June 14, 2024

Another mental health post

What everyone calls low self esteem is just me trying to make sense of the senseless

I started reading about delusions, initially to try to refute transphobes' claim that being trans is a delusion, but I found they're quite interesting in their own right. One particularly fascinating example is Capgras delusion, in which the patient becomes convinced that their loved ones have been replaced by some kind of duplicate.

The likely cause of this is damage to the areas of the brain that connect face recognition to emotional connection. The patient can see that the person in front of then has all the facial features associated with their loved one, but the emotional recognition isn't there.

Our brains are very good at coming up with explanations for the things we experience, but the one thing they can't do is recognise when they have been compromised. Faced with someone physically identical to a loved one but emotionally a stranger, the most logical explanation is that the loved one has indeed been replaced by a carefully crafted imposter. If you point out that this is an extremely unlikely thing to happen, an otherwise rational patient might well acknowledge that it is - but remain unshakeably convinced that it is happening.

I've noticed a similar thing, on a smaller scale, happening to me. I haven't, to the best of my knowledge, suffered any physical damage to my brain, but perhaps sustained emotional trauma can produce a similar effect. The brain is plastic and responsive, after all.

I keep saying that the people I spend time with "hate me". When they point out the logical fact that they could simply not spend time with me in that case, I admit that they don't hate me, but remain convinced that they find me annoying and only put up with my presence because of what I can do for them. If they tell me they actually like me as a human being, I assume they're only saying that because they think it's expected. There is no argument that can convince me they like me.

I keep wondering whether a similar mechanism to Capgras delusion is taking place. I take no joy from my friends' company, whether because depression has drained away all my joy or because my capacity to enjoy human connection has atrophied after too many years of struggle. So while I can understand that they are acting like people who like me, I don't have that emotional sense of being liked. Thus I can't escape the suspicion that their liking is actually faked or cynical.

It's not just my friends that I have to explain away. I can't take pride in my achievements, which I instinctively attribute to them actually being not all that impressive. But if I consider it purely logically, I think it's more that I'm so disconnected from my sense of self that I can't see them as my achievements at all. I disowned the achievements of my pre-transition self as a protective mechanism, but I seem to be disowning my current achievements too, even as I complete them.

Most of the mental health treatment I've been offered feels like, to borrow Allie Brosh's memorable phrase1, the solution to a different problem than the one I have. The therapist explains to me that logically, factually, my friends like me, I have achieved more than nothing, and I am overall no better or worse than any other human. And I acknowledge that logically and factually, this is the case, but I still don't feel any connection with my friends or any pride in my achievements. On some level I have to believe that I'm the worst person in the world, because otherwise why would I hurt so much?

This also feels like a reason why, even if the transphobes were right about trans identity being a delusion, their preferred approach of contradicting us at every opportunity would be ineffective. When we're trying to make sense of what we're feeling, telling us we shouldn't be feeling it does nothing except convince us that the whole conversation is a waste of everyone's time. A trans person describing their dysphoria is a good deal more in touch with reality than a transphobe who thinks firm contradiction will make them snap out of it.

Even for those who are delusional rather than just dysphoric, if there was a way to awaken our brains to their own flaws, that might do more harm than good. The brain's inability to see itself as compromised could well be a self protective mechanism too. If we cannot trust our own brain, how can we know who we are at all? The existential crisis that would trigger would overshadow everything else I've described here2. Perhaps we need our explanations, however illogical, to keep us more or less functioning.

The explanations, whether in Capgras delusion or in my case, are not the problem. They're an attempt to solve the problem - a clumsy and possibly counterproductive one, but still a good faith effort. The underlying damage is the problem, and for all our understanding of brain and mind, we don't have a reliable way to fix that.