Anosognosia: The Most Devastating Symptom of Mental Illness
| Copyright (c) 2008 by Kevin Thompson. |
|
Mental illness comes in many forms. Depression, bipolar disorder,
schizophrenia, and the anxiety disorders all have the potential to be
crippling, and ruin lives. Yet as terrible as depression, mania,
psychosis, and the other symptoms of these disorders can be, there is
one that stands out as the most damaging of all:
Anosognosia
This obscure word, which is pronounced "uh-no-sog-no-zha," means
"denial of illness," and is more serious than you might think.
Most people understand the psychological concept of denial, which is a
refusal to believe an uncomfortable truth. Who hasn't heard heard a
heavy drinker, eater, smoker, or drug user say, "I can quite any time I
want," or someone with a chronic cough (which may indicate a serious
illness) say, "It's not important--It's just a cough." Pressing the
denier on the obvious gap between reality and his belief typically
yields a flurry of thin excuses that support his position, and can
provoke an outburst of anger if continued long enough.
Denial serves a useful purpose in helping people cope with sudden
change, and is harmless as long as it is not maintained too long.
Denial becomes harmful when it interferes with a person's ability to
cope effectively with the challenges he faces. Fortunately, denial is
temporary in most cases, and even chronic deniers can can learn better
over time.
Anosognosia is quite different. It is not simply denial of a problem,
but the genuine inability to recognize that the problem exists. It is a
common consequence of brain injuries, and occurs to varying degrees in
such disorders such as schizophrenia, bipolar disorder, and Alzheimer's
disease. (I hasten to add that "common" does not mean "universal!" Most
people who suffer from these illnesses are quite aware that they
are sick.)
Someone who has anosognosia isn't being difficult, or refusing to face
the truth. He is literally unable to believe that his illness is, in
fact, an illness. As a result, he does not see any reason to take
medication that can control his illness. Many people who have
anosognosia will refuse to take medication for schizophrenia or bipolar
disorder, because they do not believe they are ill. If pushed, they may
give the appearance of cooperation, while secretly discarding their
medication.
In the case of paranoid schizophrenia, where the patient believes
others are conspiring to harm him or control his life, the combination
of anosognosia and paranoia can provoke the him to violent action in an
attempt to escape his "persecutors." (Sadly, the often debilitating
side effects of antipsychotic medication, which, unlike his illness,
are all too apparent to the patient, provide supporting evidence for
his beliefs.)
For a symptom with such an obscure name, anosognosia plays a prominent
role in both law and medicine. Treatment for most illnesses is taken at
the discretion of the patient, who is free to seek, select, or decline
treatment, as he considers appropriate. However, there are times when
the individual's right to control his medical treatment conflicts with
other important principles, namely, the sanctity of life, and the
protection of others from harm. A person who is in the grip of a severe
psychotic episode, who is judged likely to harm himself or someone
else, may legally be committed to a psychiatric hospital for evaluation
and treatment, on an involuntary basis. Such treatment usually consists
of antipsychotic or mood-stabilizer medications, observation, and
possibly restraint.
Most patients who are prone to psychosis (primarily, those with
schizophrenia) do not have any particular desire to harm other people.
The danger comes not from a desire to harm, but from hallucinations and
delusions that can drive violent actions. (For example, a patient may
sincerely believe he is fighting for his life against an evil force,
when in reality he is attacking an innocent person.) So it is not
surprising that patients who are aware of the nature of their illness,
and the risk of such harm, generally do prefer treatment to prevent
violent incidents. Similarly, patients who have anosognosia about their
psychotic symptoms, but whose behavior
is harmless, may not have a need for medication that justifies removal
of their right to make decisions about their treatment
However, those psychotic patients who are at risk for committing
violent acts, and also have anosognosia, are both dangerous, and unable
to believe that anything is wrong with them. Because of this
belief, they will refuse treatment, and remain dangerous. These are the
patients whose right to control their own treatment conflicts with the
right of others to safety.
In the end, each case must be handled on its own merits, and someone
must make the difficult calls--and be prepared to live with the
consequences. It is because of anosognosia that such calls must be made.
Kevin Thompson,
Ph.D. is the author of
Medicines for Mental Health: The
Ultimate Guide to Psychiatric Medication.
You can find information about treatments for depression, bipolar
disorder, schizophrenia, and sexual problems on his Web site at
www.MentalMeds.org.
