…Anosognosia brings questions of the origin of self-awareness to the forefront. How can someone lose the ability to know when she is or is not moving? Is this some type of elaborate Freudian defense mechanism, or is this person entirely unaware of her illness? How is self-awareness represented in the brain, and is this representation isolated from or attached to awareness of others? Though none of these questions are fully answerable at this time, research into anosognosia has provided scientists and philosophers with insight into some of these ancient questions of human consciousness.
By way of BeliefNet:
[The] defilements are like a cat. If you feed it, it will keep coming around. Stop feeding it, and eventually it will not bother to come around anymore.
-Ajahn Chah, “Still Forest Pool”
From “365 Buddha: Daily Meditations,” edited by Jeff Schmidt. Reprinted by arrangement with Tarcher/Putnam, a division of Penguin Putnam Inc.
Early manifestations and first-contact incidence of schizophrenia in different cultures. A preliminary report on the initial evaluation phase of the WHO Collaborative Study on determinants of outcome of severe mental disorders.
Psychol Med. 1986 Nov;16(4):909-28.
Sartorius N, Jablensky A, Korten A, Ernberg G, Anker M, Cooper JE, Day R.
The results provide strong support for the notion that schizophrenic illnesses occur with comparable frequency in different populations and support earlier findings that the prognosis is better in less industrialized societies.
Before you think I’m defending the borderline, let me state uncategorically that I avoid them like the plague in real life.
Here’s a good article that explains why borderline personality disorder is often misdiagnosed as bipolar disorder.
While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day. These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.
I’d like to put forth the observation that psychology in the US is mainly concerned with predicting and manipulating the behavior of large numbers of people. There is little or no acknowledgement of an internal landscape, because you can’t measure emotions – you can only measure how they are expressed. The psychologists aren’t healers, they are agents of social control.
So. “Personality Disorder” means that a certain type of personality has been pathologized because their behaviors are uncomfortable to others. The behaviors relate to the coping style – but the real problem is that the person has a damaged ego. They have to rely on others to give them clues as to who they are!
The borderlines experience an overwhelming fear of abandonment. All of the crazy behavior is to prevent you from leaving. Unfortunately, the set point is so low that most of what you do looks like abandonment. Abandonment in this context doesn’t mean left alone to rebuild their life – which majorly sucks but isn’t the End of the World. Abandonment means that who they are has been taken away from them. They have little “I” so they have to be part of a “we.”
You can teach a borderline to withhold their emotions with Dialectic Behavioral Therapy (among others), but I’m not entirely convinced that any therapy changes the real problem. It has very little to do with wanting to change, and everything to do with the fact that the fear of abandonment is so deep that – well, damn, you practically have to tear down the whole house to fix the foundation. You see?
Here is the website for Dr. Marsha Linehan, Ph.D., ABPP, who developed DBT.
‘J.B.S. Haldane was once asked what the study of biology could tell one about the Almighty. “I’m really not sure,” said Haldane, “except that He must be inordinately fond of beetles.” There are thought to be at least 300,000 species of beetles. By contrast there are only about 10,000 species of birds.’
Nobel Laureate Prof. Francis Crick
in “How I Got Inclined Towards Atheism,” an excerpt from What Mad Pursuit: A Personal View of Scientific Discovery
As the years go by, I am less and less impressed with NAMI. I think their agenda is to improve the family’s comfort at the expense of the patient’s autonomy. They teach the rather disturbing idea that a large percentage of mentally ill people have no self-awareness, no insight into ourselves. Like the lower animals. Anosognosia, they call it.
The article I’ve linked to above has some glaring logical errors and has terrible ramifications for the mentally ill. I’ll list some of them.
- The article lumps bipolars together with schizophrenics as if we are all one big, happy family. We aren’t. Bipolar disorderis cyclic, often with long periods of remission in between episodes. This is not the case with schizophrenia. Schizophrenia is associated with unremitting cognitive deficits. In either case, there is no “awareness of illness” modifier to the DSM-IV codes. Frankly, it is my opinion that the majority of non-mentally ill folks are wandering around with the same lack of self-consciousness. Why are we pathologizing it?
- The article doesn’t examine in detail the cognitive effects of certain medications. Most notably, the [tag]antipsychotics[/tag] have been shown to reduce the [tag]IQ[/tag] by an average of about 10 points. In basing the sweeping generalization that we aren’t self-aware upon those individuals whose short-term memory is ravaged by their [tag]medications[/tag], the article makes a case for putting more individuals on the same meds. This will skew future research in this direction as more and more psychiatric patients are required to take meds that may cause [tag]anosognosia[/tag].
- There is considerable evidence that medications may not be necessary during remission in bipolar disorder type II – see [tag]Dr. Fieve[/tag]’s recent book, “Bipolar II: Enhance Your Highs, Boost Your [tag]Creativity[/tag], and Escape the Cycles of Recurrent Depression.” If I state that I don’t need meds when I’m in remission, that is a treatment decision, not the symptom of a [tag]cognitive deficit[/tag].
- The milder forms of bipolar disorder occur far more that the severe forms. That is, most bipolars never experience psychosis. I suspect that there is a missing qualifier throughout the article – a description of what population exactly they mean. That is, do the authors include the milder forms of bipolar in their 40% statistic, or is the article strictly based on their experience with the sickest of the sick, the ones who wound up in-patient? If this is so, then the authors are [tag]stigmatizing[/tag] most of the bipolar population based on a very biased sample. I suspect that the sample of bipolars in the article are folks who have never been educated as to the symptoms of their illness. Education alone makes a big difference in our ability to manage the illness.
- The horrible possibility that we aren’t aware of our symptoms is devastating to the self-esteem of even the most intelligent and self-aware mentally ill person. Am I acting out? Should I speak up or will my words betray my condition? I feel good today – maybe that’s just a mania talking? I disagree what what X is saying – am I delusional?
- This article opens the mentally ill to victimization by society and especially by the medical profession. The word “Anosognosia” gives society the pretense of a valid reason to marginalize the mentally ill, to victimize, to force-medicate, to control us. It enables our families, friends and employers to shrug off our ideas and opinions for no other reason than that we have been diagnosed and they haven’t. Why exactly is it that a heart patient is allowed to request that further treatment be withheld, yet a mentally ill person can be hospitalized against his will? Are we monsters?
For all its talk about stigma busters, NAMI has shown with this single document exactly what they are all about. I am not an animal. Mental illness is not a crime. And NAMI is not advocating for us.
[tag]Sylvia Caras[/tag] of [tag]People Who[/tag] accepted this post for inclusion on her own site. Stop over to People Who and check out the tremendous amount of excellent mental health advocacy information she offers.
I’ve been trying to find out where my personal evolution stopped – using the transpersonal psychology model for lack of a better plan – so that I can decide what to work on next. Change is pretty destabilizing, I’m afraid, but stagnancy is another form of death. Yeah, probably hanging on too long is an issue. When I was a kid I’d get frustrated and walk away from difficulties, so I’m thinking this is a matter of finding the Tao, the middle way. The answer isn’t immediately obvious.
I think that a big part of healing is to reframe the issues (as the Republicans say).
The nature of an epiphany is to show you everyday things in a new light. To extend your vision far beyond your normal point of view. To show you things you never even knew existed, if only for a moment. Maybe this is the source of creativity? For the most part, however, you make changes by a slow retraining process.
When I took Chinese History I learned that when a new Dynasty began, the first thing they’d do is hire historians to rewrite the history books. I don’t advocate completely lying about your past or going into denial, but you can certainly try to find good things that you may have missed, and you can underemphasize the bad things. In school you may have repeated the times tables until you memorized them. Well, it works with anything. Tell yourself bad things about yourself over and over, and you will learn that. Tell yourself that you are competent and satisfied with you life, and you will learn that. This is the difference between a winner and a loser.
The winner always gets to write the history books. *Always*
Fortunately, many of our drugs keep us from being dangerously creative, from having epiphanies, and sometimes even from feeling our own feelings.
Oh, speaking of metaprogramming the meat computer, there’s an interesting site in Australia you might like to check out. It is a free online CBT course from the Australian National University. You aren’t going to cure bipolar disorder with it, but you may learn how to keep a bad day from getting worse. Thanks go to the Pendulum Resources forum for this gem.