Introduction
Picture a sage. It could be one of the ancient variety, toga clad, dignified, brawny and serene, mental and physical solidity personified. Or alternatively, you may imagine a modern variant, with a straight back and military levels of strength and discipline, yet warm and in control. As Stoics, many of us will have a mental image of the man or woman we aspire to be, and many of us are making progress towards realizing that image in our every day lives.
Now take a figure diametrically opposed in stature and character to that of Stoic perfection. Irrational, anxious, impulsive, depressed, an insomniac, dysfunctional and reclusive. Perhaps worst of all, violent. At once, both the vehicle for wild energies blowing him around like a leaf in the wind, and the next moment deprived of all life-force, driving him back to his bed to lie thinking about ways to end his days. This is life for the millions who suffer with bipolar disorder.
Mental illness is a hard case for Stoicism. It tests its intellectual boundaries and its practical strength. It is often a match (and more) for Stoicism’s transforming power, forcing people back on their heels, dismantling their character, stripping them of dignity, and calling into question Stoicism’s core foundation, that humans possess a level of control over our inner life, namely our will and its proclivity for forming judgements and desires and guiding actions. Mental illness is the enemy within. It does not announce itself as a lion to do battle with in the arena of life, but a devil which poisons a person from the inside out. The sufferer is often unaware of what is happening to them until it is too late. It frequently ends in that most unstoical of all acts, suicide driven by a mental anguish which is too great to bear.
This essay is both a personal account and a philosophical exploration of mental illness from a Stoic perspective. Last year, I was diagnosed with Bipolar Type II, a condition which in retrospect I can now see I have spent much of my adult life managing, not always successfully. In addition, I am familiar with depression, anxiety and obsessive compulsive disorder, common travelling partners with bipolar, both within individuals and within families.
I am also a practising Stoic.
I will open with a description of my experiences with bipolar disorder, before tackling two related questions. How do we make sense of Stoicism in the light of the existence of mental illness, and conversely, what can Stoicism offer to the sufferer? I offer no neat solutions, because there aren’t any. However, what the essay might lack in logical consistency and harmony of arrangement I hope is more than compensated for by the seriousness of the subject matter, a modern day tale replicated across millions of people for whom suffering is acute and decisions become a matter of life and death.
A personal account
In 2017 I was diagnosed with bipolar disorder, a mental illness which causes the sufferer to experience both the lows of depression and the highs of a manic episode.
The experience of depression is easier to convey than mania, and pervasive enough in everyday speech and culture that its most common symptoms such as low energy, depressed mood, sleeping problems, loss of appetite, weepiness and so forth are at least partially understood by most people.
The experience of mania is less easy to convey. It’s central characteristics are an excess of energy, an impulsiveness, a loss of control. In its milder forms it can provoke irritability and severely impair sleep. In its more severe forms it can tear through a life like a wild fire, inducing violence, loss of control around sex and money, and grandiose delusions. The disorder has also been associated with creativity and even genius, with many actors and poets counted among the sufferers, perhaps most famously Robert Lowell. Even for an uncreative person such as myself mania gives life a heightened sensual nature, with music, language and images taking on an almost painfully exquisite quality.
The symptoms began in the early spring 2017. My sleep is rarely good, yet even my subsistence levels were paired back to two or three hours a night. A typical night would include 2-3 hours sleep, until 2am, at which point I would get up and listen to music, usually the same piece over and over. Strangely however, I did not feel tired. My sexual appetite also spiked, and my mood began to oscillate wildly with fits of rage, the consequences of which I am too embarrassed and ashamed to describe.
And then, without warning, in April, my intense mania gave way to depression. Everything slowed. I could barely lift one foot in front of the other and just getting out of bed became almost impossible. Before long the mania and depression were presenting themselves within the same day, sometimes several times, in a pattern known as rapid cycling. As I fell into the abyss I tried to flee, first by seeking a divorce, and then by serious contemplation of taking my own life. By June it was all planned. Instead of going to work I would drive to a quiet car park, drink four or five beers, and then cut my wrists. Each day I mentally tossed a coin. Go to work, or kill myself. I believe that if I had been childless I would have happily taken that step. I told my wife I just wanted to be switched off, and I meant it. My children moved out to be with their grandma, largely for their own protection. My life was crumbling.
The day arrived in June by which time I could no longer function. My wife took me to a doctor, got an emergency appointment with a psychiatrist, and after 30 minutes I was diagnosed with depression and given starter packs of Remeron and Brintillix.
My initial reaction was of relief. I had a solution to the nightmare and they came in two little pills. The Remeron helped me to sleep, and after a very difficult three days adjustment there was a slow and sure stabilization. I was crawling, inch by inch, out of the pit. Returning to the psychiatrist weekly for another thirty minutes of self-indulgence and increased medication, I was an avowed convert to psychiatric pharmaceuticals.
Yet little did I know that for those with bipolar a diagnosis of depression can be lethal. Anti-depressants act like rocket fuel, with the risk of “over-shooting”, or inducing mania. I mentioned to my psychiatrist I was experiencing days on which I felt utterly amazing, invincible even. I thought this was a positive sign! He expressed concern, and when the swings became almost hourly we started discussing bipolar disorder. After some research I was convinced that beyond a shadow of a doubt I had the condition. My medication was urgently altered, I was given anti-convulsants, in particular Seroquel, to take alongside the anti-depressants, and some kind of order was restored.
The moment I read a description of bipolar disorder I knew that this was in fact the illness from which I suffered. Firstly, my family history was pock marked with suicide and suicide attempts, especially through my mother’s line. My grandmother had seven attempts before being successful, my aunt two. My mother was, and still is, riddled with anxiety, compulsive disorders, eating disorders, depression, and fits of rage. My own life also led me to the same conclusion. I had had three episodes of very severe depression, for which I had sought help, plus anxiety through most of my 20s. My 30s had been better but not perfect. Yet, how had the mania gone undetected? This is not uncommon, as many bipolar patients only present themselves to doctors with depression, not seeing mania as problematic. Yet when I looked honestly it was there, including acts of extreme generosity with money which left me almost broke, binge eating, religious obsessions, and difficulty controlling myself around alcohol. I also had an episode at the age of 29 which I had never been able to explain, which included the loss of sleep for many months.
Once diagnosed, there began a journey of self-exploration and at least partial healing which took me in a direction I never foresaw. Two unrelated events meant that restoration veered away from the traditional path of the management of bipolar, recommended by the so call medical profession. The first was a disillusionment with the steady ramping of my medication and a loss of faith in the work of not only my psychiatrist but the entire profession. Over a course of six months I had been prescribed five different anti-depressants and anti-convulsants in various combinations and steadily increasing doses. There came a point at which I could not simply keep putting the larger and larger quantities of pills into my body. My soul simply rebelled. In addition, over the course of twenty or so visits to two psychiatrists, I realized that they simply had no idea what they were doing. The causes of bipolar are not understood, and so the treatment focuses on masking symptoms. In addition, the low point of each week were those hours immediately following an appointment. Talking about myself and my problems, far from being a relief, was making me feel worse!
At the same time I stumbled across that most ancient of remedies, almost entirely by accident. Fasting. My wife and I started the 5-2 diet, much against the advice of my “doctor” but in part to counter the weight gain caused by my drugs. On the two days a week of calorie restriction I felt not only better, I felt normal. It did not take long for me to start to understand the connection between food and my symptoms. Several months of experimentation followed which resulted in the elimination of gluten, refined sugar, all processed food, alcohol, most dairy and trans-fats, and even fruit and some nuts such as hazelnuts and almonds. They were replaced by fats. Mackerel, salmon, beef, bone marrow, butter, goats cheese, coconuts, avocados, eggs and lots and lots of healthy oils, plus generous doses of deep green vegetables such as broccoli, sprouts and spinach. Gone were the breads, pastas, beers, milk, cheese, rice, and all food with ingredients on the side. This resulted in a state known as ketosis, whereby the brain ceases to run on glucose and switches to ketone bodies, entities produced in the liver as a result of fat consumption for energy (whether our own body fat or fats from foods). The ketogenic diet has been used for 100 years to treat epilepsy, an illness whose medication overlaps significantly with bipolar, and miraculously it has largely eliminated my symptoms. The final proof of the quackery and corruption of modern psychiatry came when my psychiatrist urged me to cease following the diet. It was the last time I saw him, and from then on I embarked on a path of self-management through food and fasting which has produced significantly more reliable results than any medication or talk-therapy. I am already convinced I will never look back.
The challenge of mental illness for Stoic philosophy
So, you may be asking yourself, what has all of this to do with Stoicism? Did you not heal yourself with the Enchiridion? Or the spiritual exercises detailed by Hadot? Or by a conviction in fate acting through our ensouled cosmos? The answer, sadly, is no. In fact, although I was a practising Stoic at the beginning of 2017, Stoicism was not the bulwark I had expected when faced with both mania and depression. My flood wall was simply overwhelmed and daily practice exhausted my fatigued and burned out brain, rather than strengthening it. Both at a practical and deeper theoretical level mental illness was a deep challenge for my Stoicism.
The problem of free will
At the heart of Stoicism is the faculty of choice, and its necessary concomitants, free will and moral responsibility. The unifying feature of many, if not all mental illnesses, is the loss of this faculty on the part of the patient. Bipolar is no exception, and many of the acts performed whilst under the influence of mania take place without the potential consequences passing through the mind’s processes of foresight and self-control, and without the possibility of a consciously chosen alternative course of action. The influence of mania is akin to that of alcohol. Inhibitions melt away.
The most distressing realization of my descent through 2017 was the sense of powerless in the face of impressions. They were simply too strong, often lighting a fire in my mind. The aggravating impression did not pass through any conscious process, and once triggering a physical or verbal response, the scene would need to play itself out before the fire smouldered and I realized what I had done. I can only compare it to being severely intoxicated. The examples are too numerous and too embarrassing to recount, but perhaps one will serve to illustrate. On my son’s birthday, a minor squabble with his sibling sparked a fit of rage which resulted in me destroying his presents in front of his eyes. It was only several minutes later that the rage burned itself out and I realized what I had done. There was no conscious mental process which accompanied my outburst. It simply happened, as if a force compelled me. I do not believe there was a moment I could have resisted.
Only of course, it wasn’t a force from outside. Which throws into question a further Stoic dichotomy, that of externals and internals. Are the decisions taken whilst in the grip of a manic episode within the external realm, the realm of fate and providence, or within the internal realm, those things which belong to us. Well, neither and both. Something in us rebels at the prospect of either blaming the mentally ill patient who evidently had no control over their impulses or little comprehension of reality, and at the same time we are loathed to allow people to entirely disown their actions and decisions. Perhaps the internal-external distinction is like Newtonian physics. It works under most observable circumstances, but at some point breaks down under the sheer complexity of the universe and the human mind’s relationship to it.
An additional challenge is added when the human as an organic whole is considered, and the deep, intrinsic connection between the mind and the body. I am of the firm conviction that the rise in mental illnesses such as bipolar are in part the result of environmental toxins, most notably a diet wholly incompatible with our evolutionary development, involving vast quantities of grains, vegetable oils and sugars. The connection between the gut and the brain is being elucidated more and more, for example the gut is the engine for the production of many of our neurotransmitters. The line between the realm of the domain of our control and the domain of Nature is permeable and fluid.
The problem of pain
Related to the problem of free will is the challenge of mental illness for what CS Lewis termed, the problem of pain, or the difficulty in reconciling evil, suffering and injustice on earth with the claim of a benign, providential God or governing power.
Stoics have traditionally divided evil into two categories. Firstly, events which appear cruel or evil but are caused by natural events, for example earthquakes, or even death itself. Secondly, there are those events caused by moral evil, that which is the product of human choice. The criminal acts of mentally ill people have historically been treated as something for which they were required to take moral responsibility, albeit with defences offered by the law in cases of severely diminished responsibility. Yet if a schizophrenic shot up a school I am not entirely sure that this is not more akin to being hit by an earthquake, at least in terms of the explanatory power of metaphor. When kicking the toys of my child around our front room, I was undoubtedly not in control of my actions and nor was the act in any way consistent with previous evidence of my character. Yet I was still overpowered with shame and remorse afterwards. This is not easy philosophical or spiritual territory to map.
The hope of Stoicism for those with mental illness
The indispensable necessity of character
Mental disorders are an assault on your character, and it is impossible to live a meaningful, contented life without character. Beside the physical and mental difficulties of surviving a bipolar episode, bipolar has the capacity to drive you towards actions for which afterwards you are deeply remorseful, and which can alter your view of yourself in significant ways. As a Stoic, the impulsiveness, irritability and even the suicidal tendency were in direct conflict with the standard of behaviour and character I had come to expect of myself in recent years, and slashed at any delusionary ideas I may have had that I was making progress towards some sagelike being. Not only was I struggling physically and mentally, my very idea of who I was was being altered, and I was needing to deal with shame and remorse on a daily basis, hardly attitudes and emotions conducive to the good flow of life. I learned in very concrete terms the truthfulness of the claims that virtue is indispensable to happiness.
I believe, firstly, no matter what our circumstances, we must take responsibility for our actions. There are circumstances in which people are, on the facts, not responsible for what they do, and mental illness traverses this territory. However, the worst thing you can do as a mentally ill person is to disown these actions. It is core to our view of ourselves as a free and complete human being that we take responsibility for everything that we do, even when it can be rationalized or explained by factors which are not within our control. It is a peculiarly modern impulse to want to explain ourselves entirely in terms of our environment, or even to cast ourselves as victims or subject to oppression. The price of doing so is very high. It is our very self, something somebody struggling with mental illness can not afford to give away.
However, responsibility needs to be balanced with kindness towards oneself. As a rational person who accepts the challenge of bipolar I also know that I have been dealt a Herculean hand in managing it. The ideal of moment to moment attention to the dichotomy of control, or equanimity even in the face of extreme stress, needs to be tempered with a focus on maintaining a standard, even a very modest standard, which a person can maintain and build upon. It is about finding the line which you can defend, and starting from there.
For me it was going to work. No matter how awful I felt, how difficult basic acts such as getting dressed could feel, I made myself go to the office. Even if I couldn’t do anything once I was there, the act of turning up was my bottom line. It may not be something which would earn one the title of a Socrates, yet for me it was my daily heroic act that prevented all else from collapsing. I am not saying that as Stoics we lower the standards we set for ourselves. Rather, it is about setting our standards in context, being realistic, and attempting the achievable rather than perfection. Stoics are built one brick at a time and when those bricks are knocked down, we simply need to start building again.
Courage – the guiding virtue for those struggling with mental illness
Mentally ill people exercise profound courage and dedication to duty. This is often lost in the chaos, tears and descent into darkness. Yet to get up every day, in the midst of mania or depression, having not slept and not knowing what was happening, and drag myself into work, was such an act and far braver than many acts of seemingly greater importance which were undertaken in a state of relative calm. Even brushing one’s teeth whilst depressed can take on a virtuous significance it may not otherwise possess in normal every day circumstances.
There are other acts which I undertook which required bravery. One was admitting my state to my father. I knew he didn’t quite understand, despite the history of suicide in my mother’s family which forms a reliable predictor of the recurrence of mental illness through the generations, but I felt I owed it to him to be open. The deep remorse for how I treated my wife and children, and the steps I have taken to restore my relationship were also courageous in their own way. I could have washed my hands of responsibility, but I chose not to. Stopping medication and traditional medicine and pursuing healing through food and fasting too took courage, and a trust in the deep inner wisdom of our own bodies rather than the prepackaged medical advice which often comes with a hefty price tag and life long addiction to pills.
The ultimate act of courage would be to be entirely open about the illness, as many in the celebrity realm are. I can’t do that. Attitudes are such that I know it would impact my career and my life prospects, and I don’t feel the need to allow others into my life in such a personal way. That said, when people with bipolar are open it is tremendously liberating for other sufferers. Men are particularly reluctant to confront or even admit problems such as depression, and the result is often extreme isolation and even suicide. A world in which we can confidently assert that we battle with depression or bipolar without fear of repercussions is a world in which we allow ourselves to be a little more human, and in which we are able to stand a greater chance of finding support and supporting others. I have never been one for celebrities, but the openness of people such as Stephen Fry is of tremendous help to me, to know such a talented and successful man can have the courage to tell others he has bipolar and even make documentaries about it gives a sense of kinship and support.
Know thyself
My struggles with bipolar have given me an intimate knowledge of my own mind, soul and body, and a greater sympathy and understanding for others. If one of the defining characteristics of bipolar is a loss of self-control during a manic episode, the best remedy is to take steps to avoid the manic episode happening in the first place. Sufferers of bipolar tend to have triggers. These range from substances as seemingly harmless as caffeine to stress or lack of sleep. For me those triggers were mostly food related. Once I noticed the connection between what I was eating and how I reacted afterwards a journey ensued following which I had cleansed my diet of offending food types. The chief offender was gluten but there were many other less obvious triggers, including dairy and certain seeds and nuts.
This type of knowledge may not be obviously related to Stoicism. However, it is the beginning of seeing ourselves as we really are, acknowledging our intimate relationship with nature and everything in our environment, and our evolutionary past which shaped our minds and bodies across billions of years, from the bottom of the ocean to the African savannah. We have been carved by the logos in tremendous sympathy with the fabric around us, of which our food and water is an obvious example. When at its best our reason uncovers this sympathy, rather than departing from it, to restore us, as far as possible, to something like our truest nature. Our basic functions as humans take on a spiritual nature. We are reconnected to the animals we eat and their well-being and health. We are reconnected to the water we drink. We are reconnected to our vegetables and the health of their soil. We cease to be isolated fragments but become intimate parts whose lives depend on Nature itself. The first casualty of civilization, for many, has been their bodies, and in developed countries such as the US and UK it is visible in the wretched state of public health, both physical and mental.
Bipolar has also given me a far greater sympathy for the struggles of others. When we see a person at work or on the street, we see a fragment, only that part which they want you to see. We actually have no idea what struggles they face, now or in the past, or what is driving behaviour we find objectionable. We have no idea about the condition of their brain or their health in general. My own efforts to hide my disorder from friends, family and colleagues left them searching for explanations about my own behaviour. It is a moral imperative that I extend that same generosity to others.
Conclusions
This essay may have left a mixed impression as to the utility of Stoicism in the context of mental health. However, my bipolar disorder has led to a deepening of my understanding of the role of philosophy and indeed the necessity of what it means to follow Nature. It has forced me to return to first principles and honestly assess what Stoicism is and how and why I should adopt it as a way of life. I leave you with three brief thoughts:
i. Stoicism as a life hack, or merely a technique, is like a plant uprooted from its soil. The moment it encounters a strong wind it is overpowered. Reasserting the dichotomy of control or the power of our judgements is almost certainly not a cure for a bipolar manic episode or deep depression.
ii. The true soil of Stoicism is Nature itself, and the truth and accuracy of our understanding of Nature and how we position ourselves accordingly. This starts at the level of bacteria in our intestines and ends in our relationship to the gods, the logos, and providence. We cannot abstract ourselves from our evolutionary past and the sometimes grimy and even cruel reality of biology. Equally, we are spiritual beings who seek relationship, meaning, patterns and purpose. We must attend to the full spectrum of our reality and our being.
iii. A person must be able to look themselves in the mirror to be happy. Our own perception of our good character is indispensable to flourishing as a human. Virtue really is the only good.