The Selves We Show the World |
Repression of emotions is common, but it does not necessarily indicate a psychiatric disorder.
Identity is plural, and people naturally perform different roles depending on social context.
Understanding the difference between individuality and pathology depends on control and social acceptability.
Some identifying details have been altered to protect confidentiality.
I took a psychiatry class years ago, and during lectures my professor used to say, “We all have a diagnosis.”
We used to laugh at that. It sounded provocative. But what if he wasn’t joking? What if diagnosis is not something “they” have, but something that exists on a spectrum we all live on?
When we started our practice at a psychiatric facility, I saw an unsettling scene in the hallway. A janitor was arguing with a patient about a painting. The janitor was screaming, “Give it to me, it’s mine.” At first, I thought maybe she was just having a bad day. Later I learned she had worked there for more than 10 years, closely with patients.
That was the first crack in my understanding. Who was the patient in that moment? The woman diagnosed with schizophrenia (a psychiatric disorder involving psychosis, disrupted thinking, and altered sense of self; Estroff, 1989), or the woman who had worked there for years and had slowly lost emotional boundaries?
Before entering the patients’ rooms, we were told to remove earrings, rings, and to tie our hair back. The rooms had no doors, just curtains, beds, tables, and windows. There were no mirrors or sharp objects because some patients were suicidal. I learned that psychiatric patients can be physically strong; their grip is powerful.
I was standing in the phone room, where patients could call relatives by request. One woman had already made a call but wanted another. The doctor, our professor, refused. She stood behind me, placed her hand on the phone, and would not let go. She screamed, “Give me the phone.” Helpers came, big athletic men trained to restrain patients. She received an injection and was placed in a white restraint garment with long sleeves. Watching that was unsettling and heartbreaking.
I did not believe all of them had severe conditions. Some were dancing in the hall, singing, smiling, though the smiles felt unsettling. One patient with a developmental cognitive disability (what older textbooks called “oligophrenia”—congenital intellectual impairment with lifelong cognitive limitations; Freierov, 1969) approached me and spoke about heaven.
I felt sad. I asked whether this condition could be treated. Unfortunately, there is no cure, only support.
It was my first practice interviewing patients and trying to establish contact. We were instructed not to make sudden movements. I felt scared. I felt heavily responsible for anything that could go wrong. I was afraid of triggering something, so I forced myself to maintain eye contact, even though inside I was trembling.
She said she had been there and someone was waiting for her. At first, I thought, we also have thoughts like that. But then she said there was a phone up there and people could make calls. She asked me if I had been there.
As she spoke, she slowly moved closer to me, looking straight into my eyes, almost as if asking for help. I nodded, trying to make her feel comfortable, and trying to understand words that did not make logical sense.
It was around 6 in the evening when my practice ended. I took the bus home as usual. But I could not return to myself for a week. I could not eat. The scene hurt me to the core. And what unsettled me most was the realization that this was permanent. Some conditions do not disappear. Some lives unfold within limits that cannot be reversed.
One day the professor brought us paintings made by patients. Simple white paper. Blue and black ink. But the intensity was overwhelming and captivating. I could not take my eyes off one painting. For me, it was a clear definition of true and meaningful art.
It was a wolf standing upright, like a strong man. From his chest, another version of the wolf in black ink was emerging, as if reborn like a phoenix. Everything was similar except the expression, the new face looked dark, and evil. They were different, yet the same. Imagine, two beings from one body.
That painting did not look like illness to me. It looked like conflict. It touched me to the core.
I asked for the diagnosis. The professor said the patient had a dissociative identity disorder (a trauma-related condition characterized by the presence of two or more identities with disruptions in memory and sense of self; Gleaves, 1996). I asked to see more of his work. Every painting contained two characters, two heads, two bodies.
I could not believe that this person was “a patient.” I did not see the pathology. For me, he just expressed what others sometimes hide.
Now when I think about identity, I see that we all carry many versions of ourselves. We perform different roles. Goffman (2009) described life as a stage where we all perform different roles depending on the audience. If that is true, then identity is already plural.
We change our identities all the time, but we call it growth.
We choose how to present ourselves, through tattoos, style, names, gender expression, careers, and online personas, curating the identities we show the world. Psychology calls some of this identity formation. Some call it self-enhancement. Some call it compensation for insecurity. In extreme cases, it becomes pathology.
But where exactly is that line?
In everyday life, people experience multiple roles or aspects of self (e.g., professional vs. personal self). This is “normal” and adaptive. These variations are shaped by culture, values, expectations, and social contexts but not by psychopathology. People may repress certain feelings because they are socially unacceptable, but this repression doesn’t imply a loss of reality testing.
It is important to note that identity roles are part of personality development and social functioning, not psychosis.
The difference is suffering and loss of control. When identity shifts cause delusion, danger, or inability to function, that’s when psychiatry intervenes. By contrast, when identity shifts are aesthetic, socially accepted, or culturally admired, we call them transformation.
In other words, maybe we simply manage our contradictions better or we just hide them better. Maybe we channel them into acceptable forms: art, fashion, ambition, reinvention.
However, even in everyday life, repression can be heavy. People hide anger, frustration, or aggression to maintain social acceptance. Channeling these emotions into creation such as art, music, performance, can help integrate the self and transform experience.
This brings me back to my professor’s words: “We all have a diagnosis.”
Perhaps what he meant is that diagnosis is not a category, but a degree. Maybe we are all managing contradictions inside us. Some people externalize them in paintings. Some in surgery rooms. Some in Instagram bios. Some in therapy sessions.
Ultimately, the real question may not be “Who is sick?” but “Who gets labeled?”
Perhaps the difference between illness and individuality is not identity itself, but how well we can control it, hide it, or make it socially acceptable.
And finally, maybe the real danger is not having a shadow but refusing to face it.
Estroff, S. E. (1989). Self, identity, and subjective experiences of schizophrenia: In search of the subject. Schizophrenia Bulletin, 15(2), 189–196. https://doi.org/10.1093/schbul/15.2.189
Freierov, O. E. (1969). Oligophrenia (Congenital Dementia). Soviet Law & Government, 8, 377.
Gleaves, D. H. (1996). The sociocognitive model of dissociative identity disorder: a reexamination of the evidence. Psychological bulletin, 120(1), 42.
Goffman, E. (2009). Stigma: Notes on the management of spoiled identity. Simon and schuster.