People who seem unaware they are suffering a disabling medical condition may have anosognosia, a severe form of denial that can be physiological or psychological in nature. Originally, anosognosia referred to someone who, because of damage to the parietal lobe of their brain, couldn’t process the fact they were missing a limb or were debilitated by a serious disease.
Strokes and traumatic brain injuries are common causes of physical anosognosia. Researchers think that damage to high-level processing of sensory information interferes with a person’s ability to sense bodily or spatial representations. In some cases, individuals with anosognosia may have multiple impairments but only acknowledge one impairment while remaining unaware of the others.
Denying Mental Illness
If someone denies they are mentally ill even after they’re shown clinical evidence of it, they are typically said to be “in denial.” However, acute mental illnesses like schizophrenia and bipolar disorder often prevent that person from perceiving reality objectively. In other words, a severely mentally ill individual may not be consciously choosing to deny their problem.
For people with anosognosia, the inability to have insight into their own psychological issues feels convincing and real to them. Unfortunately, this creates conflict with family members and friends who know their loved one needs help.
Anosognosia also prevents mentally ill people from seeking treatment, since they truly believe nothing is wrong with them. They may even accuse others of being overly critical of their behavior or of trying to get rid of them. These effects in those with paranoid delusions or mania could lead to reckless or dangerous actions.
How Is Anosognosia Diagnosed?
People who consistently deny they have a mental illness but have been clinically diagnosed with one are given self-reporting questionnaires to assess deficits of their metacognitive knowledge. Responses are evaluated in conjunction with evidence of behaviors correlating with anosognosia, such as refusing to take medication for their mental illness or blaming others for their inability to hold a job.
In severe cases, coercive treatment and hospitalization may be necessary if the person becomes a danger to themselves or others. Research has found that mentally ill people with anosognosia who are compelled one way or another to participate in drug therapy and psychotherapy improve to the point that they admit they have a mental illness and continue treatment without being coerced.
Are You Suffering from Anosognosia?
Denial is a natural human defense mechanism that kicks in when our mental or physical equilibrium is so powerfully disturbed that it makes us extremely anxious and terrified to admit something actually exists. A form of emotional repression, denial is not a healthy way for someone to cope with disruptive and disturbing situations. But the human drive to maintain psychological and physiological homeostasis is so strong that when faced with seemingly insurmountable difficulties, your subconscious steps forward and asserts denial as a coping
Denial is a way to repress emotions so unpleasant and trenchant that possible serious psychological damage could affect the person who cannot cope with unpleasant facts about themselves or others. Mentally ill individuals with anosognosia refuse to think about how their bipolar or schizo-affective disorder is impacting family, friends and themselves. Failing to acknowledge the consequences of not getting treatment for their mental illness is one way for people with anosognosia to avoid feeling a strong sense of guilt and responsibility.
Denial or Delusion?
A thin line exists between denial and delusional thinking. The difference between the two involves the dismissal of truth and a belief in something that’s blatantly false. Denial is a product of the subconscious designed to protect our psychological equilibrium and reduce the stress of an unacceptable reality. It often gives us time to absorb and assimilate an uncomfortable fact that, when we allow ourselves to think about it for just a second, floods our system with such powerful emotions that our coping abilities are overwhelmed and, essentially, deactivated.
On the other hand, delusional beliefs do not deny something. Instead, delusions affirm the validity of an unsubstantiated belief. A sign of a deeper mental illness, delusional thinking typically revolves around beliefs that the individual is being watched, attacked or controlled by certain entities such as extraterrestrials or government spies. Although someone holding a delusional belief cannot provide a rational answer for their belief, it’s difficult to get them to change their mind, even when they’re confronted with hard, factual evidence.
If you answer “yes” to two or more of these questions, you may have anosognosia:
- Has a family member or friend ever told you to seek psychological treatment?
- Do you think everybody is out to get you or doesn’t want to see you happy?
- Do people express skepticism when you tell what you believe about provocative subjects?
- Do you have trouble keeping a job?
- Do you have difficulty maintaining close relationships?
- Do you think psychiatry is a type of pseudoscience?
- Are you addicted to prescription or nonprescription opioids or stimulants?
- Have you ever been placed temporarily in a hospital for emergency psychiatric care?
Even after experiencing homelessness, incarceration or physical harm, many people with anosognosia continue refusing to admit they have a mental illness. Entering an intensive mental health program consisting of medication therapy, cognitive behavioral therapy, and coping skills training needed to deal with overwhelming emotions is the only way a person with anosognosia can significantly improve their quality of life.
A serious mental illness will not resolve on its own. Self-treating depression, anxiety, hallucinations or delusions with alcohol or illicit drugs only worsens the mental illness and makes it harder to treat professionally.
Mental illness is a very real disorder of the brain. Getting into treatment as soon as possible for a mental illness can restore stability, meaning and hope in your life.