"None of that was real": Folk metaphysics and psychopathology

A brief selection from Irvin Yalom's latest book of psychotherapy vignettes: A newly qualified clinical psychologist (Helena) seeks psychotherapy with Yalom after realising that a recently deceased friend and travelling partner would have met criteria for bipolar disorder. Reflecting on their exhilarating travels together, Yalom’s patient expresses an unsettling worry:

What I used to consider the peak of my life, the glowing exciting center, the time when I, and he, were most thrillingly alive—none of that was real. (Yalom, 2015. Italics in original).

There is a peculiar sort of folk metaphysics on display in this complaint. Helena has just qualified as a clinician and now reinterprets the behavior of a gloriously energetic friend in terms of illness. Perhaps aspects of the friend’s life do make sense in terms his having of a mood disorder, but the idea of such an illness seems to rob some of his experiences of perceived authenticity. Although it is less tangible a harm than stigma, detention or forcible medication, this sense of lost reality seems to be a profound and damaging alteration in conscious experience.

Here in microcosm we see a hint of how people (even clinicians) think about psychiatric disorder categories. Not real. Not mine. Not me. I feel bad for the clinical psychologist's patients. What an impoverished and concrete way she has of thinking about their experiences.