I believe in much of the rest of the world doesn't help people. If anything, it makes people worse. I don't know if I can advocate that people not seek help but, until the System is fixed, it may be better for patients to sort themselves out rather than seek 'treatment'. William's comment that he wanted mental illness to be treated the same as physical illness is also stupid – we already live in that world. This is why psychiatrists rely on medication as usually the sole form of treatment. Sometimes, yes, mental illness is a physical illness, when someone has received an injury to the brain or has developed dementia. Most often though it is the result of environmental stressors and this needs to be recognised.
This post has stray well off its original subject. I hope readers will forgive me. I will try to be more focussed in future posts.
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