We’re taught to forever believe that there is never a price too high for our sanity, as if being normal is a prize all on its own. For all its acclaim, what exactly is sanity? It has to be more than just being not insane. I like to believe that somewhere between sanity and insanity, there’s a place where the music isn’t jarring or somnolent, but just right; a push-and-pull collateral between gaudy and subtle, stringent and supple, rare and overdone. And while assessing the state of being sane is slightly more complex than preparing a steak (says the vegetarian…), our minds merely do not operate at two different levels but on a continuous spectrum. Six weeks of enduring the psych wards in one of the busiest hospitals on the east coast made me realize that stipulating normalcy is like trying to standardize what people see when taking a Rorschach test; what is orthodox to one is unorthodox to another. Thus, the act of defining often becomes futile in face of all the components that defy the very definition.
The psychiatry field has taught me, if nothing else, that normalcy, not just beauty, is in the eye of the beholder; often times a diagnosis can be more of a question than a statement as no two bipolar, suicidal, or schizophrenic patients are ever the same. What started off as a frustrating aspect of psychiatry actually turned into something I appreciated in the field, as it is not only more engaging for a diagnostician, but helps you understand the intrinsic diversity each patient showcases regardless of their blanket diagnosis.
Schizophrenia is not just Leonardo DiCaprio weaving a world of his own on Scorsese’s Shutter Island, it’s also the 20-year-old student that has no change in expression or movement, and sits silently in the corner. Depression is not just immeasurable grief for unknown reasons, it’s the woman who learns to subsist for the past two years but still carries on with her daily routine. Bipolar is not just Bradley Cooper dramatically substituting drugs for love in Silver Linings Playbook, it’s an individual that is trying to grasp onto some form of stability without grandiosity and theatricality.
One particular day, I had to see four new bipolar patients with my attending on top of the three already on our service. I quipped, referring to Cyndi Lauper’s hit, “It is literally manic Monday.” A friend would later advise me to be careful as bipolar patients can be quite “tricky,” and may even “try to steal from you.” Little did I know, I unintentionally perpetuated a stereotype. My flippant remark was just an off-the-cuff, unknowingly insensitive comment I made to reflect on how difficult it can be to create stability around a sea of patients who unknowingly and unwillingly are losing their own equilibrium.
However, what could’ve been a sobering experience and a teaching moment turned into a mockery, and I turned into a vehicle for typecasting a disorder that really offers a mélange of presentations. All patients with appendicitis do not automatically present with abdominal pain in the lower right quadrant or even rebound tenderness. Similarly, seven bipolar patients may all have a single diagnosis, but their mania or depression is not the same, no matter how many cluster of symptoms one person shares with another. We rush to fill a criteria, to label our patients, to herd them along the paddocks of the unknown into the known by giving their disorder a name, but a diagnosis can just as much be a stifling burden, a life-long title that strips each patient of their individuality and embosses them with a caricature of what they should look like instead of who they really are. Like I said, perception is everything and what we really end up ascertaining is that being normal is often a delusion, abnormal a misperception, and that both demand better insight.