For the last week or so I have been tracking this weird word, trying to understand what it meant and the implications of that meaning.  In many ways it is the foundational concept of the platform the Treatment Advocacy Center supports for involuntary treatment.  Basically it means that people are blind to the fact they have an illness.  According to TAC 50% of people with schizophrenia and 40% of those with bipolar suffer from this disorder.  And because of this “blindness” the reasoning goes it is only kind to make sure that people get the treatment they need for their own good, rather they understand it or not or rather they want it or not.

According to TAC anosognia is the result of a brain injury to the right side of the cerebral cortex.  And according to the TAC all this is a proven scientific fact (a “psf”).  According to them anosognia is the primary reason that so many people refuse for example to take psychotropic medication for their illness.

Unpacking the meaning of all this I have discovered all sorts of fascinating things and come up with a raft of unanswered questions.

  • The concept of anosognosia was developed for stroke patients and others suffering various brain insults who may not realize they were paralyzed or blind.  It seems to be an argument by analogy more than anything else.  I found lots of folks who would tell me it was a “psf” but not a lot of information about how it was proved to be a “psf.”  If anyone has actual links to the studies that “prove” this I would love to have  them where I could actually look at the studies.  It really seems to be proof by pronouncement more than anything else.
  • Some psychiatrists say that brain damage causes an inability to see your need for psychotropic meds.  Dr. Peter Breggin turns that notion on its ear.  He says there is such a thing as intoxicational anosognosia and that taking taking psychotropic medication damages your brain and makes you unable to see what a problem medication really is.  To me, to be honest, it sounds like people calling the people who dont agree with them brain damaged because they dont agree with them.  I know a psychiatrist who has bipolar anosognosia.  He believes that the diagnosis is largely a fad and where others see clear evidence of bipolar he normally sees none.  I dont think that proves brain damage as much as his colleagues might disagree with them, but some folks seem to believe that what name you call people explains their behavior.
  • anosognosia means blindness.  It does not mean denial, rationalization, or blaming.  It does not mean making excuses.  It means they dont know something is wrong.  I know some people who are in denial of their issues.  I know some people who rationalize their issues.  I know some people who blame others for their problems.  I am coming to believe that I really dont know the right people, but I dont know anyone who believes nothing is wrong.  Most people I have known seem to be constitutionally unable to not see their life has went to hell when it goes to hell.  And if half the people with mental illness suffer from this why dont I know anyone?  Why do I not now of anyone I at least suspect from this?  I have a hard time buying it to be honest.  I believe denial and other coping mechanisms, but those are more a function of being a human being.  We all do those.  I cant help but wonder why no one with anosognosia seems to live around here.
  • I double checked to make sure I wasnt missing something, but I dont think I am.  I know many people labeled with schizophrenia and maybe when they are actively psychotic they dont know, but most of the people I know are acutely aware they need help.
  • When I looked at the percentages they quoted as having anosognosia I couldnt help if that wasnt a code word for saying they didnt want to take medication.  The belief that only brain damage can cause someone to not want to take medication is one big assumption.  To me it seems like it takes a certain degree of blindness (anosognosia?) to believe there is no way that someone could make a rational decision to not take medication.  It ignores their prior experience with medication, the lack of success meds often have, the side effects they have, the effect medication has on the quality of their life, their values, and ultimately their right to make decisions about themselves.
  • Their is a huge unspoken notion is this idea.  To my knowledge there is no test that clearly differentiates between the brain of someone with bipolar and someone without.  All the theories about neurotransmitters and stuff like that so far simply havent been proven.  What most responsible people right now will tell you about what they know is that they dont know.  From personal experience there seems to be a wide divergence between doctors in what is and isnt bipolar  to begin with.  Yet this idea of anosognosia says that a definable brain injury causes this blindness to bipolar.  You are in the unique position of saying that something you cant prove you have causes brain damage that you can prove.   I dont know if anyone but me finds that to be something of an incredibly bizarre notion, but I do.
  • One of the things I never found was even a hypothesis of mental illness causes anosognosia.  It seems to be a major weakness of the whole idea and asks that people accept a lot on faith that might easily be explained in other ways.
  • I couldnt help but wondering if this isnt another example of backward thinking masquerading as scientific truth.  A nice theory was developed about mental illness by watching what medications did.  If they affected neurotransmitters and people got better then the lack or surplus of neurotransmitters must cause the illness.  Great idea…… but it doesnt appear to be true.  People dont see the need for treatment…It seems like the same problem that many people with brain injury has.  They must have a brain injury.  Great idea…..But is it an assumed truth by people who want it to be true or a proven truth by people who are open to any truth.  You answer that for yourself.
  • One study I did see says that people who were blind to the need to treatment but who were forced into treatment improved in their insight about their need for treatment.  Are they saying that treatment (read medication primarily) cures the brain damage that causes the original anosognosia?  How real does that seem to you?  You have brain damage assumed with a cure that no one can begin to explain how it works.  Maybe people get more insight because they gain skill in telling people with control over their lives what they want to hear to get them off their back.

There are more questions but perhaps the horse really is dead and I need to stop beating.  After the last 6 weeks or so of looking into the facts they TAC claims and the studies they point to it seems clear to me that they consistently overemphasize and distort most of the studies they quote.  They believe in truth by pronouncement.  If you say it often enough and attack those who disagree with you with enough vigor the theory seems to be that eventually it will seem true.

Anosognosia is a critical concept for TAC.  It legitimizes acting against people on the basis “they dont know what they need and they need us to act in their best interests.”  It makes those with a mental health diagnosis into second class citizens and is, I believe, a pseudo science term that is mental health stigma at its meanest and most severe.

I would love to hear more about what you think.


9 thoughts on “Anosognosia”

  1. Excellent article, There’s only two people in psychiatry, the compliant and the non compliant, those that believe and those that don’t, there are two types of doctors as well the abusive drug pushing criminal type and the outcast moralist non drug dealing psychiatrist, how easy is it for bad psychiatry, give them poison with any mental illness or madness you want to mention already in it, call them mad, and uninsightfull, and if they pull uninsightfull apart, hit em with a bit of Anosognosia just in case they might almost look real, and if they’re fight( with the victim they’re torturing) is getting too much for them, they electrocute it away.

  2. “outcast moralist non drug dealing psychiatrist,” which you boldly distinguish from pharma shills as if it were a simple manichean war between good and evil. Balderdash. I read well respected psy docs who admit to using drugs in therapy AND YET who argue for more interaction, compassion and education. They do not fit your theory. If anything, what I read being targeted to the phama dispensers, it is to be cautious and at leqast due the due diligence before heading to a off your head diagnosis and fix. It is easy to miss this if you are afraid to see what the “other side” is actually saying.

    There are psy docs, one a respected teacher also who don’t “get” anognosia, and like some reactionary haters, think its just a ruse to evade dealing. I wonder how the anti-pharma practitioners persuade these “deniers” that they need some help coping in the world. I have the idea they should share those strategies and let them fulfill their “evidence based” reality. But the fight and pettiness seems to be the rule. sigh! BIG SIGH! no, the denial means refusing admitting the problem, not just the drugs are the answer side of things!!!

    Of course they cant have anognosia, because this “metaphorical” mental disease is not biological!!! how often is THAT put out as, just as you accuse TAC with its “propoganda? can we both sides be honest?

    1. sorry I’m so late with this– i hope you get it–but i just realised something Walt– it’s so ironic, but its actually psychiatry who really have anosognosia– their the ones who are in denial– denial of their own abusiveness and so- so much more — far too much to mention. I’m so glad I’ve seen that now. I wonder how the psychiatrist abusing deniers can be convinced they need some help to stop their adverse poisoning and abusive ways– the violence they use- the kidnapping they do- the name calling- the security abuse–poisoning people with psychosis-etc etc — as i said the list goes on– ye ha-whats good for the goose– well leave it there hey.

  3. mate I’m just a carer– part of an extended family who all feels abused by what they’ve done to our loved one– just like all the other victims and their families— the non believers with anasognosia– not the believers like yourself– calling the non believers names just like them–and getting away with it—think about it Walt– you’ve got one group saying please stop hurting us- me– and the hurters saying your stupid –shut up– Ive seen the movies mate –its pretty easy to see who the baddies are–9/10 their the ones inflicting the pain–lets just imagine/visualize- i take you to the bin voluntarily- and an hour later to everyone’s surprise– your involuntary– and you’ve been drugged insane— and then when you flip out about what they’ve done to you and the debilitating psychotropics effect your feeling– because you’ve flipped out they(the glorified bouncers–gorillas) then (-:take you:-) to a room,put a nice fitting straight jacket on you, and put/tie you on a stretcher– tie up your arms, and legs — and then close the door for 12 hrs— and when you complain your not mad–ill just say you’ve got anasognosia– you lovin it mate– I am. No I’m not — id never do any of that to an animal let alone, a brother or a sister, a mother father,son or daughter of anyone. theirs that type of person– and then their isn’t that type of person. The fact is these people know that long term psychotropics keep you mad, We have an 80+% failure rate because we “forcefully” long term- adversely drug- all our victims/clients/patients/ “we don’t heal them”–today tomorrow,next week, a month two three–we manage them for a life time– that’s a fact mate–although, mind you– because they’ve at last–been found out–they’re now talking cure–what a joke that is–the only reason their talking cure now is because the cries of their victims have started to overtake their jibber– and their trying to cover themselves–using the language /cries of their victims– but we don’t just stand over them with incarceration and poison in the hospital–we then force drug them in the community on community treatment orders– but that’s not enough– the years go by– many attempts to escape– but we all know you go mad trying that– they actually say that!– because they wont admit what it really is- 9/10 you have a supersensitivity psychosis –that these things conveniently call a relapse–a relapse back to the insanity we say you have–how cools that–and then “we follow them/you to their/your grave”. All knowingly. The sad part is the sheople public people that buys their lies– for their own reasons, (which are many–but i wont go into that now) and supports them – against their victims cries- aggressively on social media -just like them in practice/reality..

    Where as in Finland they have an 80%+ success rate simply because they only drug short term–they heal their clients– so whoever you reckon is a good guy — belongs to a profession– that knowingly harms over 80% of its clientele–(I am talking involuntary)– and that unfortunately goes for a lifetime– because these things wont stop or wont let go because get this”their managing your mental illness”– they know you go mad going on them or coming off them– what the hell does that tell you– it tells me how disgustingly catch 22- that their killing/destroying their victims lives– one more thing did you also know that in third world countries, they get well after psychiatric INTERVENTION simply because they cant afford to pay for the medication–and– a medicine that would stop them working to feed their families because of its debilitating adverse side effects—-“so they get over it basically because they have to” but more to the truth- its not in their system long enough to keep them mad like it is in the affluent countries that abuse long term—1500 + reported and known adverse side effects in each and every psychotropic, mirroring any mental illness known to humankind. i could probably talk for a week non stop about how abusive they are and have been to mine– and you’d still probably reckon their OK– but i can tell you this much mate– anyone who has 1500 to 2000 reported and known adverse effects mirroring any mental illness known to man shoved/forced down their throat– can not possibly be called anything until those side effects aren’t in the equation. I understand what your saying walt– and fair enough in the sense of most people actually mean well– and i’m sure that the majority joins with good intent– but the system is corrupt from the top down– i feel sad for the well meaning ones– but in the end they operate in a crooked system that dictates what they must do– and what the weaker ones end up doing for a corrupt system is not much short of disgusting– that’s why the real dogs work for the government system–the public bins– and the good to better ones work in private practice. In ours 64% are foreign/alien and cant speak or understand proper English– so they alienate their already alienated victims– point their fingers, call them nasty names–and poison them for dollars and ego.

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