The Price of Insight

F

I'm OK A prominent feature of  schizophrenia and bipolar disorder is anosognosia, a sick person’s unawareness that he is sick. — Algis Valiunas, New Atlantis, Winter 2009.

No one really understands why those of us with serious mental illness struggle with insight.  Current medical theory holds that it’s actually a core feature of our neurobiology.  It’s not that we’re in denial or stubborn—we simply can’t see.

This seems ridiculous to those observing from the outside as our behavior becomes more risky and disjointed.  But those are the times when our insight is most impaired, because anosognosia is also a symptom. We lose insight just when we need it most.

Lack of insight is relative.  It fluctuates as the illness fluctuates.  When we are in remission or in a more stable state, we can often see that we were ill.

Lack of insight is listed as the leading cause of non-compliance with medication (I’m not sick, so why should I take these drugs that make me feel lousy), and in another paradox, compliance with one’s medication regime can improve insight in some cases.

Aggression and violent behavior are also linked to lack of insight.

So, if insight is important to recovery and functionality, what can we do to foster it?  Unfortunately (and not really a surprise), the mental health delivery system has little to offer:  Take your meds.  Go to therapy.

I’ve been told by most of the professionals I’ve worked with that I have a high level of insight.  Even when my symptoms are at their worst, I retain some awareness, though it becomes harder to access and trust.  But very few of those therapists and psychiatrists ever asked me if I do anything to strengthen my awareness.  The fact is I work very hard at it.

I started meditating and working on mindfulness years before I was diagnosed with bipolar disorder, and those practices continue to help me “wake up” in the middle of an episode.  Meditation is the only “exercise” I know that builds the muscle of insight.  And like any muscle, the more it’s worked, the stronger it becomes.  We can build insight by using insight.

It’s not for weenies, this practice.  Ask any neuro-normal who sits meditation or suddenly realizes he’s projecting his fears into the future instead of living in the Now.  Most people are asleep.  To be anything else requires dedication, courage and sweat.  It also requires forgiveness, tenderness and a willingness to observe rigid beliefs with gentle curiosity.  Even then, moments of awareness are fleeting.

Insight is a Big Ticket item, and most people would rather spend their hard-earned psychic cash elsewhere.  I get that.  I’ve taught meditation for fifteen years with many online groups like Askyourguide and BeHere. Most people don’t stick with it.  Sitting with oneself can be uncomfortable.  It can be frightening.  Why not practice golf instead?  At least that’s fun.

That’s been my experience with neuro-normals.  Now I’ve been asked to teach meditation to folks like me with serious mental illness.  I’ll introduce it gently next week, then see if anyone wants to continue.

Because these are people who will recognize the price tag.  And they might decide it’s worth it.

Treasuring the Rope

Rope 1In a bipolar life, there are days, weeks, sometimes months, where the illness never lets up.  Most of the time, I can ride those long spells.  They’re a fact of my life.  I understand that.  But, I suppose like anyone with a chronic illness, the relentlessness of it sometimes swamps me.  The despair of dealing with the illness combines with the despair it creates.  The extra weight guarantees sinking to the bottom and makes it that much harder to fight my way back to the surface.

I’ve been going through one of those spells—a long season of black.  It’s been a different kind of hard this time without my two water wings of compulsive eating and compulsive spending.  Oh, the compulsions are still there.  I still pace my kitchen like a caged bobcat, opening all the cupboards, the fridge, the pantry, hoping I slipped and brought home something, anything, that will dull the wild scrabbling in my brain.  And even when I’ve budgeted a trip to Des Moines, have cash to pay for a movie and gas, the urge to keep spending is a fish hook under my sternum.  Pulling, pulling always pulling.

This past week my Start With One Serving mantra saved me from getting lost in food, but I still gained a couple of pounds.  Compared to other similar seasons, though, that’s nothing.  And while I’m on the edge of nothing in my checking account, I have enough in my piggy bank at home to get through the month.  Since I paid all my bills, put money in my car fund, and made my planned Visa payment, this, too, is far from the disaster such seasons usually bring.

I’m sure the tension of fighting these old behaviors contributes to the illness itself, but the fight is required if I’m ever to find any freedom.  I know how lucky I am to even have the option of fighting.  I’ve met others like me who don’t, who don’t have an inkling of insight, who are utterly lost in the illness itself.  I understand them.  I am them.  But, I’m also this.

There was one day last week where I thought about surrendering to being lost.  What if I quit fighting and just turned into the crazy cat lady on the corner?  Would that be so bad?  There’s a siren song to mental illness that can be so seductive.  Go to sleep, it says.  I’ll take care of everything.

Emmet AlertBut, after all this time, I recognize that purring song.   It’s part of me, but not all of me.  So, I start looking for joy.  Tiny moments.  Gentle kindnesses.  Things that make me close my eyes in appreciation.  The light on Emmet as he watches the birds.  The silky slide of the water as I swim.  A song on my Pandora station.  A kind note from an almost-friend.  The perfect taste of a vanilla latte with one squirt of raspberry.  The ballet-like fight scenes in Captain America’s new movie.  The wonder of creating an exquisite background paper for a card.  The smell of rain.  A deep breath.  An old feeling of lightness that comes while driving through town in the orange light of dusk.  A chance to listen so someone else in pain.

My friend, Lily, once told me something that has soothed me for years.  Sometimes, all you can do is hang on.  This is true.  Hang on until the season turns.  Hang on because this—whatever it is—won’t last.  Grip the rope and wait.  Most of my life I’ve focused on the tension of waiting, the feeling of not being able to hang on much longer, the sense of fingernails ripping away.  What I’m finding is that it’s even more important to notice how beautiful the rope is and to treasure it.

from my Pandora station

Blog Stats

  • 159,986 hits
%d bloggers like this: