“Every sickness has an alien quality, a feeling of invasion and loss of control that is evident in the language we use about it.” Siri Hustvedt
When it comes to articulating physical pain, we have a myriad of descriptors at our disposal and a universally-understood terminology for bodily ailments. The same isn’t wholly true for psychological disorders, the complexities of which are matched by the vague and fluid terms ascribed to them.
While the cancer patient is categorically diagnosed with a well-understood condition, the patient suffering from auditory hallucinations or depression, for instance, is an entirely different conundrum.
Pharmaceutical treatments and in-patient care can readily be offered to someone diagnosed by physical examination to have a definable disease. The brain cannot be probed to identify the cause of psychological disturbance with any comparable level of precision.
Disease versus disturbance – each are loaded terms of the kind that illustrate the stigma associated with brain disorders. We talk of cancer cells invading the body and mutating the genes, the threatening metastatic spread of a contagion that hijacks the body – the problem, while emanating from within the individual’s own immune system, is described like an uninvited guest, an imposter from the outside.
Compare that to hearing voices, seeing things that aren’t there, a crippling case of depression – such cognitive impairments similarly relate to a biological malfunction, synaptic connections gone awry or chemical imbalances. Yet they are commonly described as though they are a failure of a person’s self. The cause is confused with the symptoms, and blame is ascribed in a way that suggests the person with depression simply needs to “pull themselves together”.
When it comes to prognosis, decades of scientific and clinical progress provide for optimism; the patient can hope to recover their normality, their identity will not necessarily suffer permanent damage, even though the body may carry some lingering – albeit fading – scars.
Matters of the brain, however, are not as clear cut. And sufferers of bipolar disorder, schizophrenia, multiple personality disorder, Tourette’s, obsessive compulsive disorder, and a host of other conditions that afflict the brain and manifest themselves in so-called antisocial behaviour, are afforded comparatively less compassion.
The novelist Siri Hustvedt articulates this with admirable lucidity, partly owing to her personal experience and partly thanks to the “rapacious reading” that has furnished her with a deep understanding built on an impressive multitude of perspectives, taking in philosophy, neurobiology, medicine and even religion.
In her autobiographical account, The Shaking Woman: A Short History of My Nerves, Hustvedt writes with a lyrical quality about the capacity for neurological disorders to wrack, if not entirely wreck, an individual’s sense of identity, noting:
“The fact is that all patients have stories, and those stories are necessarily part of the meaning of their illnesses. This may be even more true for psychiatric patients, whose stories are often enmeshed with the sickness that one can’t be untangled from the other.”
Is her shaking due to a neurological predisposition? Is it a form of disassociation, “a personal metaphor for the unspeakable,”? Despite a tortuous cycle of treatment and assessment, the reason that Hustvedt’s body is occasionally gripped by violent convulsions that oddly leave her vocal and mental abilities intact, is never really explained.
The ambiguities of brain disorders are continually subject to divergent scientific and philosophical interpretation and misinterpretation. Diagnosing and caring for the sick body is so much easier than dealing with the sick mind.
Neuroscience, while becoming increasingly ‘on trend’ in recent years, attracts proportionately less financial investment than it does popular interest. The landscape of science funding does seem to be changing though, with more being invested in studies exploring the pharmaceutical options and repercussions from a biomedical perspective, investigating the roots of the malfunctioning grey matter where greater understanding is still needed.
But scientific progress is necessarily slow, and sadly the results of such exploration can hardly hope to keep apace with the runaway development of disease. Science takes care, caution and consideration – as well as risk – to formulate a hypothesis and seek results which may disprove the theory and take enquiry down an unexpected path. Depression, psychosis, motor neurone disease, Alzheimer’s – they are not so logical.
The captivating work of Hustvedt, just like the rightfully celebrated Oliver Sacks, at least provides us with a glimpse into what can otherwise be an isolated and misunderstood private arena, articulating an Other’s inner world:
“I locate myself through that inner voice. Language is intimate to my sense of self – that endlessly ruminating verbal interior that accompanies me as I go through my daily activities. I feel that I own my commentary, that I form it to match what I am thinking or feeling or seeing, and when I speak, I express myself with greater care to be understood, just as I listen intently when I want to comprehend what another person is saying.”