Confronting Toxic Power by Destigmatizing Mental Illness
It still seems hard to believe. Eighteen years ago last week, our nation suffered its worst attack since Pearl Harbor. For those of us who came of age during the comparatively placid 1990s, the new world disorder came as a particular shock. U.S.-led invasions of Iraq and Afghanistan ensued as part of the War on Terror. In addition to physical casualties, a generation of veterans remains burdened by the psychological, relational, and economic effects of long and repeated deployments. Despite a decline in violent crime overall in the U.S., the new era has coincided with an increase in mass shootings, proof of disproportionate violence against people of color by law enforcement, widening disparities of wealth, political gridlock, ecological crisis, and, especially recently, the scapegoating of immigrants, LGBTQ+ people, non-Christians, and those with mental illnesses as sources of America’s woes.
The America born on September 11, 2001, has reached maturity. But, like any new-found maturity, this is a condition fraught with internal-conflict, paradox, and room for growth. In a nation at odds with itself and with its neighbors, we Americans can remain hopeful of reconciliation so long as we can accurately diagnose this present madness. My own mental illness has helped me understand much that I might have otherwise missed, misunderstood, or refused to believe. On the basis of that experience, the time has come for me to shed what light I can. In the following analysis, my diagnosis serves as but one possible point of departure; people with other mental health conditions can doubtless offer further insights into the true state of things.
When My Mind Betrayed Me
For me, 9/11 coincided with my first and thus far only mental health crisis. Within a few days, the brain part of my body had betrayed me completely. Too often, I hear people speak of mental illness as if it were a fiction, a self-inflicted personal choice, or somehow other than a physical phenomenon; nothing could be further from the truth. That’s why medication works as part of treatment and why psychiatrists are medical school graduates. Mental illness is not exclusively physical. The struggle, its triggers, and recovery all have emotional, intellectual, social, and spiritual dimensions. Yet these are more elusive than the incontrovertible physical facts. Our brains are the electro-chemical central processors of our meat-and-bone bodies. For some of us, this machinery is as high-maintenance as it is high-performance. Those who offer the false promise of “willpower alone” misunderstand this.
I had just graduated college, spent the summer staffing a retreat center, and begun a campus ministry internship at my church. I woke that cloudless morning at sunrise without an alarm clock, musing that this boded well for my newly-attained adulthood. At the hospital while visiting a friend struggling against a potentially terminal illness, I watched a news report of the first plane hitting the World Trade Center. And then live footage of the second. We soon heard about the crash at the Pentagon. During the next four days, I undertook a series of urgent, rapid, increasingly reckless, and, in retrospect, comical responses to the attacks. (It can be healing to laugh at yourself after the fact.) I produced apocalyptic flyers for campus, gave a cryptic if impassioned speech to an auditorium full of confused students, and charged to my credit card a few thousand dollars of “Jesus [heart] Arabs” t-shirts that I had custom designed. I intended to sell them along my way to Washington to meet with President George W. Bush, whom I was convinced God had prepared to receive me as a prophet. My supervisor stopped me as I loaded my car for the trip and dared me to undergo a psychiatric evaluation. Assuming that God would prove him wrong, I acquiesced. At the hospital, able to relax for the first time in four frantic, sleepless days without a full meal, I blacked out. I awoke in another hospital, drowsy, heavily medicated, and soon diagnosed with bipolar.
For those unfamiliar, bipolar disorder (a.k.a. manic-depression) is a mood disorder affecting roughly 3-5% of the adult U.S. population. That’s one out of every 20-35 people, so you probably know at least one person with bipolar, perhaps several, even if you don’t realize it. One of them might even be you. Symptoms include extreme mood swings, with high “highs” (mania) low “lows” (depression), and even periods in between.
Everyone has mood swings, just as everywhere outside of the tropics transitions between shorter days in winter and longer days in summer. However, in some places that change is more pronounced. During my years in Fairbanks, Alaska, in the darkest days of winter the sun briefly peaked above the horizon before plunging beyond once more; and in the brightest days of summer the sun descended until midnight, touched the horizon without setting, only to rise again in a series of unbroken days. Hence, “the Land of the Midnight Sun.” That difference of seasonal light variation is akin to the difference of possible mood extremes between those with bipolar and those without. Everyone has ups and downs, but some of us have them, at least some of the time, with greater intensity and unpredictability, often independent of external circumstance.
Periods of mania (high highs) tend to provide: overflowing ideas, all of which seem brilliant to the one who possesses them; a sense of personal importance swelling beyond measure, perhaps with religious overtones; perceptions of connection (real or imagined) between ostensibly unrelated things; accelerating thoughts, speech, and desire to undertake concrete action; this acceleration speeds out-of-control, while others seem to impede one’s mission; hence, irritability, anxiety, and paranoia; but also, often, a sense of joy, even euphoria, as flashes of perceived but increasingly dubious insight, inspiration, and general high-energy abound; decreased need and desire for sleep; heightened libido; and increased likelihood of risk-taking behavior, including financially and sexually. During the peak of an untreated manic episode, one might lose touch with reality. This is delusional state is psychosis, not to be confused with psychopathy. A manic episode might feature some or all of these, with details varying based on an individual’s circumstances, predispositions, and, still to some extent, choices. Not that one can opt out of an episode, but one might knowingly or inadvertently dampen it or fan its flames. Many afflicted by mania self-medicate with drugs and/or alcohol either to sustain mania or to slow it down. Substance abuse may also trigger mania or depression in those already genetically predisposed.
Because it is more common, depression is easier to understand. Often paired with oversleeping or, paradoxically, insomnia, depression can bring with it: sadness; low energy; slowness of thought; difficulty finding words to speak; a lack of desire for activity; a lack of a sense of personal worth; and/or an overwhelming despair. As with mania, a given bout of depression might feature all or just some of these features. Contrary to popular belief, one need not be depressed “about” something. To some of us, depression periodically just happens, one of the ways that the brain parts of our bodies fails us—just as some part or another of all of our bodies will fail us, should we live long enough.
There is significant variation within the disorder. Bipolar type 1 has equal highs and lows. Bipolar type 2 has more lows than highs. Both include the possibility of mixed states, combining elements of both mania and depression. Cyclothymia represents a sort of “bipolar lite,” with higher-than-typical-but-not-manic highs and lower-than-typically-but-not-clinically-depressed lows. Schizoaffective disorder combines elements of bipolar and schizophrenia. There are also forms of the disorder that do not quite fit these classifications, as researchers continue to learn about it.
Because depression can be part of other conditions and because milder ups (hypomania) can look like other things (e.g., ADHD), the probability of misdiagnosis is high. One study reports that “the average time between a patient’s onset of symptoms and accurate diagnosis is ten years.” Patients will require further time, perhaps years, to find the most effective medication(s). That said, patients whose treatment begins earlier in life, such as young adulthood, when symptoms typically first manifest, have much higher rates of successful treatment. Only trial and error can reveal how a given patient will respond to a particular prescription for optimal effectiveness and relative freedom from side-effects. If you’re reading this and you’ve been diagnosed with bipolar but have not yet found a fully effective treatment program, be patient with yourself and with your circumstances. It is worth enduring the careful, committed version of the process for the sake of becoming a full participant in the world again, no longer estranged from it by the lies your mind may be inclined to tell itself.
Although mood-stabilizing medications are consistently effective in minimizing the intensity and frequency of episodes of mania and depression, they take a long time to build up to therapeutic levels in one’s system. They can come with side-effects, including possible weight-gain, lethargy, and the feeling of emotionlessness. It is therefore easy to see why medication compliance is a major issue. People with bipolar who begin to “feel normal” again once on their medication might, against the advice of their doctors, stop taking it. Kayne West is perhaps the most high-profile example. Because bipolar is a chronic condition, without treatment further episodes are inevitable, with a tendency to increase in frequency and severity. Upon resuming medication after a break, one must wait days, even weeks, for it to take full effect. Feeling normal had been evidence that the medication was working, not that it was no longer needed.
My Diagnosis Comes of Age
For some, bipolar can be utterly debilitating; for others, a minor inconvenience; and, a few, a source of enduring purpose. For me, it has been all of these in turn. Medication, counseling, and careful lifestyle choices offer relief to many of us. Fortunately for me in the long-run, I was well-behaved during my manic episode—rock and roll without the proverbial additives—while simultaneously exemplifying most symptoms of mania, making it straightforward for clinicians to diagnose me.
I needed a year for my doctors to find medications that work for me. The mind-fog they induced gradually dissipated over the next two years, as my doctors tracked my progress and reduced my dosage to its current levels. It would be another three years before I felt that I was at 100% in terms of cognitive processing. My counselors gave good advice on the importance of: good nutrition; regimented sleep; frequent exercise, preferably outside; avoiding drugs, alcohol, and caffeine; quality time with friends and family; outlets for self-expression; and continuing to take my medication on a daily basis.
In one thing, my counselors erred. As I bounced between part-time jobs in that particularly foggy first year of bipolar life, I must not have seemed destined for much vocationally-speaking. Once the elation of my mania wore off, I felt like what I suppose they saw: a confused, disappointed, fearful young person without any obvious marketable skills. They couldn’t have known my former deep sense of calling, which I remembered and gradually began to reclaim. Against the advice of everyone advising me, I went to graduate school. (I wouldn’t have been eligible, but at various points during that first year, I also considered enlisting, even to the point of meeting with a recruiter.)
Life in the nearly two decades since has been personally if not psychiatrically eventful. I have learned a few languages, completed two advanced degrees, published a book, gotten married, traveled the world, and begun the adventure of parenting. I’ve moved to Ohio, back to North Carolina, then to Missouri and New Jersey, before landing now in California. I have frequently had to bend. But, since putting the fragments of my psyche back together, I have remained unbroken.
On the one hand, I seek to dispel the notion that such things are impossible for those with a bipolar diagnosis. At the same time, I seek to undermine the assumption that people’s value comes primarily from their career achievements. Through no fault of their own, some with bipolar find long-term, full-time work to be unattainable. Some forms of the disease are resistant to currently available treatments. The current U.S. healthcare system is such that we who have bipolar must have unwavering resolve, outstanding health insurance, family support, timing, and general luck in order to succeed in worldly terms. The true measure of success with a chronic mental health diagnosis lies not in the outward achievement of the afflicted but in their consistently choosing to accept the challenges of each day, one day at a time. The truth is that my success does not belong to me alone. A constellation of friends, family members, mentors, counselors, doctors, pharmacists, and researchers have empowered me in my ability to choose and to keep choosing to embrace life.
My lifestyle has taken on a rigor that might feel austere, were it not a source of such stability, clarity, and calm. In order to surmount the hunger, blood sugar crashes, and slight mind-fog caused by my medication, I run 20-30 miles per week and eat a carefully calibrated balance of lean protein, whole grains, fruits, and vegetables in the form of seven modestly-proportioned meals throughout the day. And I take my medication. It works for me. One benefit of growing up on military bases is that I comply readily to a disciplined regimen, especially when I understand its rationale. I remain baffled by medication skeptics. I still perceive unlikely connections between disparate things, as my list of publications bears witness, but no longer in a rapid-fire roller coaster that inevitably bottoms out in a cognitive quagmire. That ride wasn’t worth the cost.
For me, then, the eighteenth anniversary of 9/11 marks my own maturation as a person with a chronic but well-managed mental health condition. I look back with a sense of tragedy and of triumph, though our shared war against socio-political madness is far from over.
The Case Against “Crazy”
As a person of mixed race, I remain perplexed by how frequently people insist on speaking of race in either/or categories. The same goes for mental illness. Many, including some supporters of the neurodiversity movement, frame bipolar as one vital form of human cognitive diversity. A few assert that this means that the disorder should remain untreated. They are wrong. By contrast, some clinicians claim that, because the illness must be treated, it is fundamentally unhelpful or even dangerous to frame bipolar as a form of neurodiversity. They are also wrong.
Bipolar is both an illness and a potential gift. I now have almost a dozen friends with bipolar. Many have flourished in spite of it. Some of us would even say that we flourish both in spite of and because of it, especially in the ways that it has forced us to adapt. For all of us, stories of hope have made a difference. I regularly meet students whose stories are similar to what mine was in my early 20s, back when I longed to know—even know about—someone who had walked the walk.
Openly bipolar clinical psychiatry professor Kay Redfield Jamison remains the foundational hero for many of us who share the struggle. Her memoir, An Unquiet Mind, remains without equal, as does her definitive clinical text on the disorder. The list of actors, musicians, and other celebrities who claim the diagnosis has grown in recent years. Such high-profile role models are critical. But so are more ordinary ones. More of us need to come forward. If you have only recently begun the struggle, you need stories of hope to hold onto, especially in those dire moments when the doors to a meaningful life seem shut. That, too, is an illusion. Your life is meaningful already, no matter how it feels in the moment.
Under careful treatment, those of us with bipolar have the potential to continue to experience overflowing energy, emotion, and potential insight, albeit of variable and often questionable quality. Given adequate discipline, we can channel those experiences into productive activities, as demonstrated in Touched With Fire (1993), Jamison’s analysis of the connection between bipolar and creativity. (All page references below taken from that text.) The relationship is one of complex correlation, not simple causation. Most artists are not bipolar and most people with bipolar are not professional artists; yet the connection between the disorder and creativity offers but one compelling refutation of simplistic either/or understandings of the disease. One could undertake a similar analysis of the role of overcoming bipolar in shaping leaders in politics, such as Winston Churchill, or in business, such as Ted Turner. For many individuals, bipolar is both a source of problems and, largely by virtue of individuals’ contending with those problems, a catalyst for solutions.
Both Jamison’s original research and her compilation of others’ reveal a higher incidence of mental illness in general and bipolar in particular among architects, sculptors, painters, musicians, prose authors, and, especially, poets. Add plausible historical cases to confirmed contemporary ones, and the list is staggering, including Byron, Tennyson, Woolf, and Hemingway (pp. 60-62, 267-270).
Jamison asserts, “many critics who are opposed to the idea that psychopathology is linked to artistic ability express concern that labeling artists as mentally ill ignores the enormous discipline, will, and rationality that are essential to truly creative work.” These are the very qualities that those of us who have bipolar must cultivate, should we seek to thrive. She continues, “Artistic expression can be the beneficiary of either visionary and ecstatic or painful, frightening, and melancholic experiences. Even more important, however, it can derive great strength from the struggle to come to terms with such emotional extremes, and from the attempt to derive from them some redemptive values” (pp. 97, 116-117).
We who have bipolar are not alone in this; but such character-building experiences are hard-wired into our lives with particular frequency. For us, artistic self-expression meets real needs, as Jamison explains, “Creative work can act not only as a means of escape from pain, but also as a way of structuring chaotic emotions and thoughts, numbing pain through abstraction and the rigors of disciplined thought, and creating a distance from the source of despair” (p. 123). To feel often and with great intensity is a burden that can yield lifegiving results.
Although a potential gift, bipolar is often more destructive than rewarding. According to one study, 70-90% of people who commit suicide have either bipolar or some form of depression (p. 58). Accounts of suicides by celebrity with bipolar seem to outnumber success stories. Even survivors of bipolar may bear scars in such forms as ruined friendships, lost jobs, or alienation from family members, resulting from rash actions undertaken under the influence of the disease. Those with chronic mental health issues are also significantly more likely than the general population to deal with underemployment, homelessness, and incarceration, with those risks further amplified by other forms of marginalization, such as race and socio-economics.
Those of us with bipolar and with other chronic mental health diagnoses have a right to be seen, heard, and understood for what we are: complex individuals with real struggles. Like everyone else. For those of us who need it, mental healthcare should be as mundane in the eyes of the world as going to the dentist. Mental health success stories like mine should not be anomalies but common features of a compassionate society. By offering adequate insurance coverage, clinical treatment, and social support to those who might otherwise languish, society can empower people with chronic mental health conditions to contribute in meaningful ways, working jobs, paying taxes, and, perhaps, even perceiving non-obvious solutions to the burdens on our shared future. Unfortunately, misinformation, discrimination, general lack of awareness, and structural lack of access impede the process for many who need help the most, making timely and effective treatment less attainable than it ought to be.
The stigma against mental illness compounds these problems. It has flourished in popular culture. Too often, it serves as a punchline, as for Tracy Jordan on 30 Rock, his excuse for acting out (season 1, episode 1). It can also serve as cause for horror, as in the case of Arkham Asylum in Gotham, located in a neighborhood where even law enforcement fears to venture (Batman Begins). Even Hannah Gadsby, in the midst of her otherwise enlightening comedy special “Nanette,” frames misogyny as mental illness, as if one might ameliorate that actual social ill by aligning it with a whole class of assumed (but not actual!) ones. Mental illnesses are real illnesses requiring treatment, compassion, and a lack of social baggage for struggles that patients themselves did not choose.
Perhaps most troubling, because of their power, is the stigmatization of mental illness by political leaders and members of the news media. From mass shootings to political tyranny, when human action yields tragedy, the blameworthy often receive labels such as “crazy people” or “that psycho.” Not only does this unfairly associate mentally ill people—the vast majority of whom, like the vast majority of everyone else, are not violent—with people guilty of causing great destruction. Blaming mental illness fails to provide an accurate or adequate explanation for violence, greed, cruelty, and hate.
The Case For a Socially Relevant Concept of Evil
It seems that much of the U.S. public has lost its vocabulary for moral disorder, deliberate wrongdoing, or, better put, evil—which I define here as the deliberate harm of others. As far as working definitions, that is a starting point. Some reticence to use the term “evil” is understandable. It risks connoting that one is wholly given over to it, as if people were either all evil or all good. This, of course, ignores the fact that we are all a bit of both—an observation with its own risks, for we are not all equally situated between the two extremes and should not navigate the world as if we were.
The failure to accurately understand evil seems tethered to much further either/or thinking. Was the murderer’s decision based on either nature or nurture? As if some deterministic reckoning could boil down a decision either to genetics or to upbringing. Some might glibly assert that it is a bit of both. But even this ignores the fact that decisions are acts of will.
A person’s upbringing and their genes may bias, limit, and empower them in various ways. Different people in different circumstances may even vary in the extent of their ability to make an uncompromised moral decision—which I define here simply as the capacity to decide whether to harm someone. One should judge someone differently if they harmed others accidentally, knowingly but not as their primary goal, or deliberately for the very sake of harming them. It also depends on whether we are looking at the just application of force in the context of military action or law enforcement. There are gradations of culpability in those who make immoral choices regarding the lives of others. But there is always a choice.
No one chooses the hand they are dealt. But each of us gets to decide how to play the cards that we have. Those who kill become killers because they have chosen to kill. Perhaps their brain chemistry left them without the feeling of empathy (e.g., psychopaths). Maybe they simply believed themselves to be following orders (e.g., many perpetrators of the Holocaust). But they still made a choice. For those who give voice to their racism, perhaps their intoxication (e.g., with alcohol) or mental state (e.g., mania) removed their verbal inhibitions, but those things do not cause racist thoughts, much less racist actions or speech.
What my own struggles have taught me is that our decisions shape us. We cannot control our feelings in the moment. But we can question our initial interpretations of those emotions. The things that you first think after feeling strong feelings aren’t necessarily realistic, helpful, or true. We can control what actions we take in response to our feelings, even to the point of denying them and disciplining our thought patterns over time. This can include making the choice to remember the clarity of the past, even in the midst of present shadows.
More than our upbringings or our genes, but shaped in part by them, our actions are what defines us. Mental illness is not the cause of mass shootings. The single greatest predictor of violence is violence. As Business Insider noted two years ago, “The men behind the U.S.’s deadliest mass shootings have domestic violence—not mental illness—in common.” (Perhaps conflating correlation with causation, the attempt by PolitiFact Texas to refute this belies the statistics that its own article cites: “of Everytown [for Gun Safety]’s 85 listed shootings in which a person [also] shot a family member, 41% were preceded by other acts of domestic violence,” making this a consistent, if not solitary or universal, predictors of mass violence.) A recent suggestion that law enforcement should track those with mentally illnesses ignores the facts. Let us all be judged because of what we have actually done and not because of stigma-based conjecture.
The Power of Weakness vs. the Weakness of Power
I love America, but I know that we can become a force of greater good only by facing the reality of what our nation has become over the last eighteen years. Veterans and first-responders, including to the 9/11 attacks, have struggled to receive adequate support. Growing numbers of families in the U.S. have become homeless because of predatory profit-seeking, while many families from Central America flee escalating violence at home; and somehow, in both cases, loud critics either blame these victims for their problems or even define them as being problems for the rest of us.
To be fair, with the exception of persistent mass shootings, the most egregious social problems of today are not unique to America. Around the world one can find numerous examples of ascendant authoritarianism, worsening economic disparities, animosity toward immigrants and refugees, persecution of religious and ethnic minorities, targeting of LGBTQ+ people, and disregard for the long-term viability of our natural environment. What makes the position of the U.S. distinctively ironic is the disconnect between what is and what ought to be, given our nation’s historical claims of moral exceptionalism and amplified by its economic vitality, military might, and cultural influence.
Why? Why do such egregious, pervasive, structural injustices exist anywhere? Why do they seem to be spreading? Any why do so many seem to involve deliberate misdirection as to who is actually complicit? Evil-as-individual-choice proves unable to yield wholly adequate explanations. The scale of our problems as a species defies any sort of individual-only approach. We need a more nuanced, expansive definition of evil. One that can reveal the common origin of disparate dimensions of our fraught present.
Dominating, possessive, exploitative, arrogant, vengeful, toxic power drives terrorism, nationalism, imperialism, authoritarianism, greed, violence, and unlimited consumption of limited resources. Therefore, what might be tempting to perceive as unrelated woes stem from this same kind of corrupt and corrupting human force. Many of us are passively complicit in sustaining it by such means as our consumerism. But they bear disproportionate blame who seek such power deliberately for personal gain, heedless to the consequences to others. This is a form of evil and of weakness, a moral failure which, if left unchecked, will ultimately destroy humanity. Those who wield toxic power depend on masses who are indifferent, afraid, or angry but misguided in their anger. The vulnerable, including those with mental illnesses, represent easy targets for that fear and anger. Such scapegoating helps justify further consolidation of power while distracting from actual problems.
Fortunately, there are other kinds of power. Compassionate, humble, self-aware, self-giving, even self-sacrificial, healing strength drives those who possess it to stand in intersectional solidarity with the marginalized. At its foundation lies deep awareness of the mortality of all of us and, thus, of our profound mutual need. In fact, outwardly, healing strength can look like weakness. Undimmed in its hope, yet grounded in the pragmatic pursuit of concrete action, such healing strength must take root, spread, and counterbalance toxic power if we humans are to survive. This must be with the understanding that compassionate idealists, too, are subject to the corruptive forces of power and that all leaders require constant accountability.
No either/or thinking will be helpful here. No “good guys versus bad guys.” Though all have potential, many people embody neither toxic power nor healing strength. Some individuals, national governments, and other institutions, including religious ones, simultaneously embody both to varying degrees over time. For example, even as the U.S. collaborated with its allies to liberate Europe from Nazi tyranny, its bombs killed numerous civilians abroad and its laws oppressed African-Americans at home. Any person, institution, or nation that would be a force of good must engage in constant moral battle with itself.
Whether as insiders or outsiders, those would would wage this war must “speak truth to power,” especially the truth of the moral responsibilities and failings of the powerful. Greta Thunberg provides a vivid example of this. With her utter personal devotion to the cause, the teen climate activist has shamed older generations for their ineffectiveness, indifference, and generally passivity in the face of imminent disaster. Some of her critics have questioned the legitimacy of her activism on the basis of her Aspberger’s diagnosis. She replied, “given the right circumstances, being different is a superpower.”
Bipolar and other chronic mental illnesses can also be such forms of difference. This should not be confused with the popular myth that bipolar itself is a superpower, one that Kanye and Homeland have, at various points, perpetuated. The myth is misleading, unhelpful, even deadly, for it discourages people from seeking potentially life-saving treatment. Mania’s seeming insights are often untrustworthy. The energies generated by the disease are frequently destructive, spurring some to embrace toxic power. Rather, the very state of being different, marginalized, stigmatized, keenly aware of one’s own personal weaknesses, and cognizant of the shortcomings of the world around us can provide a catalyst for acquiring and growing in healing strength. Mental illness offers but one potential point of entry into that harsh but liberating upward climb. There is power in recognizing dire realities. After all, the first step in any recovery program is recognizing the existence of the problem. Individually and collectively, we humans need help. Together all of us just might chart a path through this present madness.