Denial. Everyone goes through it to some degree in any illness. But in mental illness, it is especially a factor. It’s quite hard to deny an x-ray showing someone they have a lung tumor. But it is not difficult at all to deny that you have a mental illness. First of all mental illness affects the very organ you use to discern what is real and what is not, namely your brain. Also, sometimes being out of touch with reality (as in mania, schizophrenia, deep depression) is something you don’t remember. So while in the throes of the worst stages of mental illness, you don’t remember those periods. When you come out of those phases where you’ve lost touch with reality, the memory of that is not there. In which case it’s easy to deny that you have mental illness. Also, mental illness is experiencing extreme moods, extreme sensitivity, sometimes it’s normal to experience extreme moods. So mentally ill people, sometimes don’t realize they have a mental illness. They do not have insight (see the following post on INSIGHT I posted on 2/3/2015: https://wordpress.com/post/72261148/792/) Insight is the ability to realize that the things you’ve been thinking, doing, aren’t the real YOU. It’s the mental illness that is making you feel and do these things. For example, you are having wild moods, angry, weepy, depressed, belligerent, you are even picking up objects and throwing them at people you are angry at. This is not normal behavior for you. When your dose of medicine has been adjusted, you look back and think “Wow, who was that in my body? Why was I doing all those insane things?” THIS is insight. And that is the end of denial. And until you stop denying that you have a mental illness and start going to see your doctor, start taking your medication, MOST IMPORTANT is the medication, you will not be free of your mental illness. Just like an alcoholic has to stop denying that they are an alcohol addict, and admit that alcohol is in fact a big problem in their life, once they stop denying that and accepting it, then they can start treatment and take steps to be free of their illness. Just like that, a mentally ill person, after they stop denying that they have a mental illness and start going to see a psychiatrist and taking their medication, after this step, they can get counseling on how to deal with a mental illness, they can exercise, meditate, do yoga, anything that will relieve stress and for people with bipolar d/o, keep their mood in the normal range, this is absolutely, positively grand!
When I first became sick, went into a suicidal depression, at first I had no idea what was happening to me. But when the doctor told me I had major depression, I accepted it. And yes, there were times, in the midst of manic phases, when I didn’t know I was sick, but there would always come a time, even in the most lalaland phases, I would realize that I was very sick. And so this insight has helped me cope with my illness much better than if I didn’t possess it. In that sense, I count myself lucky, that I have this insight.
So no denial and lots of insight are the prescription for a better outcome for people who have mental illnesses.
Insight may be the single most important factor in determining how well a person with a mental illness does. Major mental illnesses, of course, come with delusions, thought disturbances, illusions, and the seeming inability to accept the very fact or total or partial denial that “I” have a mental illness. This can lead to bad things. Then “I” will not go to see a psychiatrist, “I” will not take my medication, because “I” do not think there is anything wrong with me. In the meantime the disease is getting more severe and more difficult to treat. Also as time passes, bipolar disorder and schizophrenia will cause neuronal cell death in brains and this will be worse in unmedicated brains.
So the important thing then is to help the mentally ill patient realize that they have an illness. Make them aware of the symptoms, for example in mania the symptoms are:
- Inflated self-esteem
- Poor judgment
- Rapid speech
- Racing thoughts
- Aggressive behavior
- Agitation or irritation
- Increased physical activity
- Risky behavior
- Spending sprees or unwise financial choices
- Increased drive to perform or achieve goals
- Increased sex drive
- Decreased need for sleep
- Easily distracted
- Careless or dangerous use of drugs or alcohol
- Frequent absences from work or school
- Delusions or a break from reality (psychosis)
- Poor performance at work or school
These (except for the break from reality or psychosis) may seem like normal human behaviors, but when many of them are present at the same time and with a high intensity, then it may be fair to assume that this is an illness and not just normal behavior. If untreated, people will bipolar 1 disorder will go into a psychosis, meaning they will have delusions and be out of touch with reality. This is the most dangerous part of the disease. And psychosis happens at the extreme end of mania as well as at the extreme end of depression. Both very bad places to be. In mania you may think you are super man and you can fly and literally try to do so, causing yourself harm. In depression you may think other bizarre, unreal thoughts, such as you are a “dark lord” with powers, who knows, at this point in someone’s illness, they can think anything and may do some very strange things, that can result in self injury or injury to others.
So, as I said, insight, which is the ability to judge who you really are, and when in one of these episodes, realize that this is not you, it is your illness which has taken over your brain and is now making the decisions of how you act for you.
I think I was “lucky” in a way because I didn’t manifest bipolar 1 disorder till I was 25 years old. So, I had 25 years to be ME, so when the illness took over me and my life, at some point I knew it wasn’t me and called the doctor. Even when I had reached the psychosis stage, in between periods of being out of touch with reality, when I would come back to myself, I realized I needed to be in the hospital and even though it was done with a lot of drama and emotion, I did have my self hospitalized. And I strongly believe that because of my insight, I have only been hospitalized twice in the last 29 years. Most of the time, I and my doctor, we have caught the disease early enough so that it was treatable by increasing the doses of the meds I was on, or temporarily adding another medicine. My champion of course is Lithium Carbonate extended release (ER.) Since last March, I have been on 900 mg of Lithium and have experienced no major mood disturbance. Most notable is the absence of the yearly foray into mania around the end of the year.
I have had minor mood fluctuations, mostly towards the depressive side, but thankfully nothing too extreme. Also, these may be happening because I am totally off Zoloft, a selective Serotonin reuptake inhibitor (SSRI,) and I have been on it since 1991, when it first came out. So, having been on it for so long, there are changes in the brain that happen, and these changes (changes such as Serotonin receptor down regulation and Serotonin synaptic vesicle up regulation, both of these result in less Serotonin reaching the Serotonergic neurons) make Serotonin less available to the neurons. And since Serotonin is needed for normal mood, not having enough of it would cause depressive episodes. These changes take about 6 months to a year to reverse themselves. This is what makes it so difficult to come off of SSRI’s. And this problem only happens specifically for SSRI’s 😦 But I’ve done difficult things before and coming off Zoloft successfully is just going to get added to that list of difficult things.
But, back to insight, if we can somehow cultivate insight, or perhaps find someone whose judgement we trust and listen to them when they say “Uh oh it’s happening again,” meaning the disease is acting up again, then I seriously believe we’ll have a fair chance of beating mental illness.
So lets all keep a check on our moods and actions and feelings and take action when it seems like they are running rampant upon out lives. Insight can and will help us keep our illnesses from destroying our lives.