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People who seem unaware that they’re suffering a disabling medical condition may have anosognosia, a severe form of denial that can be physiological or psychological in nature. Originally, this term usually referred to someone who, because of damage to the parietal lobe of their brain, couldn’t process that they were missing a limb or were debilitated by a serious disease.
Today, anosognosia and schizophrenia are often linked because of the tendency for people suffering from the latter not to understand their condition — even if they recognize the symptoms.
In this piece, we’ll discuss anosognosia, particularly as it relates to schizophrenia and substance abuse, including how it’s diagnosed, how it’s addressed in treatment, and what to do if you or a loved one are exhibiting symptoms.
What Is Anosognosia?
Anosognosia is a condition in which someone refuses to recognize a physical, mental or behavioral health condition.
Strokes and traumatic brain injuries are common causes of physical anosognosia, but the mental and emotional varieties of the condition — also known as “lack of insight” — are less understood.
Researchers think 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’re 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 trying to get rid of them. These effects in those with paranoid delusions or mania could lead to reckless or dangerous behavior.
Common Links Between Anosognosia and Schizophrenia
Lack of insight and schizophrenia are often mentioned in the same breath because, more than with other conditions, they’re likely to coincide. According to the National Alliance on Mental Illness (NAMI), an estimated 30% of people with schizophrenia experience anosognosia.
Because schizophrenia and bipolar disorder affect the part of the brain that controls self-awareness, people with these conditions are less able to distinguish between what’s real and what isn’t. This can lead to an inability to recognize the reality of their condition(s).
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 people become 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 mechanism.
Denial is a way to repress emotions so unpleasant and trenchant that possible serious psychological damage could affect those who can’t 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.
Anosognosia and Substance Use
Anosognosia typically refers to the denial of a mental or physical health condition, but people who struggle with addiction often exhibit similar tendencies. For example, people who habitually use (and abuse) drugs or alcohol recognize what they’re doing and understand what addiction looks like, but they still feel they don’t need help.
Most people have heard the “I can stop any time” stereotype, but this is often what people with substance use disorders think, even when they’re aware of their own problematic habits. This closely mirrors the classical definition of lack of insight.
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 don’t 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. (When someone’s beliefs are sufficiently divergent from reality, a diagnosis of delusion disorder may be appropriate.)
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 still refuse to admit they have a mental illness.
How is Anosognosia Addressed?
For people struggling with lack of insight and schizophrenia, the disease will be more difficult to address without understanding the effects of anosognosia. Treatment for anosognosia is important, and insight into your own health is a key part of being engaged and willing to participate in the best course of treatment.
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 won’t 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. If you or someone you know is struggling with mental health conditions or substance use and a lack of insight, addressing the issue is a critical step toward getting better. Seeking medical advice and treatment as soon as possible for a mental illness can restore stability, meaning and hope in your life. Contact FHE Health today for help by calling us at (833) 596-3502.
