In the medical world of mental health there is a condition that isn’t talked about much with patients or families. Yet it “affects 50% of people with schizophrenia and 40% of people with bipolar disorder. It can also accompany illnesses such as major depression with psychotic features,” and some kinds of dementia.* It is often mistaken for “denial” and is under-recognized as a contributing factor in medication noncompliance.
It is a malfunction of the brain’s frontal lobe that impacts self-awareness. It keeps people from being able to rightly assess their own thoughts, words and behaviors. It blocks the insights that would lead to seeking medical help or staying on medications. For those impacted by this condition, refusal of help isn’t necessarily because they WILL NOT admit they are ill. It possibly means they CANNOT see that they need treatment. Perhaps it isn’t that they are UNWILLING to take medications. It may mean they are sincerely UNAWARE of the need to do so.
Anosognosia comes from Greek and means “to not know a disease.”* This condition is a nightmare for caregivers who cannot convince their loved ones to get help. Families develop complex emotional contortions to convince their loved ones to seek treatment, with little success. Their love compels them to keep trying, to keep cajoling, to keep insisting. They never give up.
As I have danced through the complex choreography of anosognosia with our son, and watched other families try to find their steps, I have also become more aware of the fact that each of us actually struggle with a spiritual form of anosognosia. Just as Douglas at times hasn’t been aware of how truly ill he was and how greatly he needed help, so I am unable to be aware of how desperately sick my heart is (Jeremiah 17:9). And, like Douglas, I cannot begin to fathom the tragic trajectory of my life without intervention.
I also think of all the ways God has tirelessly tried to help me “know a disease”—to be aware of my need for His love and forgiveness to cleanse me from the sin that is destroying my life. He gently but faithfully shines His goodness on my blindspots. But I just don’t get it. However, God has compassion on my sin-sick soul, and with unwavering kindnesses reaches out over and over again.
With mental illness, the resistance to treatment caused by anosognosia often results in homelessness and/or incarceration.* Unable to see their illness and unable to heal themselves, some live out their days in isolation and fear.
Spiritually, without the convicting work of the Holy Spirit and the transformative effects of Christ’s sacrificial love, we too live in aimless isolation, imprisoned by our fears and failures. On our own we cannot see our need for salvation and we cannot save ourselves. We become increasingly spiritually blind and dull.
Let us pray, then, for the gift of repentance so we can know our need for redemption and lay hold of the deep healing of our souls. And let us continually pray for our loved ones, that they can be healed from anosognosia and accept the treatment they so desperately need.
P.S. In his incredibly practical book, I Am Not Sick, I Don’t Need Help! How to Help Someone with Mental Illness Accept Treatment, Dr. Xavier Amador provides steps and tools to help you help your loved one accept help, even amid their inability to recognize their own needs.