Refusing help for mental illness may not be denial or stubbornness. Anosognosia is a condition that makes someone believe they're healthy despite being unwell. The name comes from a Greek word that means “without knowledge of disease.”

Lesley McCuaig did not have anosognosia symptoms before she was diagnosed with schizophrenia. However, she hopes that bringing attention to this little-known condition will help social understanding and reduce the stigma around severe mental illness.

It has become apparent over my time advocating for severe mental health conditions, including for people living with schizophrenia, that there is something that sets me apart from my peers with the illness. 

For example, why can I manage daily life despite having auditory hallucinations?

I think part of this can be attributed to my not having something called “anosognosia.”

What is anosognosia?

Anosognosia is a condition where a person doesn’t realize they have a neurological or mental health issue.

Someone with anosognosia isn't choosing to deny their mental health condition. It's not that they're stubborn or avoiding reality because it's difficult or distressing. The brain areas that detect changes in the mind and body are damaged, so they physically can't recognize the problem.

Anosognosia is more common in some conditions than others. For example, research suggests that anosognosia affects more than 80% of people with Alzheimer's disease, 40% of those with bipolar, and 50% of those with schizophrenia.

The issues with anosognosia 

Unfortunately, dealing with anosognosia isn't as simple as insisting someone realize their health condition.

Anosognosia can make others' concerns fall on deaf ears. Relationships become strained, leading to emotional, physical, and financial hardship for the person with the illness and their relatives.

Likewise, not recognizing their condition can lead to mounting socioeconomic costs. People unaware of their condition are less likely to seek help, reducing early treatment chances.

In the wider economy, hospitalizations, homelessness, emergency services, and, in a few cases, internment are all costly expenses that could be reduced with early recognition and treatment.

I recognized that my auditory hallucinations weren't "normal"

What has led to me having insight into my illness?

Before my schizophrenia diagnosis, when I was really unwell, I sensed that something was seriously wrong because I was hearing things that weren't there. I was too scared to tell anyone that I was experiencing auditory hallucinations, but I was aware that I was sick.

This recognition doesn't happen for people with anosognosia. You see, they cannot self-reflect and, therefore, cannot identify that they have a mental illness.

So, why am I writing about a topic I don't experience? Because I think it's an important phenomenon for people to know about.

I have a better understanding of my illness, which has helped me achieve my academic, financial, and family goals. I may not have accomplished these things if I were unaware of my condition.

I can notice when my symptoms get worse, so I can adjust my sleep, diet, or exercise. I can go to a doctor without a support person to discuss my treatment. This helps me to manage on my own, which is important for someone with a severe mental illness.

I didn't learn how to have insight into my illness; I just had it.

How to help someone with anosognosia

It's important to know that people with anosognosia can still find ways to understand their illness.

I strongly support mental health counseling for those with severe mental illness, as it's often overlooked in their treatment.

A counseling method called motivational interviewing has been effective in overcoming the challenges of anosognosia. Another method that has had some success is Cognitive Behavioral Therapy (CBT) for psychosis.

One of the most effective methods is the LEAP technique for families and mental health providers. LEAP stands for:

• Listen
• Empathize
• Agree
• Partner

Listen

Listen to your loved one's views on themselves, illness, and treatment. Though it may be difficult not to react emotionally, do your best to stay calm and hear them out.

Practice active listening techniques. Repeat what your loved one says back to them to check if you understand them correctly.

Empathize

Your loved one won't pay attention to your point of view if you don't do the same for them. You don't have to agree with their words, but you can show awareness and support for their feelings.

Remember that empathy doesn't require you to understand everything your loved one is experiencing. Chances are, you don't. However, validating phrases like "That sounds scary" or "I can see your point" can be helpful at this time.

Agree

Once you've both had your say, highlight the points you agree on to find common ground.

If you don't agree on anything, refrain from letting the situation get heated. Call "time out" on the conversation and go back to it once both sides have cooled down.

Partner

You and your loved one must work together to form an action plan. Sharing your thoughts can help you build trust with one another.

But remember - enabling harmful behaviors, like substance abuse or avoiding treatment, isn't the same as supporting someone. Going back to step one (Listen) can help your loved one with a severe mental illness to open up further. What they share may give you some ideas on how to make treatment more attractive to them.

If your loved one is showing signs of a mental health crisis (i.e., no longer well enough to have any form of discussion) and still refuses treatment or help, it may be best to seek emergency care.

Having insight into my schizophrenia allows me to be a valuable advocate

As I mentioned before, anosognosia has many socioeconomic implications. It can be very difficult for the family member and/or caregiver who is trying to get treatment for their loved one.

There isn't a day that goes by where I am not grateful that I don't have anosognosia. I understand that I have the privilege of living independently and managing my own medication.

I achieved a Master of Arts degree in Counseling Psychology. I work full-time as a Registered Counseling Therapist Candidate. I enjoy healthy relationships with family and friends. And I do all of this with a schizophrenia diagnosis.

Partly, this is because I don't have anosognosia, and I'm very thankful for that. But because I do have this insight into my illness, I need to spread that insight around. The stigma surrounding schizophrenia and other serious mental illnesses still exists in society. We may see someone with, to us, "obvious" severe mental health symptoms, then label that person "difficult," "selfish," or even "dangerous" when they don't accept what we tell them and refuse help. But remember, it may not be unwillingness - it could be anosognosia.

The information presented is solely for educational purposes, not as specific advice for managing physical or mental disabilities. Please consult a professional who can apply best practices and appropriate resources to your situation.

The individual(s) who have written and created the content in and whose images appear in this article have been paid by Teva Pharmaceuticals for their contributions. This content represents the opinions of the contributor and does not necessarily reflect those of Teva Pharmaceuticals. Similarly, Teva Pharmaceuticals does not review, control, influence or endorse any content related to the contributor's websites or social media networks. This content is intended for informational and educational purposes and should not be considered medical advice or recommendations. Consult a qualified medical professional for diagnosis and before beginning or changing any treatment regimen. 

NPS-ALL-NP-01429 JANUARY 2025