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Handling Anosognosia – Neurological Inability to Recognize Your Mental Illness

Anosognosia is the clinical unawareness of one's own mental illness. Learn more about handling this type of delusion. Breaking Bipolar blog.

There is a type of denial of mental illness that goes beyond mere psychological denial – this is called anosognosia and it is the clinical term for the lack of insight required to understand you have a mental illness. Anosognosia is a neurological disorder thought to be caused by abnormalities in the frontal lobes (Impaired Awareness of Illness (Anosognosia): A Major Problem for Individuals with Bipolar Disorder).

Anosognosia – What, Who and Why

Is it denial or anosognosia? Put another way, anosognosia is the lack of awareness of the deficits, signs and symptoms of an illness. It is not merely a denial; it is an actual neurological deficit. Anosognosia is seen commonly in psychotic disorders like schizophrenia and bipolar, but it’s also seen in those who have right brain hemisphere lesions due to stroke, dementia and traumatic brain injury. Some studies show that people with schizophrenia also have brain hemispheric asymmetry in the anteroinferior temporal lobe and this asymmetry correlates to a lack of illness awareness.

The important thing to remember is the anosognosia is neurological and beyond a patient’s control. According Puihan Chao, MA and Michelle Kawasaki, MA of the Adult Mental Health Division at the Department of Health in the State of Hawaii, anosognosia is characterised by:

  • A severe and persistent lack of insight
  • The erroneous beliefs (such as “I am not sick”) are fixed and do not change even after the person is confronted with overwhelming contrary evidence
  • Illogical explanations and confabulations that attempt to explain away the evidence

(See also: My Daughter Does Not Want to Recover From Her Eating Disorder.)

What to Do about Anosognosia

Understandably, anosognosia is one of the more troubling symptoms of severe mental illness as it prevents a person from getting the help they need. The “easy” way to handle this is to rely on a “doctor knows best” approach and simply medicate without consent. And, indeed, sometimes that is the only approach that works and is the most appropriate.

Chao and Kawasaki though, recommend another approach that relies on:

  • Listening to the patient
  • Empathizing with the patient
  • Agreeing with the patient
  • Partnering with the patient

This approach, signified as LEAP, is laid out nicely in their PowerPoint presentation.

You Can’t Talk Someone Out of a Delusion

I think the critical thing they stress though, is that you can’t talk someone out of a delusion. That’s the definition of delusion. It is a belief in the face of contrary evidence. And anosognosia is a delusion. If you believe that your cat is sending you signals from god, I will not simply talk you out of that belief because the belief isn’t rational in the first place. If rationale were all it took, then no one would ever be delusional.

And the other thing they seem to stress is listening to the person with anosognosia. Use the patient’s own framework to reach them. If the person doesn’t feel that they are sick, find out what problems they do believe they have and address those. For example, if a person feels their problem is that they are too paranoid to sleep, focus on addressing that issue with treatment rather than trying to convince them of an illness.

The crux of this treatment then, is to get the person to see the need for treatment in their own way rather than forcing medication on them. This is a type of Motivational Enhancement Therapy (common in addition therapy) and motivational interventions were found to be more useful than simple psychoeducation approaches by Zygmunt et al in 2002 in terms of medication adherence in schizophrenia.

Long story short, this might be the more humane way of approaching those with anosognosia for doctors and those around the person with the mental illness.

You can find Natasha Tracy on Facebook or GooglePlus or @Natasha_Tracy on Twitter.

Author: Natasha Tracy

Natasha Tracy is a renowned speaker, award-winning advocate and author of Lost Marbles: Insights into My Life with Depression & Bipolar.

Find Natasha Tracy on her blog, Bipolar Burble, Twitter, Google+ and Facebook.

24 thoughts on “Handling Anosognosia – Neurological Inability to Recognize Your Mental Illness”

  1. There needs to be more to this here. This should not and never be used as a weapon so that abusive husbands or enemies could torture someone. Domestic Violence has turned into mental abuse so the real criminal can’t be caught. We need Science behind this with evidence so that innocent women can’t be victimized, terrorized and without question. Men are gas-lighting their wives and this link and information is being used to justify and protect them from their criminal behavior! We need MORE research done into this. Do not just say it’s denial because it darn well could be an abusive partner. I know a few people now who have fallen for this and it’s growing. If anyone is using this information to continue to torture people they want revenge with it needs to be stopped and it needs to be stopped with Science. The next time someone says “He’s abusive” maybe you should listen.

    1. My son is 18 and has never hurt anyone until now. He is having all the signs of schizophrenia but has no knowledge or insight of his behavior. Here comes the real hell…..he doesn’t see what’s happening at all, he is a different person. Anosognosia is a symptom like that of someone who has suffered a stroke. They are not aware that the paralized half of their body even exists. I know gas lighting…and I’m afraid this is a real nightmare that happens to good people.

  2. Interesting diagnosis, anosognosia. I’ve never heard of that one before. I learn so much from these blogs

    I belive you can catch more flies with honey. The LEAP approach my pdoc uses on on me is much more effective in ensuring compliance. I don’t like to be forced to do ANYTHING the way I was in hospital. It was a terrify experience the way I was treated. I have always been a very independent person with a very strong will. I think there are many reasons why people don’t believe they are ill. Psychotic delusions of reference brought on by extreme stress is one. Believing that they are not as ill as those horrific stories sensationalized in the media you hear about is another. Of course the stigma associated with mental illness is always a big one. Abusive family members that want to discredit you so that others won’t believe you were abused by them, as was my case. Your credibility can easily be ruined by people more powerful than you. Lawyers do it all the time. The only reason I took meds voluntarily was because I was harrassed so badly that I just broke. It also broke my spirit. It further supported my belief that some people just can’t be trusted. I can’t bear to go through that experience again. It made me feel like such a victim. For now I feel fine on low doses of meds. I refuse to go on high does of mind numbing chemicals that suck the life out of me!!! So far my pdoc is fine with that

  3. We are at the point with a 54 yr old woman that no amount of listening, agreeing, walking alongside has gone anywhere over 4 yrs. This person now has lost her house (had to sell), lost her car (doesn’t know where she put it), lost a rental car (says it was stolen), is living/sleeping in another rental car jacking up her credit card. We feel the need to go beyond this LEAP method now.

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