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Anosognosia compromises self-awareness in many people with schizophrenia and bipolar I disorder.

My fluency won me a discharge home in 2016, and sent me to jail untreated in 2024.

When clinicians confuse eloquence for insight, those who might correct them are rarely asked.

A decade ago, at the age of 32, I wanted nothing more for Christmas than to move back into my mother’s house. The times were neither merry nor bright: in the course of nine weeks, I had attempted suicide four times with fistfuls of the psychotropic medications prescribed to me to alleviate my unrelenting anxiety and depression.

A few weeks prior, my mother had pleaded with my attending psychiatrist, Dr. R., not to release me after my most recent attempt had landed me in a medically induced coma in the ICU. She was not wrong to plead. But more than anything, I feared the specter of a third inpatient stay on a psychiatric ward in four months.

And so I built a case for myself, marshalling evidence that made living at home sound like a viable treatment plan rather than the escape hatch that it was. I argued that the IV penicillin had done its work to treat the neurosyphilis that had inflamed my brain—an infection discovered while I was intubated in that ICU. I expressed my terror over the prospect of being forced to participate in the soulless group therapy of a locked ward, or to eat its cardboard food on dining-hall trays next to complete strangers. I assured everyone that I would secure a competent therapist and psychiatrist, as if the process were timely and guaranteed to produce results.

Let me recover at home, I insisted, under the guidance, and with the comfort, of my mother’s love. Against her better judgment, the argument worked, and my mother relented. Dr. R.’s closing admonition to my mother would forever haunt her: “He will be your responsibility.”

A year later, in the midst of an........

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