The Insight Muscle

Anosognosia is a medical term to describe someone with a mental illness who has poor insight into their condition or situation.

Take someone who is angry all the time, bitter at the world and everyone who is close to him, constantly oscillating between crying over the fact that he lost his father and threatening to “take this outside and teach you a lesson,” all unprovoked. Then, tell him that he is diagnosed as having bipolar disorder, and that his mood swings are the result of an unfortunate mental illness. There is a 50% chance that he will agree with you, that he sees what’s been happening to his life and that it’s not normal, and that he needs to seek whatever form of treatment is available to help combat the disease. The other 50% of the time, this is seen as a threat to his way of life–you’re wrong, the medical establishment is wrong, there is nothing wrong with me. I. Am. Not. Sick.

Modern medicine, as of this writing, has a theory that anosognosia is a consequence of the disease itself. Whatever multitude of causes that lead to someone having been diagnosed with bipolar disorder, it is believed that the reason they can’t see what is obviously bipolar disorder is because of the bipolar disorder itself.

There is a lot to unpack in this kind of situation. To start with, bipolar disorder is an arbitrary designation. Everyone is bipolar in the sense that they experience mood swings. We say someone has bipolar disorder once we become really uncomfortable with the mood swings that we’re seeing.

More importantly though, my limited experience suggests that poor insight into one’s life is the norm, not the exception. The family members of the man who has been diagnosed with bipolar disorder and refuses to take any medication, yet over and over again tries to convince him he has bipolar disorder and needs medication, have poor insight. To me, that is the most likely reason the word anosognosia exists, because the people around this individual aren’t able to look deeply at their own situation and acknowledge that something is wrong with the way they are behaving. They are caught in a cycle, and saying “it’s not him, it’s the disease” allows the family to ignore the fact that they themselves can’t see their own cycle.

It’s also likely the reason we have these arbitrary designations for mental illnesses. We are fixing someone in time, and designating them to have some specific disease, not because that’s necessarily the best or most complete explanation for what’s happening, but because we ourselves are caught very much off guard with the change that we’re seeing and want to explain it away. Rather than accepting it, we designate it as wrong, try to categorize exactly how wrong it is, then try to fix the wrongness with a specific treatment. It’s much harder to say that there are a myriad of factors and reasons that go into someone being “very much not okay,” that truly we are all on that spectrum, and it’s our job to ruthlessly stare at that and try to understand as many factors as we can that led to it. It’s also our job to recognize the change, and use that observation to cherish our present life and mere existence.

To be clear, it is absolutely my opinion that these individuals need to be helped. You spend a few minutes around them, and you can clearly see how much better their lives can be. If they could stop being so angry and sad, there might be opportunities for pockets of true, longer lasting happiness. And drugs to balance chemicals in their brains are a perfectly valid way to try and solve that problem, especially when they can’t see that it’s a problem and are causing so much destruction to the people that love them in the process.

The point, however, cannot be understated–I can’t look at my father destroying his life and stop with the simple conclusion of “he has bipolar, and he needs medication.” Instead, I need to ask myself: “why is this so upsetting to me?”

Insight is a muscle. It atrophies when you don’t use it. It gets stronger when you use it, and give it the opportunity to grow. Like other muscles, you can’t improve someone else’s–so, use your insight muscle on your life.