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Do you know someone with a serious mental illness who you think is always in denial? While denial does definitely exist, someone with Anosognosia isn't simply in denial or being stubborn. Their brain can't process the fact that their thoughts and moods don't reflect reality.
Experts think Anosognosia results from damage to an area of the brain involved in self-reflection. Everyone, regardless of their health status, is constantly updating their mental image of themselves. Whenever you gain new information about yourself--say, after you get a haircut or ace a presentation--it factors into how you think about yourself. It's an ongoing, complex process. In order for it to go smoothly, your brain's frontal lobe has to take in the new info, organize it, use it to edit your self-image, and remember that latest version.
When your brain's frontal lobe is damaged, which happens often with illnesses like schizophrenia and bipolar disorder, you can no longer properly update your self-image. Anosognosia isn't always all-or-nothing. Some people partially lose the ability to see themselves clearly, or it can come and go. That can confuse friends and loved ones. It's hard to understand why someone seems to fully understand their diagnosis one moment, then claim they're perfectly healthy the next, even though objective evidence shows they aren't.
Why does Anosognosia matter? When someone with a serious mental illness insists they aren't sick (or aren't as sick as others say they are), a dangerous situation could result. Someone with Anosognosia is unlikely to take their medication. Why would you take a drug (especially one that might have unpleasant side effects) if you don't think there's anything wrong with you?
When this person stops taking medication, their symptoms will usually come back or get worse. Depending on their condition, they might start hearing voices, act recklessly, or become suicidal. They're also more likely to end up unhoused or get arrested.
If a loved one or someone you know has Anosognosia, sometimes it's best not to try to convince them that they're ill. Instead, talk about their goals, such as keeping a job or living on their own. This might encourage them to meet with a mental health professional, even if they don't think they need it for their health and well-being.
If you need help getting someone to go to a therapist who doesn't think they need to, stop in at Together We Can, 8 West Church Street and Becky and Deb would be glad to help you come up with some ideas to get them there. You can also send us an email at twc50158@gmail.com or call (515) 391-3233 and we would be glad to brainstorm ideas.
Becky Brown and Deb Williams are the cofounders of Together We Can, a mental health nonprofit based in Marshalltown.