Understanding mental illness: Examining the relationship between self-doubt and sanity

Editor’s note: What does it mean to be ‘mentally ill’? In this weekly column, Sneha Rajaram writes about navigating through a ‘mentally ill’ life — encompassing aspects that are both everyday (medications, rights) and contemplative (the universality of suffering)

As a 19-year-old I once asked my psychiatrist if I was going nuts. I wasn’t just plain depressed, but what I once called, in a moment of craving for South Indian food, “masala depressed”: depression garnished with bits of paranoia, with a side of hallucinations. My psychiatrist’s prompt answer: “If you’re asking that question, you aren’t going nuts.”

This is not to say that I wasn’t nuts. But that seems to have been a sane moment for me.

Delusion, apparently, cannot withstand self-doubt.

I know people, only some of whom would be called mentally ill in consensual reality, who have moved so far into their own paradigms that they refuse to get help, do not question their own judgement and end up hurting people around them. I suppose the social and the violent thing to do would be to call them delusional. By this logic, the sanest people are those who interrogate their own perception on a regular basis — that is, those who are secure enough to do so. (Whether psychiatry can call itself sane by this yardstick is another matter.) And that very much includes those who seek help, participate in cognitive behavioural therapy (where they’re often told to reframe how they see things), keep journals, fill spreadsheets with their patterns, learn their triggers and vulnerabilities, constantly monitor their thought processes, and move towards reducing the pain they cause themselves and others. These people – and anyone who is constantly learning, unlearning and re-learning themselves and the world – are among the sanest people I know.

Buddhism teaches us not to over-identify (or even identify, based on your interpretation) with our thoughts or feelings. We do not have to question them in a dialectical manner; we just have to know that they are not and do not represent our “selves”. Buddhism would call most of our concepts – especially those of permanence, self, and fulfilment – delusions. Taoism, which tends to take Buddhism to places I can’t always follow, raises the stakes: Lao Tzu, author of the Tao Te Ching, is supposed to have said, “As soon as you have made a thought, laugh at it.”

But not identifying with our thoughts doesn’t just mean constantly pursuing learning/unlearning. It also means not worrying if our thoughts are cool enough or clever enough or woke enough or contrary enough just in order to please our internalised social judges. It means not allowing cringes of embarrassment to live long in our heads. And with this, we can include not just the mentally ill but everyone, both on and off social media, in the murky tug-of-war between self-doubt and self-belief, those two sides of the “self” coin.

Like everything else, however, self-doubt didn’t come out of a philosophical vacuum, but is political. Second-guessing and gaslighting are especially aimed at the socially vulnerable and the mentally ill – and they are forced to internalise it. Paranoia and a diagnosis of schizophrenia are classic examples of this – even if paranoia is the painful pearl that formed around the usual kernel of nasty truth. In mania, too, we are told not to trust our judgement, as if mania were not a mirror held up to our modern pace of life. Depression makes us see things too darkly, we are told, even if depressives might actually be more in touch with reality . When we’re in a dissociative state, we are apparently a danger to ourselves – even though our entire culture is built on personal and social dissociation and is most certainly a danger to itself. It’s the biggest case of transference ever (un)observed.

I’d like to focus for a minute on black and white thinking, though, or “ splitting ” as it’s known in psychology – the habit of seeing something/someone as either all good or all bad. I do this quite often and I was told it is a symptom of borderline personality disorder (BPD). Like many mental health concepts, splitting raises questions about the way we think as a society. Our collective tolerance for complexity is not high in general – especially when it comes to politics, as Twitter can attest. Yet a BPD diagnosis may mean we practise splitting even more than the norm – or simply that our splitting makes us dysfunctional to the extent that we need help. Being able to see both good and bad in one entity is apparently a skill that children have to learn when they grow up, and some of us have trouble developing this skill , or so the theory goes, possibly because of trauma and the need to protect oneself more than most. If I can catch a single (even small) bad thing as soon as possible in a person, idea, group, or work of art, I can protect myself by rejecting it and distancing myself. This prioritises safety over community, in accordance with Maslow’s hierarchy of needs.

Taoism seems to fight the entire concept of good and bad, which can be a “good” thing, but only sometimes. One translation of the Tao Te Ching reads:

When people see some things as beautiful,

other things become ugly.

When people see some things as good,

other things become bad.

Being and non-being create each other.

Difficult and easy support each other.

Long and short define each other.

High and low depend on each other.

Before and after follow each other.

Therefore the Master

acts without doing anything

and teaches without saying anything.

If you think this is the ultimate wishy-washiness, I cannot entirely disagree. What if our tolerance for complexity became too high? Would we end up condoning people who should be condemned? Or should we approve/condemn a behaviour and not a person? And can we, in the same way, engage with second-guessing and criticism by not allowing it to speak to our sense of self, but merely to our thoughts/ feelings/ behaviours – which are by no means fixed entities?

Fear of uncertainty is very human. Our need for security demands fixtures. But the ability to stand on shifting sands – and our sanity – depend on how flexible our perception of ourselves can be. Ironically, this very flexibility may come from an inner sense of security. Time to pull ourselves up by the bootstraps, as usual.

Read more from this series here