Handling Anosognosia – Neurological Inability to Recognize Your Mental Illness
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
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.
Tracy, N. (2012, October 12). Handling Anosognosia – Neurological Inability to Recognize Your Mental Illness, HealthyPlace. Retrieved on 2019, September 15 from https://www.healthyplace.com/blogs/breakingbipolar/2012/10/handling-anosognosia-neurological-inability-recognize-mental-illness
Author: Natasha Tracy
Psychiatrist tried say same thing about me even after many many tries and fails actually diagnose any kind mental illness but just got have some kind no matter what
Is times person supposedly too sick know be sick actually right
My case this so called mental illness just got have no matter what and multiple diagnosing tries fail turns out really autism
That psychiatrist not know a thing about autism and insists stereotypes from 50 years ago is autism and since not drooling and bang head on wall and smear poop all over then autism not possible
That psychiatrist decided all problems got was from abuse as baby and just in denial and refused get off it and insisted if try over and over long enough try number 1 million and 5 be the one psychiatrist get his way
That psychiatrist still heavy pushing attachment so called therapy really abuse and thinks this going fix all problems and getting bullied just pass off as victim fault and did stuff deserve it for attention and victim always in reports as manipulative lying psychotic violent criminal and next Charles Manson if not keep the so called therapy going
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
I realize you posted those comments almost 2 yrs ago but thank you for sharing. My son was diagnosed with Bipolar 1 when he was 16, he is now 22. I've read Dr. Amador's book 3 times now on the LEAP method and anasognosia titled "I'm Not Sick and don't need help". The information we learned was invaluable in understanding our son and how to avoid trying to convince him he is ill. Not a real fan of the term "illness" in the first place to be honest. I honestly think he is gifted in many ways. I think the real answers here for all is an OPEN MIND. We have tried LEAP, we have tried traditional western medicine and they have not worked for our son. I know they work for some people but everyone is different. My son refuses to take medication and I do NOT want to continue to hospitalize him against his will. Does not make sense. My son is into yoga and meditation and we have supported him with practicing these and it has helped. I just called a Reiki master in our area and we are now going down that path. Based on your personal experience and my brief conversation with the Reiki master, we are hopeful. My son is very spiritual and has heard of Reiki so he is excited about going. So am I. Old dogs can sometimes learn new tricks too :).
Thanks again and be well
I appreciate your comments and your passions regarding "anosognosia" as it relates to a mental health diagnosis or mental distress (disharmony) however I respectively agree to disagree. I was diagnosed with manic depression/ bipolar disorder twenty years ago. We both have our own personal experience directly with psychiatry, madness, mental health disorders, characteristics, and spiritual experiences (views). Some of our experiences, and beliefs may even be mutual.
I have researched anosognosia; TAC study, DSM, etc., and I honor various aspects of science. I would like to just share my personal experience and imperfect opinion.
When I was 23 years old I was in a psychiactric hospital where I was told I was a drug addict, and that I had Schizophrenia. This did not resonate with me at all. In the midst of all the drugs that were immersed thoughout body, I felt a presence that I never felt before. This feeling, knowing, and or inner voice told me that there was much more going on. This emotional crisis, psychotic break or whatever language is used became a conscious awakening for me.
If I had listened to the propaganda from the pharmaceutical industry, the APA, my psychiatrists (2 supported me 100%), the mainstream media, my family and friends; I could be locked up in an institution for life or drugged up to the extent of possibly having a multitude of other physical ailments. Most importantly I could have been spiritually asleep!
So why would we tell people that they have a severe or persistent lack of insight to an illness or disorder? I see this as a way control people. Based on my experience what is more demoralizing is the spiritual/ religious insight of who we really are!
A persons self esteem, consciousness, and spirt can be devastated when they are handed a diagnosis that is stigmatized simply due to the fear of mental illness.
Our society is inundated with medical information; some of which is very relevant however most of it manufactures disease for profits. Our society has reached an epidemic status with the number of people taking pharmaceutical drugs. That being said some drugs are very beneficial.
Why are psychiactric medications the primary way we treat a person who is experiencing delusions, a undesirable characteristic (symptom), depression or altered states of consciousness?
My personal experience along with mutually supporting other people has shown me there are healthier as well as more theraputic paths that save society a lot of money.
I have had some very difficult challenges. I struggled with marijuana, filed bankruptcy twice, and I was on disability for five years. I have great credit today, own a home, and I no longer see a therapist or psychiatrist. I have learned who I am and I love myself. For me I am a beautiful spiritual being who is having a human experience.
I have studied what America calls "Alternative Medicine." Unfortunately most people don't realize that there is nothing alternative about it. Most of these ancient medicines have been around for thousands of years. I have studied Reiki for many years and it has transformed my life. I worked with a homeopathic practitioner (psychatrist) which was an enlightening experience. I studied Oriental Medicine for a year before I decided that it wasn't my dream anymore. People gravitate towards me, and are always sharing there experiences.
I don't look at life in terms of "right or wrong." I know that I can learn from any person, plant, animal, situation, etc., and I always remain open minded even when I have a rooted beliefs. Please think about how your thoughts and words affect other people when writing these human experiences.
I hope when you are reading this you are creating a beautiful day!
I beg to differ. The way you say it sounds like the person with bipolar is intentionally hurting others. If you really try to understand what the reality is for the bipolar person, you will be much more patient and understanding with them. A lot of the pain is caused by a misunderstanding, and yes, people are driven away during this time. Those who have understanding are not driven away nearly so much, except in very extreme circumstances. And these circumstances are generally not the fault of the person with bipolar.
When I am very depressed I have the opposite delusion: that I am a freak, so obviously abnormal that I can't go out in public or speak to anyone, and that I am to blame for this freakish "sickness" as well as every other bad thing that ever happened to me or my family. And a few therapists have tried arguing me out of these beliefs, which as you predict only served to strengthen them and root them more deeply.
Quite honestly, when I'm on the wards I sometimes have trouble telling the patients from the staff and since I'm not allowed access to the full records, I can't really say whether the "delusional" patients were just playing a little joke on me to get me to laugh since I still get a little freaked out by being on the wards.
Given that my interest in this stems originally from medical anthropology, I guess I think of it in terms of power structure and who has the power to put a label on someone else. Labels can be very good when used appropriately for people to get the help they need, but sometimes they can be painful and in the end we all should have the power to define ourselves the way we want, since it's still a free country and all that. My main research interest is autism spectrum disorders and I find that often women on the spectrum are misdiagnosed with other disorders because girls aren't supposed to be autistic...
Certainly it is your right to think so, but what about it's presence in other disorders? What about the brain abnormality that correlates to it?
How much experience do you have working with people with delusions vs. simply denial? I've seen both, and they are very different.
Like a so-called "normal" person is not going to think they have a mental illness. I guess maybe it makes more sense with Alzheimers, but with mental illness, it's a difference in sensory processing that really does change the way people perceive things so they shouldn't be "punished" for being honest about what they are experiencing with an additional label...