Both ADD and bipolar have this fun characteristic called “lack of insight.” It means that people with one or the other of these conditions can’t always perceive the disconnect between their behavior and the context, or, as it usually manifests in our household, can’t always connect behavior A with consequence B.
We’ve said for years that it’s a miracle Catharine lived through her 20s, because things like swimming in a river in Pennsylvania in January in the middle of the night; or driving very, very fast down winding mountainous roads; or staying up for days at a time in an unventilated basement building Halloween sets with spray paint seemed like a good idea at the time. “It Seemed Like a Good Idea At the Time” — that’s got to the be title of someone’s ADHD or bipolar memoir.
Thanks to medication, routine, therapy, and just growing older, those aren’t the kinds of things we’re dealing with anymore. We’re mostly dealing with more subtle things, like if she skips lunch, she’ll get weepy and miserable around 3pm, or if she doesn’t nap in the afternoon, she’ll get anxious and fall apart after dinner. Compared to the very real risk of dying she flirted with in her 20s, these are minor incidents, but when they happen over and over, day after day, they are also wearing.
I understand that her brain does not see patterns. Her brain doesn’t connect action A to outcome B. But here’s the thing — my brain does. My brain is actually really good at noticing those patterns. In the abstract, she agrees that my brain is very good at this. But in the moment, that lack of insight bites us in the ass.
It goes something like this. She mentions that she has four appointments the following day. I point out that 1) she knows that if she has more than three, that’s too many and requires a lot of recovery; 2) she’s scheduled over her usual nap time, so when is she going to have it?; 3) she needs to make sure she remembers her afternoon meds at the right time if she’s moving her nap. Her response? Oh, it’ll be fine to have four, because so-and-so couldn’t meet later in the week, and she’ll nap between appointment 3 and appointment 4. Really? I say. Because that’s only an hour, and you usually need at least an hour and a half. Oh, it’ll be okay to have a shorter nap this time.
Scene cut to the next day, when she straight up forgets to take any nap during that hour, because it’s not at the right time and she was engrossed in work, and her afternoon meds disappear as well. So by dinner she’s mentally exhausted, under-rested, and under-medicated. Her anxiety, which ramps up when she’s under-resourced or over-done, flares up and attaches to something that does need to be solved, but certainly not tonight and not in this state of mind, so she’s spiraling and freaking out and we spend 45 minutes doing the “but thing!” “this is your anxiety, we’ll deal with thing tomorrow, let’s deal with your anxiety now” “but thing!” dance until she winds down enough to be able to go to sleep.
It’s a miserable night for both of us, and one that could have been avoided. And this, dear friends, is what chaps my ass. There will always, always be those days that whap us upside the head with bad news or triggers or illness or what have you. Okay, fine. But do we have create them ourselves?
Usually what happens these days, because I am over being patient and long-suffering, is that, once the crisis is over (if it’s risen to that level), I point out how miserable things are and exactly how we got here. It sounds like I’m saying “I told you so,” but it’s more “why the fuck didn’t you listen when I tried to spare us this?” And the answer, of course, is that because her brain doesn’t connect behavior A to consequence B, when I raise concerns, it doesn’t feel to her like a real risk, any more than swimming in that winter river felt like risking her life.
We are trying to get meta about it, trying to get to the point where I can say “you’re doing that thing again” and she can connect it, if not to the consequences I’m pointing to, at least to the many, many (many) conversations we’ve had on the subject and trust in the way my brain works. It’s a work in progress.