What is Anosognosia?

Anosognosia is a condition in which an individual is unaware of their mental health condition or can’t perceive their condition accurately. Often, we deem these people to be “in denial” of the deficits, signs, and symptoms of their illness. However, this is an incorrect assumption when dealing with many people with acute mental illnesses. According to the National Alliance on Mental Illness, they may instead be experiencing “lack of insight” or “lack of awareness.” In Greek, anosognosia means “to not know a disease.”

While anosognosia may seem confusing to those of us who have never experienced it personally, it is a common symptom of many mental illnesses. Regardless of how clear the need for treatment may be to others, to the unaware individual it appears perfectly rational to refuse treatment. Often, individuals will experience varying levels of anosognosia, even within the same relative period of time. Self-awareness can go in and out, sometimes appearing as if those afflicted are acting out of selfishness or fear. However, this variance is very typical of anosognosia.

Anosognosia, or “lack of insight,” is also the single largest reason why people with severe mental health disorders, such as schizophrenia or bipolar disorder, do not seek medical treatment. Approximately 40% of people with bipolar disorder and 50% of people with schizophrenia express symptoms of anosognosia. The condition has long been recognized in patients who have suffered from a recent brain injury, stroke, Alzheimer’s disease, and/or other neurological diseases.

Studies of individuals suffering from these conditions and exhibiting anosognosia as a symptom have uncovered a link between anosognosia and anatomical damage in the right pre-frontal lobes of the brain, an area associated with self-reflection. It is not associated with any faults in the sensory system, but rather the translation of those senses into usable information. For example, a person may see a book on the table, but not be able to “see it.” In other words, the eye and the optic nerve have received the information, but the information is not being translated for the person to understand and use that information. You can see where this could apply to those not able to recognize symptoms of mental health disorders they themselves are exhibiting. They technically sense it, but they do not understand it.

These same studies have indicated an improvement in this “lack of insight” with medication. Because of this, various advocacy groups, such as the Treatment Advocacy Center, are working to improve access to treatment for people who are too ill to seek help. This traditional approach of “doctor knows best,” wherein legal criteria is met to necessitate involuntary treatment, is widely considered to be the most logical and effective approach to treating anosognosia.

Others, however, advocate a much different approach. Puihan Chao, MA and Michelle Kawasake, MA of the Adult Mental Health Division at the Department of Health in the State of Hawaii argue that the traditional approach of medicating an individual who does not understand they are sick, particularly when the medication is involuntary, is similar to someone telling you that you’ve never lived in your house and are from here on out not allowed to return. Your family has also signed off on this, and the authorities are involved. How likely would you be to comply with anyone’s orders in this case?

They argue that the best approach is to “stop arguing and start listening to the client’s point of view.” They emphasize the point of finding a common goal. To sum it up, they use the anagram LEAP, short for Listen, Empathize, Agree, Partner. Through reflective listening, wherein you ask questions and don’t jump to react; conveying empathy, which should come naturally if you first truly listen; agreeing to find the common ground, wherein you recognize that it is in both of your best interests to get better; and explicitly deciding to partner up, the doctor/caretaker/loved one and the patient can achieve the common goal of mental health improvement.

Needless to say, anosognosia can prove to be incredibly dangerous. Understandably, it is one of the more troubling symptoms of acute mental illness because it inhibits people from seeking help. That it is quite common is yet another troubling factor of the condition. Whether you believe in the “doctor knows best” approach or the more empathetic LEAP approach, it is important that the mental health community continue to make strides in its treatment.

References

“Anosognosia.” NAMI: National Alliance on Mental Illness, n.d. Web. 14 Mar. 2017.

Chao, Puihan, MA, and Michelle Kawasake, MA. “Anosognosia: Unawareness of Mental Illness.” Adult Mental Health Division at the Department of Health in the State of Hawaii, n.d. Web.

Doty, Leilani, PhD. “Anosognosia (Unawareness of Decline or Difficulties).” (n.d.): n. pag. University of Florida Cognitive & Memory Disorder Clinics. Web.

“Handling Anosognosia – Neurological Inability to Recognize Your Mental Illness | Breaking Bipolar.” HealthyPlace. N.p., n.d. Web. 14 Mar. 2017.

“Key Issues: Anosognosia.” Treatment Advocacy Center. N.p., n.d. Web. 14 Mar. 2017.

Torrey, E. Fuller, Dr. “Impaired Awareness and Anosognosia in Mentally Ill.” Mental Illness Policy. N.p., n.d. Web. 14 Mar. 2017.

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