The word anosognosia means that a patient does not recognize or understand the nature of his illness. People sometimes experience anosognosia after strokes or brain injuries, and with diseases of the brain like Alzheimer's.
"Half of all people with schizophrenia don't recognize that they're sick," says Ken Duckworth, MD, medical director of the National Alliance on Mental Illness and an assistant professor of medicine at Harvard Medical School in Boston.
Also called "lack of insight," anosognosia is a major obstacle for people with schizophrenia. If you're a caregiver for someone with schizophrenia, you know how true this rings.
Anosognosia Is Not Denial
In the past, people attributed this failure to recognize symptoms of schizophrenia to denial, a defense mechanism that we all use. Denial is the refusal to acknowledge a truth that might hurt our sense of self-worth. It can range from benign, like the person who thinks they got a great deal on their new car, to more serious situations, such as the denial involved in alcoholism or drug addiction.
But you can't convince someone with schizophrenia and anosognosia that they need help. The types of intervention strategies that may work for people who are simply in denial will not work for a person with schizophrenia and anosognosia.
What Causes Anosognosia in Schizophrenia?
Anosognosia is caused by physical changes in the brain, but scientists are still trying to understand exactly which parts of the brain are affected and lead to this lack of insight.
Improvements in medical technology like magnetic resonance imaging (MRI) have improved our understanding of anosognosia in people with schizophrenia. For example, a recent study used MRI to analyze relationships between patients' ability to recognize aspects of their schizophrenia and the volume of gray matter in different areas of their brains. More gray matter in certain areas of the brain was associated with greater awareness of schizophrenia. Different areas of the brain were responsible for recognizing that problems exist and making a connection between those problems and the illness.
Blood flow to certain regions of the brain may also play a part in the inability of people with schizophrenia to recognize their condition, according to a study published in a 2012 edition of the Journal of Psychiatry and Neuroscience.
Anosognosia in Schizophrenia: Advice for Caregivers
People with anosognosia are less likely to seek and stick with treatment than people who recognize that they are ill. "It's actually quite logical. Why would you take medication for an illness you don't know you have?" says Dr. Duckworth. This is especially true when the medications in question may come with a host of side effects.
For caregivers, it can be intensely frustrating to watch their loved one refuse treatment. But doing some homework can help ease that frustration:
Understand anosognosia: Anosognosia can be selective. A person may be aware of some symptoms, and completely oblivious to others. This can add another level of frustration for caregivers. Duckworth recommends a book called I Am Not Sick, I Don't Need Help! by Xavier Amador, PhD. Duckworth says the book explains anosognosia and other factors that may prevent your loved one from seeking treatment.
Find out what motivates your loved one. A report for mental health nurses suggests that trying to get the person to admit that they are sick may be a lost cause, because they may not be capable of understanding this information. In this situation, it’s not necessary to force acceptance of their diagnosis. Instead, caregivers should focus on symptoms while trying to find out what motivates a person to stay on treatment. For example, you might try providing your loved one with a routine through daily tasks or rules that need to be followed. You can also help your loved one set personal goals with specific steps to accomplish them to encourage them to manage their condition.
Withhold judgment. Although it's frustrating to watch your loved one go off medications, resist the temptation to criticize. Instead, ask how the symptoms have changed since the decision to quit medications. This strategy gives the patient more say in his treatment and can only improve his level of trust in you.