My brothers came to every one of my court appearances. They watched me at my worst as I was charged and punished for my actions while in a manic psychosis. But when I transferred to a state psychiatric hospital, they all but disappeared.
More than once, my mother has asked them why. Why did they stand by her through the criminal phase but remain silent through the slower, uglier work of recovery? I don’t know is the answer she hears. Her friends long offered a variation of the same refrain. On an early morning call last year, one close friend confessed: I don’t know enough about it, and I don’t want to say the wrong thing.
Since defense mechanisms, by definition, work outside our capacity to be aware of them, I don’t know may be an honest admission: we can struggle to see what’s stopping us from engaging, from asking a question that makes another feel seen. Stanley Cohen calls this implicatory denial: we accept the facts of what happened but not what they ask of us.
My brothers know the diagnosis and lived the horrors of its history, especially when my manic cruelty turned on their families. Still, I wonder why they turn away from what the knowledge would ask of them, or how it might implicate them. To be fair, I can’t read my brothers’ minds, and fear is not the only reason people keep their distance; anger, grief, and the urgencies of their own hectic lives surely play a part. But fear is a reason we rarely name.
They are not alone. For 10 years, when anyone asked what was wrong with me, I gave the same answer. While my I don’t know started in a brain that couldn’t see its own illness, theirs unfolded in selves reluctant to look. I suspect what united both was the same fear of vulnerability.
The Silence Surrounding Mental Illness
Vulnerability wears many masks. When psychiatry speaks of vulnerability, it typically means diathesis: one’s genetic and temperamental risk to develop a mental disorder. But in everyday terms, being vulnerable means fearing that others will see you as needy, wrong, scared, or unknowledgeable. And psychiatry is far less comfortable exploring this terrain of emotional exposure.
This fear of vulnerability perpetuates what my mother and I have started to call the fog and the silence of mental illness. The fog is anosognosia, a broken neurological instrument of self-knowledge rather than denial. It is an internal blindness that kept me from getting help for a decade. The silence, an external blindness, operates on two levels: the interpersonal silence of social stigma and the systemic silence of a fragmented mental health care system that never educated my family about my diagnosis or gave them a role in my care.
The mechanism that keeps mental illness hidden through the fog and the silence is not vulnerability but the defensive armor we put on to avoid it. Armor holds both blindnesses in place: it thickens the fog from within and amplifies the silence from without.
Carl Jung had a name for what you could call the fog’s accomplice: the persona, which is the face we present to the world. Mine was the intellectual hero, which was built on the conviction that I would rather be thought ambitious than exposed as afraid. When an AB in calculus contradicted the image of invulnerability fused to my intellectual identity, I vowed never again to place myself where anything could betray it.
What the persona can’t admit is relegated to what Jung called the shadow, which is where my bipolar illness found refuge, since being sick or weak had no place in the hero’s story. “When one’s conception of who one is gets stranded in time,” a leading psychologist of anosognosia, Xavier Amador, notes, “one can’t help ignoring or explaining away any evidence that contradicts it.” The illness removed my instrument of insight, and the persona ensured I would reject everyone else’s.
For its part, the interpersonal silence of stigma has its own engine: the fear of not knowing, which is how implicatory denial plays out in everyday life. It is what my mother’s friend meant when she said she didn’t want to say the wrong thing. Learning about bipolar disorder means first admitting you don’t know, and perhaps you don’t want to know, so silence feels safer than revealing it. Mental illness functions as our society’s collective shadow: the discomforting possibility we keep at a distance because it could happen to any of us.
Fear Essential Reads
My brothers’ armor did not form without cause. The threats I made were real, and they created real injuries: armor naturally forms around real wounds, which is why it can be so difficult to take off. Accepting that I have changed since then would require them to become vulnerable in the face of that harm, and open to the realization that their account of events is incomplete.
Moving Beyond Fragmented Care
The mental health care system has its own armor of specialization and siloing. While I was treated by psychiatrists, psychologists, neurologists, and social workers, no one practiced the kind of slow medicine that could see my case whole. Narrow clinical expertise is a structural way of never having to admit I don’t know. As Arthur Kleinman explains, patients need to know “that you, the caregiver, are also willing to reveal your own vulnerability.”
Recovery, for me, has been a story of embracing my vulnerability: owning both the illness and the harm, across a decade of my life, rather than exiling them. Jung described the task each of us faces as learning to “reconcile himself with his own nature—how he is to love the enemy in his own heart and call the wolf his brother.”
We can encourage the same reconciliation in those who love us. It begins with curiosity. My mother once did not know the word anosognosia, or much about bipolar disorder, or how to connect with a son who couldn’t hear her. She began by reading, asking questions, and speaking into the silence of ignorance. Where I don’t know closes the door, curiosity pries it open.
Curiosity requires exposure to the very vulnerability the silence conceals. For a brother, a friend, or a clinician, it may require them to confess ignorance, feel uncomfortable, risk being wrong, or modify an interpretation of the past where they found sanctuary. Curiosity can break the silence with the same three words this article opened on, followed by two more: I don’t know. Tell me.
References
Amador, X. (2020). I Am Not Sick, I Don’t Need Help! How to Help Someone with Mental Illness Accept Treatment (20th anniversary ed.). New York: Vida Press.
Cohen, S. (2001). States of Denial: Knowing About Atrocities and Suffering. Cambridge: Polity Press.
Jung, C. G. (1933). Modern Man in Search of a Soul (W. S. Dell & C. F. Baynes, Trans.). New York: Harcourt, Brace.
Kleinman, A. (2019). The Soul of Care: The Moral Education of a Husband and a Doctor. New York: Viking.