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Untreated mania often targets the people closest to us, exploiting fractures already present in families.

When clinicians disregard a family's knowledge, the family learns to stop offering it.

Recognizing one's illness requires a mirror, and mania and the system drive away those who could hold one.

In the fall of 2016, my mother found me drunk and crying in the upstairs bedroom of her home. “I want to die,” I confessed. I had turned the bedroom into my hideout when my life descended into the depths of a catastrophic depression. It was then that the mere thought of composing sentences for a job interview sent me scavenging for alcohol and pills. My mother drove me to the emergency department.

Psychiatry could not evaluate me until I was sober, so my mother went home to wait and fell asleep on the couch, where a phone call awoke her at 12:30 the next morning. The doctor explained that I would be discharged, since I had told him I no longer wanted to die and had no desire to harm others. My mother, as she records in her journal, was incredulous: “What makes you so confident he is telling you the truth?” The doctor’s stoic response was that I did “not meet the criteria for admission.” “Then his blood is on you if he commits suicide,” she screamed. Six weeks later, I found myself intubated in the ICU after an even more serious suicide attempt.

Last week I wrote about the eloquent refusal that anosognosia, the neurological impairment of self-awareness, can produce, preventing many from accepting their diagnosis and seeking proper treatment. Far too many, like me, are alone when the correct diagnosis arrives. This week, I want to explore the question: Where did they go? The answer indicts both the illness and the shape of the system built to care........

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