A diagnosis changes everything. Maybe you started to notice a change in mood/behavior. Maybe you began to think 'this person is losing it'. You comment about it and crack jokes about it, but after a diagnosis, it's not so funny any more. You might have assumed something at first, but it wasn't a for sure thing. Once diagnosed it's much more real. You don't joke about it anymore because it's not funny.
Then you look back at the relationship you have with this person. In the case of a bad relationship, regret hits. Maybe it wasn't their fault they were so moody or so angry or said so many weird things? Maybe their legitimate craziness was the cause. Then it's 'I wish I would have been nicer. They couldn't help what they were doing, but I could have been the bigger person. I could have walked away. I could have apologized. There's something I could have done.'
And finally, you worry. First it's 'what will people think?' Will people begin to judge you when you're associated with someone who's sick? Will they begin to use that as an excuse when you do things they don't understand? Then it's 'what about me?' It could happen to anyone, and it did. 'Am I next?' What does one do to protect himself from becoming crazy? Like it's a disease that's contagious or something...
And the whole time all you can think is I wish I never knew. You'd much rather sit around and continue to make fun of it because it's just a joking assumption. It's not real. But the moment it's solidified you realize ignorance is bliss.
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