I can get pretty irritable sometimes because of my depression. I seem to lose access to all of my more mature self, and revert to what may have worked best when I was five years old. This can have a major impact on my behaviour, and sometimes I have let fly with yelling, screaming, and swearing. This has occurred most often when I’ve been hospitalized, and has been directed at nurses and doctors whom I perceived as making things more difficult for me. One of my former community psychiatrists once told me “you can be a real bitch when you’re not well”.
Several years after my first hospitalization, I learned that one of the diagnoses on that first discharge summary was borderline personality traits. Subsequent psychiatrists have disagreed with that diagnosis, as the maladaptive coping mechanisms only make an appearance when I am ill, as opposed to personality disorders involving traits that are consistent over time. It begs the question, though – to what extent do our coping strategies and behaviour when ill reflect (or not reflect) our core selves?
I am not generally an irritable person, so when I become irritable due to my depression, I’m not sure if things are suddenly bothering me that I never would have noticed, or if I’m just more disinhibited about expressing irritation that I would normally just brush off. In other words, is something new happening, or is there just an amplification of what’s already there? While in the end it probably doesn’t make a whole lot of practical difference, it’s worth thinking about in terms of self-identity.
Is my mental illness part of me or is it something that happens to me, a monster on my back that I have to carry around? I have always tended to lean toward the latter view, because I don’t think my illness should define me. Perhaps it’s also in part because I don’t want the real me, my core self, to be responsible for my bad behaviour. Then again, no one is responsible for my actions but me, although the options I have to choose from seem to be very much influenced by my illness.
The perspective that I’ve sort of settled on is that we all have our inner caveman brain, including bits like the amygdala, and in times of stress and difficulty, that is what gets activated. Our prefrontal cortex, the most advanced part of our brain in terms of evolution, is what generates our most adaptive coping mechanisms. In personality disorders, factors such as trauma can impair the development over time of these sorts of adaptive coping mechanisms. In conditions such as mood disorders, our ability to access our adaptive coping mechanisms seems to be impaired in the acute illness phase, leaving us to default to what caveman brain can provide us.
So am I a bitch, or is it my illness? In the end, probably some of both.