Anosognosia

the medical term for not knowing how sick you are

The weather was unseasonably warm yesterday for January. I think the high hit somewhere in the low 80’s, or at least it felt like it. The snow from last week’s storm was melting fast, and the sidewalks were already clear, so I laced up my sneakers after work to hit the trails.

With songs of my favorite country artist (Luke Combs) playing in my Airpods, I enjoyed the warm breeze and was able to get in a good two-mile walk before having to head home for my 3pm psychiatrist telehealth appointment. But when a certain song came on that I hadn’t heard in awhile, I was suddenly transported back to the fall of 2021 and the notion of anosognosia came to light, crystalizing in my mind a time when I was both very sick and mostly unaware of what I was dealing with.

It was This Is My Brave’s first major stage show since the pandemic had hit and my own stress level and that of my staff was sky high. There was so much to do to ensure the show weekend was a success. We were flying in our high school storytellers from across the country, with a parent, to share their stories in our National Teen Show. There were not only travel logistics to think about, but rehearsals and meals and sightseeing in DC since for many of them it was their first time in our nation’s capital.

My two Program Managers leading the weekend were staying at the hotel where the kids and parents were staying, close by to the church where the event was being held on Sunday. I stayed at home to save on the cost since I lived close to the hotel and church. On the drives to and from the hotel and church over the course of the weekend, I’d listen to the country radio station and that song played over and over. So when it came on yesterday as I was walking I was reminded of the buzzy, hypomanic feeling that had taken over my body.

It started to ramp up on Friday. My husband Ben was out of town on a much-needed guys golf trip, so I was solo on kid duty. Got the kids home from school and then it was off to swim practice where I walked around the complex while they swam for ninety minutes. As I made the loop and crossed into the parking lot, it felt like the loudest symphony of noise I’d ever heard: the airplanes overhead, the cars zooming by on the street, even the birds up in the sky - everything was super loud. It began to feel like the world was crashing in on me. I stopped and sat on the curb and told myself to just breathe. I went over what I needed to do that night: get the kids home, make dinner and put them to bed. Then take my meds and get to sleep.

Despite taking an extra antipsychotic, the hypomania continued to ramp up and created energy and stimulation that propelled me into mania through the weekend. From picking up the families at the airport and taking them to the hotel, to going through a soft rehearsal with the teens and then taking them downtown to DC to see the national mall and WWII memorial. Mania’s spell lasted all the way through the dress rehearsal and show on Sunday, during which I nearly started crying hysterical at the end of delivering closing remarks, knowing it was my last show as Executive Director. I’d be stepping down three months later. Somehow I was able to hold it together.

I wrote about the episode in my journal two months later:

11/18/21 - The last manic episode in September was scary but I felt empowered knowing I could keep it under control. Like throwing my foot down on the gas with an open stretch of highway ahead of me. 

The tough part is that back then I didn’t realize that my bipolar symptoms were emerging at an alarming rate. I didn’t know how sick I was since it had been so long since I had been sick. After the show I sat down with my Program Managers and we talked about everything, and only then was I able to recognize I had experienced a manic episode. They asked what they should do or how they could help me when it got to that point. I didn’t have a good answer. It had been 4 years since I’d experienced a severe manic episode.

I would cycle between hypomania/mania and depression for the remainder of 2021 and all through 2022 as I came to grips with my decision to step down from the organization I had founded. I can recognize the hypomania now, after many years of living with bipolar. And through mood charting I’m able to see hypomania coming on and can make adjustments to keep it in check.

During the bouts of mania, I am unable to tell that I am ill, and during the depressions I just wish I could make my way back to hypomania. It’s a vicious cycle. I try to journal and write about the episodes and symptoms of my condition. My hope is that these notes will be reminders to help myself stay on top of hypomania so that it doesn’t lead to mania.

Anosognosia is a challenging symptom of living with mental illness which forces me to rely heavily on my incredible support system. They are the first to notice any signs of hypomania that could be concerning, such as sleeping less and one of my tell-tale hypomania signs, misplacing things around the house. I cannot help that this condition seems to go hand-in-hand with my bipolar disorder, but knowing about it is half the battle.