Why it is difficult for people to realize their own mental illness

Anosognosia (uh-noh-suh-noh-zha), or a person’s inability to recognize that they have a mental illness, affects an estimated 30% of people with schizophrenia and 20% of people with bipolar disorder. It is not denial; rather, it is hypothesized to be a condition caused by a disorder in or damage to the frontal lobes. People with traumatic brain injuries, for example, sometimes have anosognosia. Anosognosia is very problematic, as it emotionally harms loved ones who want the person with anosognosia to get treatment, and it also harms the person with mental illness, who feels frustrated and alienated by the people around them trying to convince them that they are sick. The typical solution for this problem is forced treatment. A recent Seattle Times article dives into the policy of mental health care and anosognosia. Washington State has had a very tenuous relationship with mental health care, at one point forcing patients into overcrowded hospitals. Thus, to avoid another such fiasco, the policy has reversed and Washington is now one of the hardest places to get forced treatment, and the only way to get someone with anosognosia treatment is to prove that they are a danger to themself or others. The article argues that the system’s libertarian focus is blind to the needs of people who literally are incapable of making informed decisions about their mental health, and change is necessary.

This article confronts (and also explicitly acknowledges) a very salient topic in the world of mental health. What are the rights of people with mental illnesses? Michelle, for example, has had very unpleasant experiences with forced treatment, having been strapped down and forcibly injected with a sedative at a psych ward. On the other hand, it is true that for some people the only way to get them treated is forcibly. Where do we draw the line? Washington state drew that line towards the free choice end of the spectrum, though the article is arguing for a relaxation of laws restricting forced treatment. I believe, however, that the answer lies in neither. The solution is greater individual attention towards people with mental illnesses. Nobody tried to explain anything to Michelle when she was in the psych ward, which greatly frustrated her. I can’t speak for Michelle, but I think it would have been less unpleasant if someone had sat down with her and asked her what she thought. From there, they could have decided whether she needed further treatment or not.

The keyword here is equity – it is an inherent flaw of policy that every person is different, and so has different needs. This is no less true for mental health care, and yet this topic has not received the attention and funding that it warrants. People with mental illnesses need treatment that is just right for them, which for some people is forced treatment, and for others is not. We need to stop thinking of mental illness as a monolith and start viewing it as no different from the other topics that dominate policy. Ideally, every person with a mental illness should be able to talk with an expert and have a say in their treatment (or no say, if their anosognosia is too complete). Of course, nothing in this world is ideal, as policies are fundamentally limited by reality and are merely approximations of the ideologies behind them. Still, simply talking more about mental health is a step in the right direction. If we can put ourselves on the right path and keep walking forward, that is enough.

By Matthew Ahmon

Matthew Ahmon

Matthew Ahmon is a high school junior at Horace Mann School in the Bronx, N.Y. His interests are mainly in mental health and neuroscience. Along these lines, he is a research volunteer at the Albert Einstein College of Medicine, where he remotely helps sort electrophysiological data. He’s also filming a documentary about mental health during the pandemic; if you are interested in sharing your experiences with mental health during the pandemic, please contact him at matthew_ahmon@horacemann.org. When he’s not helping out Michelle Hammer with her mission to change the way people perceive people with mental illness, he’s blogging on his own at mentalhealth-musings.org, listening to classical music, and hanging out with his family and pets (2 cats and a dog).