Anosognosia

I'm taking a NAMI course called Family to Family which provides support and education for family members of people with mental illness. It's mostly parents of grown children and very few spouses (apparently most spouses just divorce a person with mental illness so that's why there aren't too many in the class). I'm also signed up for the Visions For Tomorrow class, which is the same thing, but for families of children and adolescents (I almost didn't do this one because it's far away and on a night when we have attachment therapy already scheduled).

Last week we learned about Anosognosia and all the sudden I had a greater understanding of my kids' lack of reaction/understanding of their diagnoses.

SUMMARY: Anosognosia, impaired awareness of illness, is the single largest reason why individuals with schizophrenia and bipolar disorder do not take their medications. This impaired awareness of illness is caused by damage to specific parts of the brain, and affects approximately 50 percent of individuals with schizophrenia and 40 percent of individuals with bipolar disorder. Medications can improve awareness in some patients.
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What is impaired awareness of illness?
People with impaired awareness of illness may not recognize that they are ill. Instead, they believe their delusions are real (e.g., the woman across the street is being paid by the CIA to spy on him) and that their hallucinations are real (e.g., the voices are instructions being sent by the President). Impaired awareness of illness is the same thing as lack of insight. The term used by neurologists is “anosognosia,” which comes from the Greek word for disease (nosos) and knowledge (gnosis). It literally means "to not know a disease."

How big a problem is it?

Many studies of individuals with schizophrenia report that approximately half of them have moderate or severe impairment in their awareness of illness. Studies suggest that approximately 40 percent of individuals with bipolar disorder have impaired awareness of illness; this is especially true if the person also has delusions and/or hallucinations.

Is impaired awareness of illness the same thing as denial of illness?

No. Denial is a psychological mechanism that we all use, more or less. Impaired awareness of illness, on the other hand, has a biological basis and is caused by damage to the brain, especially the right brain hemisphere. The specific brain areas that appear to be most involved are the frontal lobe and part of the parietal lobe. (Guess where a lot of Bear's brain damage is located?!)

Can a person be partially aware of their illness?

Yes. Impaired awareness of illness is a relative, not an absolute problem. Some individuals may also fluctuate over time in their awareness, being more aware when they are in remission but losing the awareness when they relapse.

Why is impaired awareness of illness important?

Impaired awareness of illness is the single biggest reason why individuals with schizophrenia and bipolar disorder do not take medication. They do not believe they are sick, so why should they? Without medication, the person's symptoms become worse. This often makes them more vulnerable to being victimized and committing suicide. It also often leads to rehospitalization, homelessness, being incarcerated in jail or prison, and violent acts against others because of the untreated symptoms.

It is difficult to understand how a person who is sick would not know it.

Impaired awareness of illness is very difficult for other people to comprehend. A person's psychiatric symptoms seem so obvious that it’s hard to believe the person is not aware he or she is ill. Oliver Sacks, in his book The Man Who Mistook His Wife for a Hat, noted this problem: “It is not only difficult, it is impossible for patients with certain right-hemisphere syndromes to know their own problems... And it is singularly difficult, for even the most sensitive observer, to picture the inner state, the 'situation' of such patients, for this is almost unimaginably remote from anything he himself has ever known.”