Content warning: discussion of suicidality and mentions of disordered eating'
For mental health resources, see IBD Patient Support Foundation India
Maslow’s theory of motivation, originally conceived by psychologist Abraham Maslow as the “Hierarchy of Needs” in 1956, states that there are certain human needs which, depending on their order in the hierarchy, elicit a proportionate motivational response from an individual. In short, meaning that certain physiological needs such as food, water, air, safety, love and belongingness need to be fulfilled before one can find the motivation to pursue growth needs such as self-actualization. When you are chronically ill, you find yourself battling at the lower levels of this hierarchy before you can gather the energy, motivation or well-being needed to pursue self-actualization—if at all. At least for me, it’s been a challenge to overcome the fatigue, the tiredness, the anxiety, the hunger that comes with my disease, so much so that there was a professional degree I wanted to pursue in the past and now I had to renegotiate my goals to settle for a less intensive course instead given my ability to manage my chronic disease.
All of this struggle has greatly affected my self-esteem. I feel disabled and lacking in ability, especially in how I lack the energy to do all the things someone my age would usually be able to do. A part of it is based on my perspective on having fallen sick, which may not be the most resilient of all ways to view such a thing. I am sure there are people who don’t view this as such a major setback the way I do. But the thing is that I simply do feel this way, no matter what I tell myself. I try daily to cultivate a more optimistic outlook—and I really do try very hard—but with fleeting moments of strength, I wind up mostly with despair and dejection. Perhaps this is because even before the illness, I struggled with my mental health. I didn’t have an easy childhood. I spend most of my days today as I did then, in isolation, devoid of familial nourishment. As a result, I run out of the emotional and physical nutrients with very little left to pursue “growth.” I was suicidal before the illness and struggle even more so now. The pain and hunger affect me every day—not to mention, for example, the dizziness of anemia. It’s important to mention here that this may not be indicative of a general experience of every patient, but is just reflective of my experience. Despite medications and care, I struggle with a lot of pain, discomfort, and several other contingent health issues that have compelled me to follow a very limited diet, hence the hunger (and my disordered eating history).
So, this time around when I decided to end it all given the quality of my life, I really decided to end it. It was unlike all the other times because I really finally decided to do it this time. And I was simply counting down to the day I was going to do it. And in the waiting period I discovered a latent wish to live that had never surfaced before. The death wish was the only psychic motivation that echoed in my head all my life: the only thing I was most motivated towards. But this time around it was different, because the death sentence became very real. It was going to happen, I was going to end it all. And as I grew closer and closer to the decided day, I had this really trivial but strangely profound thought. I said, in my head, “But I have not listened to all the music I wanted to listen to. And I really feel like re-watching Modern Family again. Oh! And how much I want to lose myself to dance! I am going to miss that! And these two friends of mine that I have been talking to lately in my last days, Ziggy and Mo, I want to talk more with them. Talk and talk and talk, halfway to dusk, while music soothes my nerves and gently puts me to a restful sleep. And ideally I would wake up to a breakfast of aloo paratha and chai.” Well unfortunately the alloo parathas won’t happen (☹), but I stayed for the music, for the dancing, for laughing with friends, and for the love of art.
These desires make sense if you knew that I always wanted to be an actor/dancer growing up and just when I moved to Mumbai to pursue my dreams, this disease happened and things have never been the same. I still push myself to go to dance class though, even though I am struggling to have enough energy to keep up, and the dizzies that I told you about! They won’t let me progress as fast as the others, if I am going to have to drop down on my knees every 10 minutes in the choreography! And so “growth” will have to be subjectively defined. It may not look like the capitalism-fueled modern day “growth,” but choosing and finding meaning in seemingly trivial things like music, art, movies, dancing, talking to friends may just be growth needed for a chronically sad girl who chooses to live despite the pain and the disease.
Being on the edge of dying made me want to live. For the small things. For the music, for the art, for the dancing, and for the friends! Mo and Ziggy perhaps acted as a buffer between me and the death wish, giving me enough time and mental stability to arrive upon the wish for life. Eros and Thanatos as psychoanalyst Sigmund Freud would say. The two major drives/instincts that grip our psyches, meaning that the battle to choose death or life is a perpetual reality for each one of us. Sometimes maybe we need to truly choose life and the stuff of life, the experiencing of the sensory, the real and the immediate, as opposed to the ethereal ideas of success and achievement that touch us only fleetingly and from a distance. Perhaps suicidality can allow one to assert and regain a sense of control over circumstances they can’t control—from that point of choice one chooses life again! For now, that is me, and I still struggle daily with suicidality, the pain, the hunger, the sadness, the isolation, but I am glad to have arrived upon at least a list of things I could live for. And the thing about it is that the list continues to grow. Besides the music, art, dance, and friends, (and psychoanalysis as is quite evident) I also want to live to see my clients (as a therapist myself) truly thrive. Maybe all these deeply existential struggles can be used to help others navigate through these tough existential themes of living. What it tells me is that meaning has to be made, and has to be given to life which is personal to us.
Cheers to the trivial but significant stuff of life that make one choose it—every day!