Clinicians in mental health have long known the issues which face them when attempting to retain a client in treatment for their mental illness. It often seems everyone is aware of the illness except for the client themselves! Why does this occur and why is it so prevalent? Is this "denial"?
Anosognosia, which is the medical term for impaired awareness of one's illness, is caused by damage to specific areas of the brain. The disorder is well known among neurologists as it is often seen in patients who have suffered strokes, brain tumors, Alzheimer's Disease and Huntington's Disease. However, in the psychiatric community, impaired awareness of illness has only began to be discussed since the late 1980's.
The disorder is very easily confused with denial of illness but is, in fact totally different. This confusion and the lack of awareness in the public is damaging for the severely mentally ill client. Often mislabeled as denial, it has emerged as another cause of stigma.
Denial is an unconscious defense mechanism utilized to shut out or deny unpleasant or painful reality. Anosognosia is the result of brain damage, particularly in the right hemisphere of the brain.
Anosognosia affects approximately 50% of people with schizophrenia and around 40% of those individuals with bipolar disorder. The impact of the disorder is felt strongly in this population as it happens to be the number one reason why individuals with schizophrenia and bipolar disorder do not take their medications and then return to an institution. The lack of insight into their illness also makes recovery from hallucinations and delusions tougher as these individuals believe them real and not manifestations of illness. Without medication the symptoms worsen leaving the individual vulnerable to abuse, homelessness, and violence against others.
The presence of anosognosia in those individuals with severe brain disorders is an argument in favor of assisted treatment as they are highly unlikely to seek treatment on their own.
