Anosognosia. The word itself is a mouthful. A-no-sog-no-sia.  This is a medical term which has had another meaning entirely, but it has been adopted by the mental health world to describe the state of a person with mental illness who has no insight into their illness.   This is a very important distinction to be made because a mentally ill person could be accused of being in denial about their illness.

When a person is in denial, they may consciously know they have a problem but they are not willing to admit it to anyone else.  The reasons for that are many. As well, a person may be in denial and truly not be fully conscious of their mental state.  This may be a subconscious coping mechanism which serves them in positive ways and allows them to continue functioning.

Anosognosia is something else entirely, where the person is not consciously aware of their illness, even when their life is not working well and even when they are objectively suffering. Lack of insight for people with schizophrenia may be on par with someone who has Alzheimers Disease or dementia.

This lack of insight is profound.  It contributes to people being unwilling to get help. It contributes to people refusing medication. Anosognosia contributes to people becoming paranoid when everyone around them is disputing their reality. This is circular because the more paranoid a person becomes and the more their mood remains unstable, there will be even less compliance to following sound, suggestions for attaining stability.

Emerging mental illness can take family members by surprise. They feel blind-sided and this is a bad combination when the mentally ill person has no insight and the caretakers are the ones initially in denial. I’m sure there are many parents who regret ever having said to their child, “Snap out of it.”

Anosognosia doesn’t just mask over awareness of an illness. It also clouds a person’s ability to even recognize when their actions defy rational thinking. This is what allows a person to abandon good personal hygiene. This allows a person to make many bad decisions and also respond inappropriately to those bad decisions.  If a person gets evicted from their home, the mentally ill person may not understand why they are being evicted or even the severity of the consequences. Some might equate this with lack of intelligence, but it is more covert than that.

In exasperation with how the broken mental healthcare system fails the mentally ill, I have referred to the system itself as having Anosognosia.  One of the worst, “guilty as charged” examples of this is when a mental health care provider allows a patient to taper off their treatment plan because they are doing better.  For those who are chronically low-functioning and gravely ill, going off their treatment plan (like seeing their psychiatrist, therapist or case manager less often) is a recipe for relapse.  It surely makes the healthcare provider appear as though they have “lack of insight.”

One of the keys to helping a person with serious mental illness achieve a semblance of stability, is by not letting their Anosognosia stand in the way of long term care. Misinterpreting this aspect of the disease, as if it is a human right to lack awareness, will in turn result in the patient making very poor, unhealthy and even dangerous choices, and prevent the family or treatment team from intervening.

 

Kartar Diamond is a Mental Illness Advocate and Author of Noah’s Schizophrenia: A Mother’s Search for Truth