One symptom of having a mental illness is … not knowing that you have a mental illness. Really.
This symptom is anosognosia … pronounced uh-no-sog-NOH-zee-uh. It means being unaware of one’s disease, disability or defect. This is common, as many who have tried to help a loved one can tell you.
Some people who have brain-based or “mental” illness have insight. They know they have a mental disturbance that could be an illness. They recognize they have experiences, including beliefs and perceptions, that don’t match reality. Because they can see this, they are much more likely to accept treatment.
People with anosognosia often don’t accept treatment simply because they don’t think they are sick.
Anosognosia affects 50 percent of people with schizophrenia and 40 percent of people with bipolar disorder. It also can be a symptom of major depression with psychotic features.
What Causes This?
The symptom can vary over time. Sometimes people understand they are ill, and sometimes they don’t. They are not being stubborn or difficult. The same brain dysfunction that causes hallucinations and voices also causes anosognosia.
People constantly update their own mental images of themselves. You remember that you have a sunburn or a bruise or a runny nose, so you are not surprised when you see it again. The updating process takes place in the frontal lobe.
Unfortunately schizophrenia, bipolar disorder and dementia damage the frontal lobe. So our loved ones can lose the ability to update their self-images.
Without an update, they have an old self-image from before the illness. Since our perceptions feel accurate, they believe they are well. They decide that our families are lying or making a mistake. When families insist that they are right, the person with the illness may get frustrated or angry. They may begin to avoid family and friends.
Why Is Insight Important?
Lack of insight not only causes conflict. It usually causes a person to avoid treatment. It is also the most common reason that people with mental illness stop taking their medications. When combined with psychosis or mania, lack of insight can cause dangerous behavior.
How Can You Tell If It’s Anosognosia or Denial?
It’s likely to be anosognosia if:
- The lack of insight is severe and persistent (lasting for months or years).
- The beliefs (I am not sick, etc.) are fixed. They don’t change when you confront the person with overwhelming evidence.
- You hear illogical explanations or elaborate statements that attempt to explain away the evidence of the illness.
How Can You Help Your Loved One?
Anosognosia is a delusion. We can’t talk people out of delusions. (That’s what a delusion is: a belief in the face of contrary evidence.) So stop arguing about it.
The alternative that experts stress is listening to the person. The LEAP method, developed by Dr. Xavier Amador, has proven quite effective in research in helping people to accept that need for treatment.
In summary, the LEAP method is:
- Listen to your loved one. If they don’t think they are sick, find out what problems they think they do have. Lack of sleep, for example.
- Empathize. Let them know you understand how difficult things are.
- Agree with the loved one on some point. Example: Lack of sleep makes things hard.
- Partner with the loved one, starting with solving the problem that they recognize.
The method is detailed in Dr. Amador’s book, “I’m Not Sick. I Don’t Need Help.” Details on also available in the videos here. They are worth watching.