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Anosognosia Symptom: Lack of Insight into Mental Illness June 22, 2010

Posted by Crazy Mermaid in Bipolar Disorder, Involuntary Committment, mental illness, Schizophrenia.
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It’s a crying shame that I had never even heard of the term ansognosia until I read Dr. E. Fuller Torrey’s latest book, The Insanity Offense (2008), since it’s such an integral part of understanding how the symptoms of mental illness interfere with a person’s ability to get help.

The term anosognosia is derived from the Greek words “nosos” which means disease and the word “gnosis” which means knowledge. The “an” prefix notates the negative.  A person who suffers from anosognosia is unaware of the existence of their mental illness.

This lack of insight into their illness, associated with damage to the right hemisphere of the cerebral cortex or the frontal lobe,  is a problem of major proportions because it’s the main reason why people with certain mental illnesses such as schizophrenia and bipolar disorder refuse to take their medications.   They aren’t trying to be a pain in the ass: they truly believe that they’re not ill.  And if they’re not ill, there’s no reason to take medication. Period. End of Story.

If a patient can be made to take their medication, a large percentage of them will improve their awareness of their mental illness and thus continue taking their medication on their own.  But under the current laws, forcing a patient to take necessary medication is illegal, in a large part because the law refuses to take into account anosognosia in making decisions regarding who should be forced to take medication and who should not.

It’s not easy to convey to the average person what it means to be unaware that you have an illness. How can someone who is sick not know it, especially when their symptoms are so obvious to others? Because it’s not like any other illness. It’s the brain, rather than other parts of the body, that is the problem.

In the case of the paranoid schizophrenic, there is another layer of difficulty to add to the equation. The paranoid schizophrenic lives in a world where the universe is out to get him.  So he views any attempt to get him help as simply another attempt at persecution.  He distrusts anyone who tries to get him help. It’s a magnification of anosognosia.

Unfortunately, treatment of a patient whose symptoms include anosognosia is impossible, since treatment for an illness requires admission that there is in fact an illness and cooperation by the patient in treatment of that illness. The law of the land is written around the concept that a person is capable of deciding whether or not he is ill, and therefore whether or not treatment for that illness is appropriate. The law, in other words, has never heard of the symptom called anosognosia, which makes it impossible for the patient to believe that he is mentally ill, and therefore makes it impossible for him to believe that he needs treatment. The result of this failure of the law to consider this singular symptom is that the patient goes about his business believing that he is not ill, living in his own world. How is this a problem?

Instead of being able to treat those people whose symptoms include anosognosia, families of people with mental illness live in fear of their  loved ones, aware they’re living with a ticking time bomb. They know it’s only a matter of time before their loved one hurts or kills someone, but they’re unable to prevent the atrocity from happening because the law ties their hands.

Prisons are full of people with anosognosia who commit crimes- sometimes horrendous crimes. Had they been forced to seek treatment for their mental illness, they might have lived full and productive lives. Instead, they fill our prisons, unmedicated, costing taxpayers tens of thousands of dollars a year. Or they murder police officers or random people before being apprehended and found to be not guilty by reason of insanity, then locked up in mental hospitals.

The streets of every major city in the United States are full of people with anosognosia who refuse to believe they have a mental illness. Instead of being forced to get treatment, they wander the streets, victims of crime, living off the streets, eating out of dumpsters, and living a horrible life simply because they cannot believe they are in need of medical help.

We have to change our laws, taking into consideration this terrible symptom.  We have to make it easier to involuntarily commit those with this symptom, thus improving the quality of life of those with anosognosia and making the world a much safer place for all of us.

(Note: Research for this article was done with the help of articles by the following: Dr. Kevin Thompson, PhD http://www.mentalmeds.org/articles/anosognosia.html ; Treatment Advocacy Center http://www.treatmentadvocacycenter.org/index.php?option=com_content&task=view&id=27&Itemid=56; Pages 112 and 113 of Dr. E. Fuller Torrey’s new book, The Insanity Offense (2008) among other sources)

Comments»

1. Lois - June 25, 2010

How do we change the laws????? I have a daughter with no insight. My sister in law had no insight. She was homeless for years and ended up being murdered.

Crazy Mermaid - June 27, 2010

Here in Washington State, we’ve just made some changes to our commitment laws, and that should help with the situation to some extent. I wrote a blog about it about a month ago. As far as a national law goes, a logical place to start changing the law would be through NAMI. (National Alliance on Mental Illness). I have no idea where they stand on this. Regardless, there’s power in numbers.

2. Cherrie Herrin-Michehl, MA, LMHC - June 28, 2010

Excellent research, as always. I had never heard of the term, although I realize it is a common problem.

Cherrie

3. Victoria - June 30, 2010

Great blog….I have bipolar 2 and am so glad to have learned about anosognosia….about a year ago. I watched a really informative utube video about it and it has helped me so much in my own recovery and my understanding of others….especially in my peer support work. I believe that we, (people with mental illness) can become more self aware through caring individuals developing relationships with us. I believe that the brain can heal and change given love, support and people encouraging us in recovery. I live in B.C. Canada…and have been blessed to be the recipient of excellent free mental health support. We mush always hang on to hope. I am so grateful that I have grown in my knowledge of my self and my disorder. It takes work and a commitment to wellness. It’s not always easy…but so much better than pre diagnosis and that “hell on earth” and lack of insight. God bless :)


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