The Consequences of Poor Insight - a Review of "God Knows Where I Am" by Rachel Aviv

Photo by  Volkan Olmez  on  Unsplash

In 2001, my Uncle Jim died from complications from pulmonary fibrosis. My aunt Mimi, my father's sister, was financially well off after Jim's passing. After years caring for my uncle, she  decided to retire. She moved to the tiny community of Deer Lodge, MT where, to all outward appearances, her life fell apart. She started drinking, stopped taking care of herself and was found one day delirious from malnutrition on her living room couch by a house painter who was doing some work on the property. She was hospitalized, recovered, told everyone she was fine, returned home, and then fell ill again from self-neglect. Unfortunately, it was a pattern that repeated multiple times over for the next several years. My father, his sister and the local community tried to intervene to provide additional care, but my aunt refused any additional help and no one could prove that my aunt was crazy, depressed or otherwise not capable of making her own decisions. She died in 2015 alone in her house when she apparently fell in her kitchen while drinking and hit her head on the counter.  She was found a few days later by a family friend who had brought her something to eat. 

 I couldn't stop think about that scenario while reading the great long-form New Yorker article (>15min) from 2011 called "God Knows Where I Am"  by Rachel Aviv. It recounts the tragic life of Linda Bishop, a single mother who suffered bipolar disorder and schizoaffective disorder. Intelligent, charming, and fiercely independent, she additionally suffered from "poor insight" (ie. awareness of her condition) also known as anosognosia. She refused to believe she was "crazy", didn't want treatment and shunned the family members that tried to help her. After being released from a mental hospital, she wander a few miles to an abandoned house and lived for the next four months surviving on apples from a local orchard and rainwater, taking notes in a journal, and waiting for her imaginary husband or God to save her. She died of starvation only a few miles from the home of some family friends who could have helped. It is a devastating story with no easy answers on an individual's right to autonomy and self-determination and the limits society is willing to put on those rights when someone isn't capable of caring for herself. The story was later made into a documentary of the same name.