Lack of Insight Into One's Mental Illness or Anosognosia

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Anosognosia affects 50% of individuals with schizophrenia and 40% of patients with bipolar disorder. According to the Treatment Advocacy Center, “Anosognosia, also called ‘lack of insight,’ is a symptom of severe mental illness experienced by some that impairs a person’s ability to understand and perceive his or her illness.”¹

It took the loss of my college graduation and all my possessions, the self-imposed estrangement of family and friends, and five years of homelessness, including two times in jail, as well as two hospital stays before I gained enough insight to accept my diagnosis and begin treatment.

Today, I am thankful to be recovered from schizophrenia. Schizophrenia has had a profound impact on who I am. It has become part of my identity. I do not consider myself to still be mentally ill today, but mentally well and thriving.

When I look back at the trajectory of my illness since 2002, what surprises me most is my total lack of insight before my diagnosis and for months after I was diagnosed.

I had flunked out of college, though I was formerly an honors student. But I began to believe I was too intelligent to need formal education.

While no longer a student, I was arrested by police for trespassing on university property. But I thought I still had the rights and privileges of an honors student.

I traveled to Africa alone, without leaving any contact information except my email address with friends and family. I thought I would relieve poverty singlehandedly.

When I was diagnosed, my life had fallen apart, but I could not see it. I believed the doctors had to be wrong. In fact, I thought I was a shining example of mental health.

Looking back, I remember believing that whether or not I was mentally ill was my choice. I believed that if I refused to accept that I was mentally ill, then I wasn’t. I thought it was like choosing not to be eccentric or not to be weak.

Accepting one’s mental illness and overcoming anosognosia is a process. I agreed to accept medication about a month after my initial diagnosis, as it took that long for the medication to clear my mind. That was only the initial step toward acceptance of my condition. I could not admit I was hearing voices until later on, about three months after beginning antipsychotic medication. Over time, as my medication was working, my former beliefs and past perspective even began to seem ridiculous.

As a mental health advocate, it is remarkable how many times I am contacted by a family member concerned about a loved one who is severely symptomatic and entirely unaware of their mental illness. Some of these people have lost jobs, dropped out of school, suffered through divorce, and lost custody of their children. Yet, they still have no awareness that anything is amiss.

Building trust with your loved one struggling with a lack of insight is key. It often takes many hours for a caring relative, friend, or health care professional to build enough rapport to effectively help the patient realize she or he is not seeing clearly and communicate that his or her sense of reality is distorted.

During my second hospitalization, my doctor broke through to me and helped me see the world as it was. He also helped me find a new direction in my life, the goal of returning to college. My parents also spent countless hours listening to me describe my distorted reality before they found opportunities to gently disagree with me and help me gain a new perspective.

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Occasionally, today, I meet a patient who insists on getting into treatment even though his or her family tells them clearly that they should not seek help due to stigma and shame. But I find this happens rarely.

Breaking through anosognosia is one of the most crucial milestones on one’s journey to recovery. Kindness, and a commitment to investing time building a relationship and building trust, are the keys to breaking through anosognosia and can radically change a patient’s life.

For more information on breaking through anosognosia, visit my recent blogs on Xavier Amador’s LEAP method.