anosognosia: Lacking insight that you are mentally ill

My inspiration (ramble?) for today’s blog was prompted by reading about the Elizabeth Smart case. Elizabeth Smart was the fourteen year old girl who was kidnapped a few years ago and subjected to daily rape by her captor. The article talked glowingly of how well adjusted she is these days because of the strong support by her family and the fact that “they believed what she told them.” In cases of trauma, a psychologist wrote, it is important to believe that what the victim is telling you is true. Believing Elizabeth Smart doesn’t look like that much of a stretch to most people. I wouldn’t give the family too much credit here for psychological insight. Of course what she told them is true. The supporting evidence is right there in the open.

Well, we all know that apparently this sage advice doesn’t apply to mental health. As faithful reader of this blog, Marian, points out, people “get” the origins of physical trauma, they don’t “get” the origins of mental trauma.  There are many parents who believe in something called “serious mental illness.” I feel very sorry for their relatives who spend a lot of time in psychiatric institutions not getting better. I suspect they remain there because their voices are not heard by the people who count — their parents. The parent prefer to believe their relatives are seriously mentally ill, and rage is what they get in return.

What parent would sit by and let their child languish for years in an asylum? There is something very strange going on with parents who allow this to happen. They are washing their hands of their relative, but they don’t see it this way, of course. From the way many of them go on about how hard it is to see this happen to their troublesome relative, you’d think it was all about them. Yes, it is all about them.

The parents suffer from anosognosia, a refusal to admit that they are deluding themselves and are in need of help. The children are trying to tell them there is something wrong if they would only believe them, and the parents aren’t listening.

“The more people became shocked and worried about him, the more withdrawn he got,” Ms. Castle said.       
                                                                      
This quote about Jared Loughner is from the NY Times. It is a huge indictment of the way people in a mental health crisis are treated, before they seek help and even after seeking help. While I would like to think that medical help will alleviate the shock and worry attitude directed to the person, unfortunately, medical intervention usually exacerbates it. Shock and worry is an example of high expressed emotion and is studies show it leads to people doing less well. High expressed emotion (and its opposite, low expressed emotion) is a term that few parents are familiar with.

If we view the person as weird, sick, creepy, we hinder the person’s integration back into society. I have written many times on my blog about how the doctors in our case used language and body gestures that escalated my worry about my son, which I, of course, projected right back onto him. I can only imagine how Chris must have felt getting a double dose of worry.

Actually, I know how Chris felt. The more my husband and I projected worry and concern, the more nervous and isolated he got. His last relapse taught us a huge lesson in this regard. We decided to leave him largely to himself, safe to do and think what he wanted to in the comfort of our home, free to speak or not to speak, free to fail a course, free of our daily cheerful inquiries about his state of mind. Positive concern is still concern, so we backed off talking glowingly about his future prospects. We say very little. Chris is thriving under this approach. He still has a way to go in his rebuilding project, but he’s getting there.

The medical profession and its friend Pharma, has made schizophrenia a very high expressed emotion condition. They tell us it is the “most serious mental illness.” I didn’t know any better at the time and I took them at their word. Being “the most serious mental illness” implies that medical professionals, the people in white coats, are the best people to handle psychosis. The medical professionals, of course, administer drugs, which immediately ups the ante and makes schizophrenia a “very, very serious mental illness.”

Everybody agrees that mental health care needs a huge overhaul. I can’t think of a better way to express the basis for any treatment philosophy and practice than repeat the quote from the top of this page.

“The more people became shocked and worried about him, the more withdrawn he got.”

You can also interpret the quote as one of scale, meaning “the more people” who Loughner shocked and worried, the worse it got for him. For me, this is a clear call to de-escalate a mental health crisis as soon as possible by creating an environment of optimism within a small circle of caring. I have heard that the Open Dialogue Program in Finland does this well. Any large scale attempt to do the same generally falls victim to over-professionalization, almost by definition engendering a climate of fear and worry.

Jane Alexander is the author of the blog Adventures of a rebel Taoist. Today she takes on Kay Redfield Jamison, author of An Unquiet Mind: A Memoir of Moods and Madness, whose book is widely admired by those who believe in the chemical cure.

Well, I have something to say to you Kay Redfield Jamison author of Unquiet Mind and steadfast promeds advocate. I consider the unasked-for treatment of my bipolar symptoms with psychiatric medication to be medical malpractice. The treatments you espouse so enthusiastically did nothing but poison me. When I first read your opinion in your book I wondered for a few seconds if it wasn’t possible to sue you somehow for influencing my psychiatrist and caregivers to ‘treat’ me with your horrible lithium.


I also find that you wimped out of the full scope of bipolar treatment. You took the lithium but you never took the brain damaging antipsychotics even though you admit you were ‘floridly manic’. You are missing out on the full ‘bipolar treatment experience’, doc. You don’t know what it’s like to be that patient whom you told, “You’ve been given a shot of Haldol. Everything is going to be alright.” It didn’t turn out to be all right did it?


Further in, she has the gall to blame the man’s mania on his lack of lithium. I am not joking. Page 107 “Neither the resident nor I needed to see the results of the lithium blood level that had been drawn during his admission to the emergency room. There would be no lithium in his blood. The result had been mania.”

I mean give me a break, ‘doctor’. How you can be so unscientific as to posit this man’s psychotic episode as the result of a lack of lithium, (and not some other kind of trigger, like, I don’t know, maybe… stress?) This is kind of like how a headache is the result of not having aspirin in your blood, right? Sure. Makes perfect, logical, scientific sense Kay. No. Not really.

The full rebel Taoist’s dismantling of KRJ’s near sainted status with the biochemical crowd can be found here.

I was planning not to post about the recent tragedy in Arizona in which a disturbed young man killed and injured a number of people at a political rally.

I decided to say something in support of people like you and me who believe that there is another way. We will be shouted down by people who believe that mental illness is a brain disease in need of lifelong medication and that if only this young man had been on medication (properly “treated”) then this all would have been avoided. The biochemical group will be vocal, but not as influential as the gun lobby, which will make a better ($$) case that “guns don’t kill people, people kill people.”

Anybody who has a son or daughter sliding into mental illness knows what paranoia is. It is scary and unpleasant to witness. People who are exhibiting signs of paranoia are racist, suspicious, and abnormally interested in the current gods of mythology, e.g. political figures, the CIA, the KGB (if you are Russian), the Stasi (if you were East German), movie stars, and religious figures. This preoccupation goes with the territory of paranoia. There is nothing abnormal about the accused in this regard when you compare him to thousands of others of the same age (22) and sex (male) who are also exhibiting signs of paranoia.

Here I’m going to get shouted down by readers when I say that chances are, if this young man’s problems had been recognized and treated sooner, had he been on medication, chances are this scene could have been avoided.

I’ll start with the “had he been on medication.” Sure, had he been on medication, he would have been considerably slowed down, his paranoia may have subsided to a dull grumbling sound, and he would have been home on the couch or in bed, not toting a gun to a rally. But, my concern is for what happens after this. Millions of other young men are being forced, through government policies, insurance companies, lobby groups, pharmaceutical companies and doctors, to sacrifice the rest of their lives to medication for the deeds of one of their own: a young man with the same problems that the health care system won’t properly treat.

The mental health care system, such as it exists in most of the Western world, refuses to address a young man’s mental health crisis holistically. It has constructed a fortress of terror in the mind of the public that so-called mental illness is a chemically driven urge that can be fixed by dumping more chemicals on top of more chemicals. Despite the fact that there is no genetic marker, no scientifically proven test for “diseased brains,” it has convinced a gullible public that mental illness is virtually untreatable without these drugs. Once you are sucked into these drugs, such as our sons have been, the pressure is on to continue to medicate. The health care system in most jurisdictions pays for medication but not lengthy therapy. And yet the National Alliance on Mental Illness is puzzled why 80% of people with a mental health diagnosis are unemployed. It’s hard to hold down a job if you haven’t really addressed the underlying problems of your life.

This young man’s crisis could be sorted out eventually if he has access to a better way — support, sympathy, understanding, recognition that good mental health is a journey. “Eventually” means it takes time. It takes effort. It takes understanding of what paranoia is. Your son and my son are lucky it never got this far. This young man’sconfused mind can be healed, but the trauma of what he did will never go away. That’s punishment enough, in my opinion. Considerably less evolved members of the public will want to sort out his problems through life imprisonment or the death penalty.

So, yes, as a mother, I have a great deal of sympathy for this young man, which is no less than what I feel for the families of the people he killed and maimed.

Oh dear. After fussing over my sample query letter to the agent and twenty pages of manuscript, reading and rereading them for spelling errors and sloppy sentence construction, I discovered, to my horror, after I pushed the send button, that I had failed to notice a big, fat, mistake. I used a completely wrong word! I never use this word, but I inserted it in my last minute revisions. The word means the opposite of what I intended. It’s as if I had dropped jam on the spot, or squashed a big housefly between the pages. It’s so horribly THERE.

I can’t resend the e-mail with the offending word corrected. Agents would assume I would be a pest as a client, forever cluttering their in-box with the latest “updates.”

So, the deed is done.

Turning to other matters, it’s Chris’s 27th birthday today. Last night the choir made bought him a birthday cake. He was really happy about that. He’s been invited to sing in a local Gilbert and Sullivan production. He’s happy about that. He got the Adyashanti book from his parents and a religous book from Taylor, his youngest brother, about finding  his mission in life. I was impressed that Taylor is encouraging his brother.

Chris has a phone “date” with career intuitive Sue Fredericks this afternoon. I’ll let you know how it goes.

Have a good week-end, everybody.

I’ve been quite busy recently and not able to concentrate on my blog as much as I’d like to. I posted the manuscript for my book on the author’s website authonomy which demands continuous work on my part. I just can’t leave it there if I want to play the authonomy game. The authonomy game is a slippery slope. Inactivity on my part means I topple off the rankings that activity on my part got me to. If I want people to read and comment on my manuscript, I’ve got to be equally generous of my time with theirs. I’m also preparing twenty pages of my manuscript for review by an agent in February. I remind myself, before getting too excited about my daydream of becoming an overnight literary sensation, that I paid $50 for this privilege as part of the writers’ group I’m involved in.

Chris celebrates his birthday tomorrow. Ian and I are giving him a copy of The End of Your World: Uncensored Straight Talk on the Nature of Enlightenment, by Adyashanti. The book is about what happens after you begin to wake up from the dream state. Chris appears to be momentarily stuck on co-existing meaninglessness and superiority. These sticking points, according to the book’s author, are common traps. Ian and I feel that Chris is capable of applying himself to vocational training or further academics or a sense of purpose that fires him up, but right now he doesn’t see the “point.”

What Ian and I are hoping for Chris is that he soon decides to return to ordinary life, something that inspires him enough to get him out of his bathrobe and slippers and get going. Make no mistake about it, Adya teaches, the ordinary state is where you eventually want to be.

Adyashanti, a Zen master, teaches that enlightenment actually eventually leads you back to the ordinary, but with a newfound appreciation of how marvelous the world really is, and how one must work to add their own unique value to it. Chris is still wobbling on enlightenment’s path.