A man about thirty years old with a broad smile is standing on the front step.
“Hello, Mrs. Lipska!” he says brightly.
How weird—he acts like he knows me! I’ve never seen this man before. What does he want? Something is very wrong—I can sense it. Something dangerous.
Without waiting for my invitation, he steps forward as if to enter our house.
I block the door.
“I’m John,” he says. “From pest control.” He holds out his hand. I don’t shake it.
“Who?” I demand.
“John. We provide pest-control services for you, remember?”
He’s definitely up to something.
“We’ve been providing termite inspection service to you for over twenty years,” he says, speaking more slowly now.
That change in his voice—he knows I’m onto him.
“This is our scheduled visit,” he continues. “May I do the inspection?”
“The inspection? Oh, really?” I make sure my sarcasm is clear. “Why are you here today, exactly?”
He gives me a puzzled look.
“What,” I ask again, “do you think you’re going to do?”
He starts to talk about termites. That reminds me of something urgent.
“Ants!” I shout. “They’re everywhere!” I dash into the kitchen. “Come! Look here and here!”
I point at the windowsill, where a few tiny ants are marching along the wall to the back door that opens onto the outside deck. “Ants! See? And you absolutely have to see the stain on the wall in the basement. It might be mold.” My words pour out in a torrent. “Go look, quickly!”
He rushes downstairs to the basement. I’m relieved to be rid of him but a few minutes later he returns, talking about something or other. The only word I hear is chemicals.
He’s going to spray some chemicals.
“Chemicals!” I jump as if someone’s poked me. “What do you mean, chemicals?”
He looks scared.
I knew it! I’ve caught him.
“Our chemicals are very effective against ants and fungus,” he says, but his speech is halting and uncertain.
Aha! His little game is up.
“We have another spray, for the termites.” He pauses and then adds, “Don’t worry. They’re all very safe.”
“Safe? Chemicals?” I shout. “Chemicals are poison! Don’t you know that? How can you say that they are safe?”
“Well, customer safety is key to our—”
“Then tell me, what’s in these chemicals?” I demand. “What compounds do you use?”
He stares at me blankly.
I have him cornered! “You have no idea, do you? Safe? Ha! I’m a chemist! You can’t fool me. I have young grandsons! Are you trying to poison them? To poison us all? Is that your plan? All chemicals are toxic. I forbid you to use any chemicals in this house.”
Somebody approaches behind me, and I realize that Mirek has come down the stairs.
“Hello, how are you?” Mirek says to the young man.
Why is Mirek greeting him so cordially? This stranger is trying to poison us!
Mirek turns to me. “Don’t worry, he won’t do anything today,” he says soothingly. “He’ll just do the inspection. Here, I’ll sign the papers.” Mirek turns to some documents the young man has placed on the kitchen island.
“No way!” I shout, inserting myself between him and the island. I lean in toward the young man and yell, “You are fired!”
His face is frozen in disbelief. Before Mirek can say anything, I continue. “Not only are you not working for us anymore, but I’m going to call your manager and tell him that you are totally incompetent. How can you not know the chemical composition of your own spray!”
Unbelievable! What an idiot!
I turn and storm away, leaving Mirek and the stranger alone in the kitchen.
These kinds of changes in normal behavior often signal that something serious is occurring inside a person’s brain. My emotional overreactions—anger, suspicion, impatience—suggest that my frontal lobe is undergoing catastrophic changes. But these warning signs are lost on me. As an expert on mental illness, I, more than most people, should be able to see that I’m acting strangely. But I can’t. Although I don’t know it yet, my six tumors and the swelling around them are shutting down the frontal cortex, the part of the brain that allows for self-reflection. Paradoxically, I need my frontal cortex in order to understand that mine has gone missing.
This inability to recognize my own impairment is often observed in people with mental disorders. Known as anosognosia, or lack of insight, it’s a feature of many neurological and psychiatric conditions. Little is known about which brain regions are responsible for lack of insight, but some investigators suggest that it may be related to dysfunctions in the midline of the brain, which separates the right and left hemispheres. Damage to the right hemisphere may also be involved.
In schizophrenia and bipolar disorder, a lack of insight into one’s condition is thought to be a manifestation of the illness itself rather than denial or a coping mechanism, as it may initially seem to be. About 50 percent of people with schizophrenia and 40 percent with bipolar disorder cannot understand that they are sick, so they have no real awareness of their condition and won’t accept their diagnoses. If they experience hallucinations or delusions, they don’t see them as a sign that something is wrong with their brains; even the most dramatic symptoms, such as hearing voices or believing that they are God, are indistinguishable from reality. Because people with schizophrenia and bipolar disorder who suffer from a lack of insight don’t believe they are ill, they’re often very resistant to psychiatric treatment. They may not take prescribed medications or participate in behavioral therapies. And there’s no cure, at present, for this kind of lack of insight.
Just like someone with schizophrenia, I don’t think that there’s something seriously wrong with me. I think I’m absolutely fine mentally. If anything, I believe I’m just stressed or tired—worn out by the poor design of a medical facility, by the inexcusable wailing of a child in a hospital waiting room, by the appearance of a
