Admitting That You Have a Mental Illness Is Essential to Recovery
You can have a mental illness for years and not be fully cognizant of it.
I know that, because that was the case with me. The condition is called anosognosia (meaning lack of awareness of one's mental illness).
A website, TAC.org, states,
Anosognosia, also called lack of insight, is a biological condition that prevents some people with severe mental illness (SMI) from knowing that they are experiencing symptoms of a brain disorder. Anosognosia is thought to be the most common reason for not seeking or maintaining treatment for people with severe mental illness.
Beginning with my freshman year at college, I was depressed and in anguish at times, but never associated my condition with needing mental healthcare. In retrospect, the first signs of depression and hypomania occurred, unrecognized by me, in my senior year of high school. Then I felt, at times, a high degree of alienation from my fellow classmates, with the exception of a handful of friendships, coupled with hypomanic high achievement.
Indeed, I felt mal dans ma peau, French for uncomfortable in my own skin. However, I thought this was the way I was and the way that I would always be. Although I briefly saw a psychiatrist when I was a student as an undergraduate at Yale, I didn't see how therapy could help me because I didn't recognize the severity of my mental and emotional disorders. Marijuana and alcohol were self-medicating, but appeared to be acceptable as daily habits in my life that eased my pain.
In retrospect, I believe that I was hampered in developing friendships by social anxiety disorder, avoidant personality disorder and dependent personality disorder. The symptoms of these disorders often overlap. They were later found to be due to my depression, and after that a final diagnosis of bipolar disorder ll.
To this day, I find it hard to understand how I could be unaware of how my personality was so off key, so ridden with anxiety, despondency and social discomfort without realizing that I was in need of therapeutic and medication help. Indeed, anosognosia is considered a neurological disorder unto itself.
I believe that many people struggle with such symptoms while assuming that they are so much a part of their personalities that they don't think of therapeutic or medical treatment. A further problem is that many psychiatric disorders are nuanced and fluid. As an article in Psychology Today notes "psychiatric diagnoses may be imprecise, they may change over time, and there may be mitigating factors." Bipolar disorder, for example, often exists on a spectrum that changes from time to time.
One estimate is that 50% of people with schizophrenia and 40% of people with bipolar disorder have anosognosia before being diagnosed or are never diagnosed at all. This, as in my case, can take years upon years. The lack of vitally-needed treatment may contribute to suicidal ideations and actual suicides.
I was fortunate. I never thought of committing suicide due to my despair and helplessness, even though it literally took decades before I was properly diagnosed. Only then did therapy and medications help lift me out of my despair and hypomania, which manifested itself as dysphoria at times (mixed mood states including both depression and hypomania simultaneously). Dysphoric symptoms include discontent, irritability, stress, aggression, and feelings of anger, guilt, or failure.
For me, in any case, there were only limited anti-depressant and bipolar medications in the early '70s when I was in college and in the immediate years after I graduated in 1973. Many people today are taking effective medications to help manage severe mental illness. However, before the '80s they might have received electroconvulsive therapy or have been institutionalized in the absence of all but a few medication options. Or they might have lived their lives in ceaseless helplessness. There were also more limited therapeutic options.
Fluoxitene (Prozac), the oldest SSRI, was not available on the market until 1988. Until then, only a limited number of antidepressants, most notably monoamine oxidase inhibitors and tricyclics -- which could have serious side-effects -- were available. Lithium was prescribed in research and off-label, but is was only approved by the FDA in 1970 to manage bipolar disorder. Since Prozac was approved by the FDA, there has been steady progress in the development of many medications to treat depression, bipolar l and II and other mental health disorders.
When you self-medicate, becoming addicted to a substance, which I did, you travel even further away from seeking a means of alleviating the dread of your mental health disorder, while actually exacerbating the underlying mental illness. The self-medications further kept me from an awareness of the need for seeking help.
It is vital to get outside of "your own skin" and look at your moods and fears as if you were a third party evaluating your condition. If your symptoms match a mental disorder, you should seek a professional evaluation. If you do not do so, and you have a mental illness, you may condemn yourself to a lifetime of torment and desolation, or even suicide.
This is a life-changing lesson I learned the hard way.
Mark Karlin is retired, after a long career in advocating against gun violence, as a hospital executive, an online journalist, a consultant, and founder of a progressive website. He graduated from Yale University, cum laude, with an honors degree in English and received his MA from the University of Illinois.