Anosognosia is a word composed of three Greek words that in combination means “without knowledge of disease,” it may also be called “lack of insight.” The term was coined in 1914 by Hungarian neurologist Joseph Babinsky. He noticed that sometimes after a stroke people are unaware of their deficits. This is presumed to be the result of pathophysiologic changes in the brain and not a psychological defense mechanism of denial.

For example a person actively experiencing an episode of psychosis which is impairment in reality, and suffers from hallucinations, delusions, perceptions and beliefs, may not realize that what they are experiencing is the product of a mental illness.

Anosognosia is a symptom of severe mental illness that impairs a person’s ability to understand and perceive his or her illness. It is the single largest reason why people with schizophrenia, bipolar, and anorexia nervosa refuse medication or do not seek treatment.

This is possible even if there is extensive proof that a condition does exist.

Among neurological patients, anosognosia is seen most commonly in Alzheimer’s, and different kinds of dementias, such as a Lewy body dementia, frontal temporal disorders, vascular dementia, Hunnington’s disease, stroke, Parkinson’s disease, anorexia nervosa and traumatic brain injury.

Anosognosia is a result of changes in the brain. It’s not just stubbornness or outright denial, which is a defense mechanism some people use when they receive a difficult diagnosis to cope with.

The frontal lobe of the brain is heavily involved in the constant reshaping of our self-image. The frontal lobe has a role in problem solving, our sense of reality and understanding the context and meaning of experiences and social interactions. Some mental health conditions can cause alterations in this area of the brain. This can cause frontal lobe tissue remodeling over time. Eventually, a person may lose the ability to take in new information and renew the perception of themselves or their overall health.

To a person with anosognosia the inaccurate insight feels as real and convincing as other people’s ability to perceive themselves. But these misperceptions can cause conflicts with others and an increase in anxiety. Lack of insight typically causes a person to avoid treatment. This makes it the most common reason why people stop taking their medications. Often combined with psychosis or mania, lack of insight can cause reckless or undesirable behavior.

When someone rejects a diagnosis of mental illness, it’s tempting to say that they are “in denial.” However a person with acute mental illness may not be making a conscious choice. They may instead be experiencing “lack of insight” or “lack of awareness” because of a symptom of anosognosia.

Self awareness can vary over time, allowing a person to acknowledge their illness at times and making such knowledge impossible at other times.

There are approximately 8.3 million adults with schizophrenia or bipolar disorder, approximately 3.9 million are untreated in any given year. An estimated 42 percent of Alzheimer patients are unaware that they are compromised by illness.

Consequences of non-treatment are approximately, 169,000 homeless people, 383,000 inmates in jails and prisons, 50 percent of persons with schizophrenia and bipolar attempt suicide in their lifetime, an estimated 29 percent of family homicides are associated with untreated mental illness and an estimated 50 percent of mass kills are associated with untreated mental health issues.

“What mental health needs is more sunlight and more unashamed conversations,” said Glen Close, actress and mental health advocate.

Overfield is an advocate for the National Alliance On Mental Illness of Park County, Wyoming. (307) 250-2978 or (307) 272-3998.

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