Psychiatric anosognosia: Does the psychiatric vision need some good therapy?

One of the shadier concepts in psychiatry in that of anosognosia.  It basically means that because you have mental illness that you have suffered some kind of brain damage that makes you unable to realize that you are ill.  It is remarkable notion that is used most frequently by people like the Treatment Advocacy Center to justify that the mentally ill need to be forced to accept treatment for their own good because they dont even know they have an illness.  “Treatment” in the way they use it is basically medication and/or hospitalization.  By appealing to the concept of anosognosia these folks try to annul any criticism of psychiatric intervention by those who have endured it as being the result of distorted thinking or personal blindness on their part.  In its most extreme variations it pictures psychiatrists in terms most people  use only for God.

The conception of personal blindness as something peculiar to people with “mental illness” functions  to justify taking away someones’s rights to make decisions about their own life and through linguistic sleight of hand to make interventions which are frequently cruel, frequently dangerous, often demeaning seem to be something done for “their own good.”

There is ample evidence that personal blindness can be a major problem,  but the clear evidence shows it is a function of being a human being and not ahuman being  with mental illness.  Social psychologists have been studying “the confirmation bias” since the 1960″s.  Wikipedia defines it as “a tendency for people to favor information that confirms their preconceptions  or hypothess regardless of whether or not the information is true.”   The article continues, “The biases appear in particular fo remotionally significant issues and for established beliefs.”  And finally, “Confirmation biases contribute to overconfidence in personal beliefs and can maintain or strengthen beliefs in the face of contrary evidence.  Hence they can lead to poor decisions, especially in organizational, scientific, militiary, political and social contexts.”  50 years of social psychology research clearly prove that personal blindness (confirmation bias) is a normal, regular, predictable characteristic of “normal” human beings that influence all areas of human life including “scientific” endeavors.

When I listen to people talk in a serious fashion about how science has proved that 50% of the mentally ill have anosognosia I cant help but wonder about the effect of the confirmation bias.  I think that maybe nobody is as blind as those who continue to preach about how  blind  everyone else is.  How else can educated, intelligient human beings talk with blind faith about the glories of psychotropic medication when more and more evidence is piling up each day about the dangers they present.  How else can educated, intelligent human beings seem to be unable to see the trauma of psychiatric hospitalization for so many people.  How can educated, intelligient people see nothing but “what is done for their own good” and fail to see the harm and needless cruelty that so often characterizes the system?  Perhaps scientific research has as much to say about the scientists as it does about anybody else.  From the Wikipedia article again, “Experiments have repeatedly found that people tend to test hypotheses in a one sided way, by searching for evidence consistent with the hypotheses that hold at a given time.”

In my experience psychiatrists, at least in the public mental health system, really dont control all that much.  The psychiatric vision- the conception of what is real and what is not real- does however.  It is that paradigm that could really use some good therapy.  If you read through the research about the confirmation bias and insert the term psychiatric vision as the subject it is really scary how accurate the description seems. 

The research seems to indicate that those with mental health diagnosis are not necessarily less realistic than those without a diagnosis.  One author of a recent book, Dr. Nassir Ghaemi in “A First Rate Madness” says that point blank.  He points out several historical leaders who because they were depressed were more realistic rather than less.  They didnt have the tendency to blindly accept what made them look good or feel good as more “normal” leaders did.  His book is very controversial but the points he raises are worth thinking about.

I keep coming back to a talk I heard Robert Whitaker make recently about the need for an honest mental health system.  What if it was not about who was right or wrong?  What if it was not about defending your turf from others trying to say that your version of the truth really wasn’t that true?  What if it was about what helps?  Would that not really be a revolution that could benefit all of us?

When I hear people talk about recovery sometimes their visions are not real clearly articulated, but what is always clear is their bottom line.  What is important is what helps….what improves the qualityof life.  And once you find out what works do it and continue to do it and when you figure out things that help more do them with even more passion.  Is not the mental health system in the end supposed to be about how we help those in distress and pain who need some help to live the kind of life and have the same kind of opportunities that all human beings should have?




2 thoughts on “Psychiatric anosognosia: Does the psychiatric vision need some good therapy?”

  1. My personal diagnosis by itself does not help. In my case, bipolar disorder or psychizosaffective mood disorder(I can’t spell the word) but in the words of one doctor I saw “It is a catch all term and no one knows exactly what it means’. I don’t like the second diagnosis for it sounds like I have an exotic terminal disease. I can grasp the diagnosis bipolar disorder although that term is more generic than the diagnosis that used to be in vogue “manic-depression, which is really a more accurate term in my case. None of that matters to me. I don’t like my life out of control or losing my freedom in an hospitalization so I take meds that give me greater control of my life but it took a lifetime to figure out my place in society and to get beyond a “mentally ill” label. In the beginning I hated myself when I ended up in a hospital. That really was an indictment of the way others viewed my problems particularly my parents(and others). The truth is every person has their unique set of problems whether or not you end up with mental health diagnosis. We are all flawed. There is no way to get around that. It took me a lifetime to learn that.


  2. It has been my observation that even people with severe cases of mental illness are not dysfunctional 100% of the time, and can gain insights, function well, and provide valid observations of their own mental states during periods of lucidity. Once again we see that old prejudices die hard, and that “anosognosia” is just another buzzword to consign us, the diagnosed, with permanent invalid status, despite evidence that being high-functioning and productive members of society is possible.

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