The Difficulty in Seeing Your Own Illness
By Brendan McLean, NAMI Communications
March 30, 2011

Despite schizophrenia's outward expressions that make the illness perceptible to an onlooker, many people living with schizophrenia do not believe they have an illness. They lack the ability to view their symptoms, such as delusions and hallucinations, as being effects of a disease. Even when presented with hard evidence, the individual may still not believe they are sick. This lack of awareness, or insight, into their own illness is known as Anosognosia.

Anosognosia can occur in any mental illness, regardless of its severity, although, it is more common to occur in cases of serious mental illness. It is more commonly found in schizophrenia, where approximately 60 percent of individuals diagnosed do not believe they have a mental illness, than in bipolar disorder or major depressive disorder. This inability to gain insight is not only witnessed in individuals living with mental illnesses but individuals who have experienced a traumatic brain injury or have other diseases, which can include Huntington's and Parkinson's.

Unlike someone who has experienced a brain injury and may not physically be able to retrieve information, Anosognosia, when observed in a mental illness, is the attribution of symptoms to sources other than the illness. It is not a conscious choice to misattribute, or deny, the symptoms but rather a symptom of the illness in itself.

There are three main distinctions between Anosognosia and denial. In Anosognosia, the lack of insight lasts an extended period of time (sometimes years), the beliefs do not change even when presented with overwhelming evidence to the contrary and illogical explanations are used to explain why what they are experiencing is understandable.

What Causes Anosognosia?
Like schizophrenia, Anosognosia, has not been pinned down to one specific underlying factor. Some research has shown that lack of awareness is only correlated with the positive symptoms of schizophrenia, while other has shown it is correlated with negative symptoms or a specific symptom, such as formal thought disorder. Needless to say, separate research has shown that the occurrence of Anosognosia is unrelated to the prevalence of a certain symptom or category of symptoms.

Demographic factors, such as age and gender, are also not predictive of its likelihood. The impact of some demographic factors, including race, are not agreed upon. Some studies have shown that white individuals living with schizophrenia have more insight into their illness than minority ethnic groups. However, many claim that these results are attributable to the different cultural beliefs from their doctors and the cultural beliefs' effect on the expression of the illness.

Why Is It Important to Become Aware of Your Illness?
Studies have found that becoming aware of your illness is related to a better prognosis and outcome. One study found a 34 percent reduction of being re-admitted for relapse. However, it was not the level insight at the occurrence of the first psychotic episode, but those individuals whose insight levels increased early in their treatment who had a better outcome.

Unfortunately, individuals who have been categorized as high-risk for developing psychosis often show significant deficits in insight, making individuals who are already at the greatest risk even more difficult to convince of an impending illness. Insight levels have been shown decrease as more episodes of psychosis are experienced, revealing the importance of early intervention and care.

Can Anosognosia Be Cured?
There is no cure or ability to "magically" increase insight. Medication has not been shown to be effective in increasing awareness. And while some studies have shown education about mental illness may increase awareness, others have shown that despite an ability to attribute symptoms to schizophrenia to others, they can not do so to themselves.

However, if someone you know is living with Anosognosia, there is hope and ways to get them to accept treatment. Although it may seem difficult at first to try and convince them they have an illness, there are methods that may help. Make sure to check out NAMI's Fact Sheet on Anosognosia to learn how best to help.