The guy got served with a guardianship petition and he objected to it, arguing that he was married and his wife could take care of him. His wife had gotten a restraining order against him.

Another guy said Adult Protective Services lied about the condition of his house and about his ability to care for his wife in it. He later explained how the cats had multiplied out of control and used the house as a litter box and if his wife had needed help she would have shouted downstairs to him from the bed to which she was confined.
The young lady said she was fine and didn’t need a guardian or medication or hospitalization and didn’t think that darting out into traffic was an inappropriate response to the voices in her head that told her she was being chased.

The older woman who wired thousands of dollars to a man to rescue him from being trapped out of country for visa reasons, and who expected him to arrive any day to visit her, was furious with her daughter for suspecting a scam and alerting the police and the court.

All of these lives play out so differently in the world of Elder Law, in run down houses or apartments, in the streets or in hospitals, in clean and cozy homes. One common ingredient to all of these cases is a lack of insight.

Anogsonosia is a word I never knew and I still can’t spell even though it recurs in my guardianship cases. It is a condition in which a person lacks the capacity to know that he is ill, typically with a mental illness. A client with schizophrenia will tell me that she cannot eat because her food is poisoned and she cannot wear clothes because they are all wired for sound and I will never be able to convince her that none of that is happening and I don’t try because she can’t know.

One key component of a case for guardianship is proof that a condition such as dementia or mental illness blocks insight to risk. I will lose that case if the judge finds that the person to be protected understands a risk and is choosing to accept it, even if most other people would not accept it.

The woman who destroys herself financially by cashing out her retirement accounts and sending it to her telephone boyfriend is more of a mystery. She has no diagnosis of mental illness, typically. She is not delusional or incoherent or disoriented. She has a single, glaring blind spot, and she ignores the attempts of loved ones and law enforcement to alert her to it. Is she making a choice, or is she unable to see the risk? Is loneliness an incapacitating condition?

I recognize my own limited insight when I fast-forward my life and project that I am just the kind of guy who would lay on the bathroom floor, unable to get up, rather than call for help; who would not sign up for Meals on Wheels even though my refrigerator is empty and I can’t get to the store. Is pride an incapacitating condition?

My most graceful clients let their insight guide and protect them. They get a reading machine when  macular degeneration progresses. They give up their keys and their car after a couple of close calls, and gentle suggestions from their kids. A few of them accept the walker, or even agree that the house is too big, and going up and down stairs is getting dangerous. Some who are mentally ill take their medications, sometimes for a long time.

These compromises cause pain and loss and sometimes shame. Insight is apparent in the willingness to make the compromise, and to realize that as hard as the compromise is, the alternative is even harder. Some people suffer from conditions that deprive them of such insight. I suspect that the clients who have capacity to see their own limitations love life so much, even as it becomes more compromised, that they will do what it takes to keep it going.