In a day and age where information is readily available to anyone with Internet access, a scenario that often pops up when you’re feeling ill is to look up your symptoms. This has led many people to self-diagnose themselves with various types of illnesses and falsely believe they have symptoms of a particular condition. While the Internet is helpful as a preliminary step before going to a doctor, what do you do when you show symptoms but don’t realize it? The people who struggle with recognizing and accepting their symptoms are said to have anosognosia. This impairment can affect the timing and quality of treatment they receive for an illness. Specifically, one illness that is quite readily affected by such an impairment is schizophrenia.
Before one can understand how anosognosia affects people with schizophrenia, it is important to know what exactly it is. Anosognosia is described as “a lack of ability to perceive the realities of one’s own condition” (Jewell, 2018). This means that someone refutes the reality that they have a condition despite showing all of the symptoms or having been diagnosed. One large misconception surrounding this impairment is that someone with anosognosia’s inability to accept that they have a condition is a conscious choice that they are making. This is incorrect because people with this condition truly cannot perceive that they have a certain symptom or condition. Making this distinction is important to truly grasping what anosognosia is because it is not the same as being in denial. For example, one might experience delusions but have no true understanding that they are delusions. Rather those delusions are what define their reality, so they feel that their grasp on what’s “real” is no different than someone without anosognosia. A situation like this takes an emotional toll on someone with anosognosia and can cause them to disregard any other symptoms that they really did experience (Jewell, 2018).
As alluded to previously, many people with schizophrenia are also diagnosed with some form of anosognosia. Around 57 to 98 percent of people with schizophrenia are reported to have “poor insight” where different aspects of their awareness can be affected. “Poor insight” in these cases relate to the lack of awareness and ability to recognize one’s own illness. Medical professionals believe that this “poor insight” is connected to any other mental health conditions that person may have. Specifically, in the case of people with schizophrenia, alterations to the prefrontal cortex and insular cortex are correlated with having “poor insight” (Lehrer & Lorenz, 2014). These parts of the brain are important players in the never-ending process of reshaping one’s self-image and any alterations can cause someone to lose the ability to ingest new information and update the perception of one’s health (Jewell, 2018). That is why doctors’ feel that a patient’s insight is a good predictor of a few things: will they react negatively to a certain treatment, will they relapse, and will their symptoms come back (Lehrer & Lorenz, 2014).
While people with schizophrenia often also have anosognosia, it should be noted that the aspects of their awareness that are affected, due to schizophrenia/anosognosia, are different and seemingly do not overlap. What this means is that just because someone lacks awareness in one domain does not mean they are completely unaware of how the other domains are affected. In one study, a group of people with schizophrenia were shown to have an understanding that their day-to-day functioning was impaired to a certain degree while underestimating their memory functioning. However, as a group, a majority of the participants were shown to be unaware that they were mentally ill (Gilleen et al., 2010).
Someone refuting that they have a mental illness should not be characterized as stubborn or in denial. There are physiological and psychological reasons for their rebuttal and it cannot just be categorized as being hard-headed. Creating an environment where people with mental illnesses and anosognosia can have an open discussion about how they feel without the fear of being gaslighted or judged is crucial in ensuring that they can get the proper treatment in a timely manner. The main goal should be helping everyone who has a mental illness and not letting anyone slip through the cracks just because “they didn’t want to get helped.”
Jewell, T. (2018, October). What Is Anosognosia? Healthline; Healthline Media. https://www.healthline.com/health/anosognosia
Lehrer, D. S., & Lorenz, J. (2014). Anosognosia in schizophrenia: hidden in plain sight. Innovations in Clinical Neuroscience, 11(5–6), 10–17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140620/
Gilleen, J., Greenwood, K., & David, A. S. (2010). Domains of Awareness in Schizophrenia. Schizophrenia Bulletin, 37(1), 61–72. https://doi.org/10.1093/schbul/sbq100