Who is mad, you or I?
Think about how you would feel if your self-perception is completely different from what other people think about you. Which is the real you? Where is the truth? The truth is completely different from demonstrability. There are things that we perceive as true, but we are not able to prove them. Sometimes people believe their self-perception, or self-image, is true but, in fact, it doesn’t match reality.
Matter of perception
In Act 2 of Luigi Pirandello’s Right you are! (If you think so), at some point Laudisi, one of the characters of the play, finds himself facing a big mirror. There is no one else in the scene, just him and the mirror. Not a word, no background music. Then, suddenly, he addresses his mirror image like they are very good old friends, and poses a staggering question.
He asks his mirror image which of the two is mad. Laudisi descried the complexity implicit in the question. He is pretty sure he knows the person in the mirror, however, he is also aware that other people don’t see that figure in the same way he sees it.
Graphics: Sóley Ylja A. Bartsch
“Laudisi: So there you are!
(He bows to himself and salutes, touching his forehead with his fingers): I say, old man, who is mad, you or I?
(He levels a finger menacingly at his image in the glass; and, of course, the image in turn levels a finger at him. As he smiles, his image smiles): Of course, I understand! I say it’s you, and you say it’s me. You – you are mad! No? It’s me? Very well! It’s me! Have it your way. Between you and me, we get along very well, don’t we! But the trouble is, others don’t think of you just as I do; and that being the case, old man, what a fix you’re in! As for me, I say that here, right in front of you, I can see myself with my eyes and touch myself with my fingers. But what are you for other people? What are you in their eyes? An image, my dear sir, just an image in the glass! They’re all carrying just such a phantom around inside themselves, and here they are racking their brains about the phantoms in other people; and they think all that is quite another thing!”
Luigi Pirandello, Right you are! (If you think so), English version by Arthur Livingston– (New York: E. P. Dutton, 1922)
Laudisi was seduced by the idea that how we think we appear is different from how people see us. From an individualistic perspective, how we feel about ourselves is often so far more important than how we are perceived. However, reality can be more complex and sometimes even a little berserk.
Unaware of your own illness
There are cases where people with a mental illness are unaware of being unwell. It’s not a form of denial. It is a neurological symptom. This condition is called anosognosia, from the Ancient Greek ἀ- (a-, “not, without”) and νόσος (nósos, “disease”) and γνῶσις (gnôsis, “knowledge”). Most commonly found in patients with schizophrenia, Alzheimer's disease, Huntington’s disease and bipolar disorder. People affected by anosognosia believe they are perfectly healthy and stop taking their medication.
Our brain constantly updates our mental self-image. Every time we acquire new information about ourselves, our brain’s frontal lobe organizes the new information, modifies our previous self-image and stores the new updates. Some mental diseases can damage the frontal lobe and as a result, it is no longer capable of properly processing new information in order to reshape one’s self-image. This is what experts believe causes anosognosia. With a dysfunctional frontal lobe, people are not aware of the changes related to their self-image and they have a projection of an older version of themselves when they were not affected by the illness. In other words, the system updates fail in people affected by anosognosia.
How to help someone with anosognosia?
Having a loved one with anosognosia may present some challenges. Those living with this condition refuse to talk about their mental illness and get highly irritated if someone points out their condition. The first thing you may want to do is to try the LEAP (Listen-Empathize-Agree-Partner) method (https://leapinstitute.org/) developed by Dr Xavier Amador. This approach will help develop a trusting relationship with the person affected by anosognosia.
The next step is to seek help from qualified mental health professionals. A combination of cognitive behavioral therapy with antipsychotic medications may further help to improve the awareness of illness.