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Does everyone else struggle to stay sane, too?
Epistemic Status: self-reported musings
Mental health is a complicated topic, and “sanity” can be a loaded word, so I’ll offer a few definitions to make sure we’re all on the same page.
The colloquial definition of sanity, if such a thing exists, is formed in contrast to insanity. Someone is sane who is not insane.
So what’s insanity?
The colloquial definition of insanity is repeating the same act over and over again and expecting different results.
The dramatic definition of insanity generally involves seeing and/or hearing things that aren’t there, laughing hysterically at nothing, and getting punched in the face by Batman.
My personal definition of insanity is not getting out of bed for two days, not answering your family’s and/or friends’ calls because you’re irrationally terrified of talking to other people, and letting everyone in your life down, including yourself, as you desperately try to pretend that everything’s fine and you’re not a huge screw-up who drags anyone who gets close to you into your nonsense.
So sanity for me is defined as…not that. But I’ll elaborate, because pointing at one particular kind of crazy and shaking my head is not particularly illustrative.
A Personal Definition of Sanity
Sanity, to me, is about being able to live your life roughly the way you want to, without too many internal mental problems. It isn’t about hating your job or being unhappy in your relationship; it’s about being a functional human being most of the time.
At first glance, this does not seem like a high bar to clear, yet it is one I have repeatedly failed to meet at many points in my life.
So what gives? Was I born defective, victim of a genetic imbalance in brain chemicals?
I look at the people in the world around me, and they don’t seem to be constantly clawing their way out of a pit of non-functionality and failure to successfully human. (Not that I always looked that way when I was; “keeping up the pretense” is a well-honed skill I suspect many of us have.)
Still, the question has followed me for years, and recently I gained a new perspective on the issue I’m keen to share.
Most of our bodily functions are autonomic1 - while they can be and often are influenced by our behaviors, our bodies mostly take care of themselves.
Think about it: when was the last time you had to actively support your heart in pumping blood throughout your body or help your kidneys do… whatever kidneys do? All of these bodily systems, from bone marrow function to immune system activity, from temperature regulation to cellular growth and senescence - they all take care of themselves without any input from us.
While our behaviors (what we eat, our level of physical activity, drug consumption, etc.) affect these systems, the systems don’t stop working when we stop paying attention to them. We don’t have to exert effort to keep them going. They’re autonomic.
So what about the mental functions?
What about sanity?
We can imagine our minds like another organ or other bodily system, a carefully balanced and complex network of interlocking parts performing a vital function for our survival.
But is it autonomic?
Is Mental Health Autonomic?
In medicine, the autonomic nervous system controls the autonomous functionality: heartbeats, digestion, etc., while the somatic nervous system controls our voluntary actions: moving, blinking, swallowing, and so on.
However, the health of one’s body is largely autonomous, with one’s choices interacting with the body, but only from the outside. Eating healthier or quitting smoking can improve the health of one’s body, but you don’t have to think about digesting more nutrients or repairing damage to your lungs. It all just happens.
In other words: people make lifestyle choices, and those choices can affect the health of their bodies, but the body is a living organism that takes care of its own upkeep. It doesn’t require daily attention to keep one’s cells dividing.
So what about one’s mind?
Is the mind like the body, such that while our choices affect it, it generally maintains itself without our input?
Or is it different? Is mental health not autonomous at all?
There are parts of our minds that work without us having to think about them, like the transfer of memories from short-term to long-term storage. These are clearly autonomous.
But mental health - sanity - is trickier.
It isn’t just the regular functions of the mind, biological machinery grinding away like distant gears to keep the engine running.
It’s a combination of emotional stability and a sustainable attitude towards life and not being crippled by an anxious wrench gumming up the works. It’s engaging with the world and being willing to learn and grow and not living too much in the past or the future. It’s keeping up with your responsibilities and paying the rent and brushing your teeth.
And for me - for most of my adult life - none of that has been autonomous. None of it has been automatic or without conscious effort.
For me, sanity has been volitional - an active effort of will. It’s a choice that I have to make, to keep up with my diet and medication and exercise and work and sleep and social obligations.
I know that it is a choice, because I’ve chosen the alternative several times, and suffered for it. Sanity is not a natural state for me. It’s not an attractor, a low-energy equilibrium I settle into comfortably.
It’s a knife’s edge that I balance on, constantly, day after day, struggling to stay upright because being on top of it is necessary for doing anything else.
The Value Add
As much as I enjoy pointless navel-gazing, there is value to be had in coming to this understanding.
There have been times in the past when I’ve fallen off the knife’s edge not because I gave up or because I wanted to, but simply because I didn’t know I had to put in the work to balance on it. I thought that my mental health was stable, I looked away to focus on other things, and everything came crumbling down.
I thought my mind was like my body, where I could trust it to do the upkeep work itself once it was in a good state.
I couldn’t, and it didn’t.
So now I know that sanity is something I have to work at, consistently (though not constantly), I can make sure that I put in the work. Daily.
As a result, I fall off the knife a lot less frequently than I used to.
Which is good! It’s progress, it’s growth, it’s moving forward.
And sometimes that’s all anyone can ask for.
Here I use the term “autonomic” to mean “involuntary, without conscious effort”, as in the autonomic nervous system, which is the part of the nervous system that keeps one’s heart beating.
The part of the nervous system we use consciously is called the “somatic” nervous system, although the word “somatic” itself refers to the body.
I’ll use the word “volitional” as the opposite of “autonomic” in this context, to mean “requiring active use of one’s will.”