Why People With Severe Mental Illness Don’t Believe They Are Ill – A Summary Of New Scientific Research From The Treatment Advocacy Center

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Individuals with psychotic disorders who cannot recognize they are ill often reject medication and other treatment, which increases the likelihood they will remain in psychiatric crisis and be at risk for violence and other consequences of non-treatment.


Anosognosia and altered brain structures

“Unawareness of illness (anosognosia) is found in approximately half of all individuals with serious mental illnesses.”

A growing body of scientific study shows that people who do not recognize they are mentally ill have structural damage to the areas of the brain involved in self-awareness, according to a summary of recent research released today by the Treatment Advocacy Center.

“There is anatomical damage to the part of the brain we use to think about ourselves,” according to “The Anatomical Basis of Anosognosia,” which identifies 18 studies of lack of awareness in individuals with psychosis in general and schizophrenia in particular. “Denial is psychological, whereas anosognosia is anatomical.”

The neurological syndrome known as “anosognosia” and often called “lack of awareness of illness” or "lack of insight" is believed to be the single largest reason why individuals with the most severe mental illnesses do not take prescribed medications that would diminish or eliminate their psychiatric symptoms. The condition almost invariably is a factor in rampage killings in which mental illness is involved.

“Unawareness of illness (anosognosia) is found in approximately half of all individuals with serious mental illnesses,” according to E. Fuller Torrey, M.D., author of the study and founder of the Treatment Advocacy Center. “Unawareness of illness increases the chances that such individuals will not take medication, which therefore increases the person’s symptoms and chances of becoming violent.”

The summary identified 15 studies reporting statistically significant relationships between the anatomical structure of the brain and anosognosia, a term that comes from the Greek words for disease (nosos) and knowledge (gnosis) and literally means “to not know a disease.” Three studies were identified that found no connection.

Anosognosia has been described by neurologists for more than a century in occasional patients with strokes and other neurological conditions, including Alzheimer’s disease. Its presence in some individuals with schizophrenia and bipolar disorder has only more recently been studied. The emergence of magnetic resonance imagining (MRI) and other advanced technologies has made it possible to investigate whether the condition is associated with identifiable brain change in schizophrenia and bipolar disorder.

To see what anosognosia looks like in an individual with active symptoms, see the video “Anosognosia” on YouTube.

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Carol Meyers
Treatment Advocacy Center
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