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What is Anosognosia?

Anosognosia comes from the Greek root meaning “having no knowledge of a disease” and occurs in both physical and mental health. Research indicates that around 50% of people with schizophrenia and 40% of people with bipolar have some presentation of anosognosia, experiencing a lack of awareness of their diagnosis, making treatment extremely difficult. This is a large reason people experiencing schizophrenia or bipolar may take their medications at times and then not take them at other times. This may also be one of the reasons why a person will engage in treatment at times and then disengage at other times.

“There can be many cycles where a person will have some insight: they take their medication, engage in treatment and think they are better, resulting in terminating both medications and treatment,” commented Steve Fisher, LPC, director of clinical services. “A person often thinks they can go back to what they used to do before they were diagnosed with a mental illness. This can include substance use, not taking medications as prescribed, living with a great deal of stress and not sleeping as much as they need. All of these can exacerbate their symptoms and can lead to psychiatric instability and even hospitalization.”

The Impact of Anosognosia

After WellPower (WellPower) participated in a National Institutes of Health teens and young adults research study for early episode psychosis (an abnormal condition of the mind that results in difficulties determining what is real and what is not real), Steve observed that one of the only things that can help a person effectively manage their anosognosia is time and lived experience.

There is a vastly different perspective for those experiencing mental illness for the first time. Teens and young adults often just want to do what their peers are doing and not accept the reality of their illness. For those in their 30s, 40s and 50s who have cultivated awareness of their mental illness after going through brutal cycles of starting and stopping medication, engaging and disengaging in treatment, they eventually learn the pattern. They learn that even if they get tricked by their mental illness and still don’t believe it’s real, the only way to not disrupt their life is by managing their stress effectively, taking their medications as prescribed and continuing to follow their treatment plan.

Collaboration between a person receiving mental health services and mental health providers is essential. It can affect how well the individual understands the objective facts of the situation – this takes time.

“When someone experiencing psychosis is unable to recognize their hallucinations and delusions as symptoms of their mental illness, we work with them to help them to consistently not act on those thoughts and beliefs,” said Steve. “When they don’t act on their belief, even when they still believe it could be real, individuals gradually see the benefits of their behavior change because it allows them to continue living in their home, working, enjoying their supportive family and friends, continue their recovery journey and lifestyle of well-being.”  

People experiencing anosognosia aren’t just being stubborn or refusing to acknowledge their mental health; its effect on the brain makes it unviable for them to do so. And this is just one nuance when looking at treating serious mental illness. There can be defense and denial, problematic substance use and non-supportive people in one’s life. There are many variables that come into play that impact a person’s motivation and readiness to change.

WellPower’s compassionate treatment providers work as diligently as possible with individuals who are going though all these stages and cycles, and people still disengage from treatment. A person we serve may not show for weeks or months even though our case management teams are out in the community trying to find them, meeting them where they are in any stage of their illness.

“The more you’re aware of anosognosia as a loved one or treatment provider, the more compassion you feel,” concluded Steve. “It gives you an appreciation of how serious these illnesses can be and how much work a person must put into their recovery. It is inspiring to watch a person overcome and manage numerous challenges (including anosognosia) on their path to creating a lifestyle of well-being.”