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Anosognosia - Lack of Insight

Anosognosia - Lack of Insight

Nearly everyone is aware of the problem:  Many people with mental illness deny that they are ill, and therefore refuse treatment. Most people understand the psychological concept of denial, which is a refusal to believe an uncomfortable truth. Who hasn't heard a heavy drinker, eater, smoker, or drug user say, "I can quit any time I want."

 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.  It is, in fact, a symptom of some disorders.

 This obscure word, which is pronounced "uh-no-sog-no-zha," means "unawareness of illness," and is often the basis for a person with mental illness not wanting to take medication or treatment.

 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.  Many of them will refuse to take medication for schizophrenia or bipolar disorder, because they do not believe they are ill. It’s best not to try too hard to convince the person of his illness. If they are pushed too far, they may become angry and withdraw further.

 Consider for a moment a scenario where someone is trying to convince you to take some medication for schizophrenia.  You KNOW you don’t have a mental illness and don’t need it, so you refuse to take it.  That belief is every bit as real to a person with anosognosia.

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 him to attempt to escape his "persecutors” -- as he sees them.

Dr. Xavier Amador, brother of a man with serious mental illness, has spent many years studying anosognosia, and has written a book on the subject:  “I am not sick;  I don't need help.”  This is a valuable resource for families who are united in the frustration of being unable to get help for their loved one.

  You can view Dr Amador at:


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