of Bucks County
Pennsylvania
Bucks County's Voice on Mental Illness
NAMI PA
Bucks County
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Bucks County's Voice on Mental Illness
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MENTAL HEALTH CRISIS Number 1-800-499-7455
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Anosognosia Keeps Patients From Realizing They're Ill A growing body of evidence points to the fact that for many people with serious mental illness, lack of insight is a medically based condition. About half of the people with schizophrenia and bipolar disorder may not be getting the treatment they need because of a brain deficit that renders them unable to perceive that they are ill, according to one expert. Xavier Amador, Ph.D.: "People will come up with illogical and even bizarre explanations for symptoms and life circumstances stemming from their illness." Anosognosia, meaning "unawareness of illness," is a syndrome commonly seen in people with serious mental illness and some neurological disorders, according to Xavier Amador, Ph.D.. People with this syndrome do not believe they are ill despite evidence to the contrary, said Amador, who is director of psychology at the New York State Psychiatric Institute and professor of psychology in the department of psychiatry at Columbia University College of Physicians and Surgeons. Amador's quest to understand the basis of this syndrome lies a little closer to home. It was his experience as a clinician and as a brother of someone with schizophrenia, Amador said, that led him to do research on anosognosia, "which is not to be confused with denial," he emphasized, although in the beginning, he did not make that distinction. "That's what I called it when my brother refused to take his medications, and that is what I called it when after his third hospitalization, I found his Haldol in the trashcan," said Amador. "This is someone who taught me to throw a baseball and ride a bicycle. I really looked up to him and was appalled by what I thought was his immaturity, stubbornness, and defensiveness." But research points to a much more complex problem. Intrigued by a 1986 study by William H. Wilson, M.D., and colleagues that found that 89 percent of patients with schizophrenia denied having an illness, Amador conducted his own investigation of the issue. Amador
and his colleagues found in a 1994 study that nearly 60 percent of a sample of
221 patients with schizophrenia did not believe they were ill. Amador also
described what it is like to work with someone who has anosognosia. One patient
encountered by Amador had a lesion on the frontal lobe of his brain. He was
unaware that he was paralyzed on his left side or that he had problems writing.
When asked to draw a clock, the patient thought he did fine, Amador recalled.
However, when Amador pointed out to the patient that the numbers were outside of
the circle, the patient became upset. "The more I talked to him [about the
drawing], the more flustered he got. . . . Then he got angry and pushed the
paper away, saying 'it's not mine-it's not my drawing.' " Amador finds the
same reaction appears when he talks to people with severe mental illness, which
sometimes involves similar frontal lobe deficits. "Instead of being an
ally, I end up being an adversary," he said. Amador urged family members
and mental health professionals to understand that collaboration with treatment
by someone who has a severe mental illness and anosognosia is a goal, not a
given. "Don't expect them to comply with any treatment plan, because they
don't believe they are ill," noted Amador. It is important instead to
develop a partnership with the patient around those things that can be agreed
upon. Amador said that family members and clinicians should first listen to the
patient's fears, such as being placed in the hospital against his or her will.
Empathy with the patient's frustrations and even delusional beliefs is also
important, remarked Amador, who said that the phrase "I understand how you
feel" can make a world of difference. The most difficult thing for family
members to do in building a trusting relationship, he said, is to restrict
discussion to the problems that
the person with mental illness perceives as problems. "You might see the
hallucinations or delusions as the big problem," said Amador. "Your
loved one, however, may be complaining about not getting to sleep at night. That
is the problem you should be discussing." Perhaps a patient will only take
his or her medications to get family members and clinicians to quit bothering
them, and this is sometimes enough, Amador said. "You have to find out what
motivates them to take their medications, then reflect that reason back and
highlight the perceived benefits." Amador
wrote about getting people with serious mental illness to accept treatment in a
book titled, I am Not Sick, I Don't Need Help: A Practical Guide for Families
and Therapists, published in 2000 by Vida Press. |
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