Your loved one has been struggling with their mental health for so long, but they finally get a diagnosis and start treatment. You breathe a sigh of relief because they start to show signs of progress, but then things go off the rails again, and you find out they stopped taking their medications a few weeks ago. If you’re ready to pull out your hair in frustration because you don’t understand why they would do this, now is a great time to learn about anosognosia. At Carolina Dunes Behavioral Health in Leland, North Carolina, we treat many patients who struggle with this lack of insight into their own mental health.
What Is Anosognosia?
More than simply denial, anosognosia is the lack of ability to accept and understand one’s own mental health condition. When a person is in denial, evidence and education will typically allow them to accept the truth. This is not the case with anosognosia, which is especially common among people with schizophrenia and bipolar disorder. In fact, research indicates that the frontal lobe of a person with bipolar disorder or schizophrenia is often damaged in such a way by the disease that the person’s ability to accurately perceive themselves is impaired. Even more confusing to loved ones is the fact that anosognosia can ebb and flow, with the person sometimes able to understand and accept their condition, and sometimes not.
Often, for a patient with anosognosia, it is easier to accept the implausible ideas below than it is to believe their diagnosis is real:
- Loved ones are mistaken or lying about them being mentally ill
- Doctors are trying to cause harm by forcing them to take medications
- Their medications are not necessary and discontinuing them will not cause harm
While it may not make sense to their loved ones, the best course of action from a patient’s perspective may be to refuse medications or be dishonest about their symptoms or medication adherence. If their friends and family continue to push, they may become frustrated or angry, even avoiding their loved ones entirely.
The Dangers of Anosognosia
When a person with a serious mental illness does not take their medications, they are more likely to:
- Exhibit unsafe behaviors towards themselves and others
- Make impulsive choices
- Have increased risk of suicidal ideation
In turn, this increases the likelihood that they will:
- Be arrested
- Not have housing
- Become isolated from their support systems
How to Help a Person with Anosognosia
There is not a medication or therapy that focuses on treating anosognosia directly, but there are ways you can gain the person’s cooperation with treating their mental health. Dr. Xavier Amador, a noted expert on schizophrenia, wrote a book that is available through the National Alliance for Mental Illness (NAMI) website to help loved ones support their friends and family members who were unable to accept their mental health conditions.
His recommendations are known as the LEAP Method:
- Listen. Without interrupting, let the person tell you about their feelings, thoughts, and beliefs. When they are done, mirror back what they said without judging or arguing with them.
- Empathize. Imagine how it would feel if you believed all of the things your loved one believes and validate the painful feelings, even if you don’t share their beliefs.
- Agree. Identify where you have shared goals. Even if you disagree about the need for medications, you may both agree that you want the person to be able to work, have their own apartment, stay out of the hospital, get better sleep, etc.)
- Partnership. Collaborate to attain those goals and use language that is agreeable to the person you’re trying to help. They may be unwilling to see a doctor and take medications to treat their mental illness, but more than happy to do those things to address their anxiety or insomnia.
It may also be effective for the person’s therapist to utilize Motivational Enhancement Therapy (MET) techniques to help the person understand the benefits of making different choices. As with the LEAP method, MET focuses on the outcome of behaviors, rather than trying to force the person to accept a diagnosis when they are not able to do so.
At Carolina Dunes Behavioral Health in Leland, NC, our team values the contributions that families make to the recovery of our patients. We want to give loved ones the tools they need to give the best possible support to our patients following discharge from our program.
