Tuesday, June 22, 2010

Anosognosia, Lemons, and Desire.

Loved this article on Anosognosia in the Times.

When I was just starting out at the training clinic I had a court ordered patient suffering from a paranoid personality disorder who, by the nature of being forced into treatment by the court, didn't see him/herself as suffering from a  mental disorder. Instead they saw that the judge was out to get them.... the Anosognosia made for an interesting process for trying to address the paranoid thoughts... which is a cute way of saying I was totally cornered in the room.

Back when I was a pre-doc studying diagnosis, there was this collective meltdown in the classroom as we learned the DSM IV and diagnosis. P
athology tends to be an over-abundance of defensive mechanisms... but everyone has a tiny bit of these defenses at work. Its the quantity of  the defensive mechanism that oftentimes is the difference between 'healthy' and 'pathological' behavior.  As a student one sees the self or some particles thereof in almost all pathology... hence the collective meltdown in class. It takes a certain amount of denial of reality and blindness towards the self (have you seen me dance?) to get through life.

Magical thinking can be helpful, so long as you know what you're up to, 
and that's the hard part... the knowing. The capacity to know where you end and where the magic begins is what the process of making something conscious is all about (watch American Idol auditions to illustrate the point). Everything you see is informed by your desires and there is no clear objective view.... unless that view includes awareness of those desires. This is why so much of talk-therapy is an attempt to reveal and narrate one's desires.  It's also why its easy to make oneself a victim in therapy and then never leave the comfort of that stance (that's another thing I need to write about, working through victimhood as a part of the process).

Making something come into consciousness from within is a big part of the therapy... and that's why all the talking. Once you can verbalize, you can see and play with the object, you can move around  and through the desires and get a bigger view from multiple vantage points, and you can soften your bias by developing a sense of humor about yourself. Through the narrative and the talking..... there's a chance to engage and change the story. And again, this can take time.