Identity in Mental Health by Sam Smith

identity in mental health sam smith

Identity is often based on no more than self-image, and self-image on what we think we’d like to be like, a compound of made-up mirror image, family likenesses and fantasy film roles. In this respect the young are often so deluded.

It was once my task to give work-experience schoolchildren guided tours around the old Victorian asylum where I worked. Some apprehensive, some unsympathetic, they sniggered at the odd human behaviours and dress on display there. To shut them up I used to tell them that mental illness, in all its forms, is a disease that not one of us is immune to. The lecture being delivered in a very stern voice with masses of eye contact, it usually did the trick.

Often it is those who believe themselves most immune from mental illness who are, if not the most susceptible, then those whose identity is the most dramatically damaged by the onset of mental illness. There are, of course, those among us who, in everyday life, believe themselves immune from every sort of ill.

In one sense I was spared this belief in immunity by having had two grandparents who had died in Exe Vale Hospital, both from dementia, with both dementias as a result of their alcoholism. And, for the first fifteen years of my adult life, I too had had bouts of self-destructive binge-drinking, so knew that the seeds of mental illness lay fertile within me. And working day in day out in such an environment one was prone anyway to diagnose all sorts of symptoms in oneself. The other side of this coin, indeed, can be that one is attracted to the mental health profession because one identifies with the mentally ill. One certainly comes to dwell in that gestalt, thinking not only in diagnostic terms but taking on the mind-set of the patients themselves and seeing only their outcomes from many of life’s difficulties. Nurses might self-medicate; and the number of psychiatrists I’ve know who have killed themselves…

Identity is at the core of mental illness: the schizophrenic mocked by part-heard voices, the hallucinating beset by an unconforming world, the abused and self-harming loathing the self they have been made to become, those without hope being unable to see a place for any self in the future, the simply misled, who allowed themselves to be misled…

Our soma and psyche inter-reacting, we will all of us anyway change, who we think we are being continually under review – as we become parents, or not, right through to retirement. Those changes, for most of us, will not be so sudden, nor so drastic, that we are unable to recognise our new undone selves, unable to retrieve our old self.

Identity is a compound of relationships, experience and present wage-earning profession. Those who have suffered traumatic mental illness often disown their making pasts, and feel themselves abandoned or betrayed by their families. (It can be a last desperate act of self-respect to render themselves single.) With their past not believed by themselves, their identity comes to reside in what they do. Unfortunately there is little for those labelled mentally ill to do once given over to ‘care in the community’, a spider’s web system based on private, profit-driven residential homes, which are staffed mostly by unskilled labour on, or below, the legal minimum wage, and which are inspected only by those social workers who have placed their troublesome clients there.

The long-term mentally ill, now called clients, become recipients, at best, of do-gooder organised trips out, at worst are left to their own day-in day-out devices, this tying in with a convenient ethos of non-interference, for which read non-intervention. Which means that all too often the clients are forcefully led – by other residents needing funds – into a drugs or drink-based lifestyles. The drink or the drugs make them increasingly labile, a danger to themselves or to the other clients, so they are medicated again into mindlessness. How to acquire a self-respecting identity there?

Although the big old asylums were often too safe, sucked patients into a comfortable institutionalised state, they did allow the most damaged to acquire a meaningful identity – if only by what they daily did. Every patient, once stable, was encouraged to work – some in the gardens, or in small factory units, on work gangs, on farms, in the library, hospital shop, as cleaners, in the laundry… Given a function they were able to function. For a token wage it is true, but it allowed their recovery to be more than passive. While very exceptional talents were encouraged. John Clare, for instance, was not only allowed to wander the local lanes on his own, but at one time a whole room within Northampton General Asylum was set aside for other patients to make fair copies of his poems. And this in the unenlightened 1800s.

I know that Day Centres now encourage those in need to various ‘activities’. But, because they rely on their referred clients finding their own way to the Day Centres, or on their being delivered to them, far too many are slipping through the net, remain lost to themselves. Mined out, depthless, these survivors are not enigmas to themselves, rather they have been left with no self against which to guage the world as it is hourly presented to them. And with identity no more than a diagnostic label, when asked what they do, do they now say, “I’m registered disabled, mentally ill”? Or might it be better to say, “I’m a farmhand, a gardener, a potter, a…”?

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