In this series, I dig a little deeper into the meaning of psychological terms. This week’s term is anosognosia.
I wouldn’t be surprised if you haven’t heard this term before, so let’s break it down. Agnosia is an inability to recognize people or things. Nosology is the classification of diseases. Throw the two together, and you get anosognosia, which is a lack of self-awareness of one’s own disease/disorder.
What lack of insight is
Anosognosia can happen in a neurological context as a result of traumatic brain injury or some other form of physical damage, like a stroke.
Anosognosia is also used to describe a total lack of insight into mental illness. It refers both to a lack of awareness that one’s experiences are a result of illness as well as an inability to recognize that treatment could be beneficial. Insight can exist on a continuum, ranging from good to none (i.e. anosognosia). It requires higher-level brain functions, particularly involving the prefrontal cortex), to properly self-evaluate. In mental illness, sometimes those higher-level functions are impaired, reducing the individual’s capacity to recognize their own illness.
People with psychotic conditions such as schizophrenia are more likely to have a lack of insight. Poor insight is not uncommon in acute mania. In depression, lack of insight could involve attributing their experiences to being fundamentally a horrible human being.
What it isn’t
Disagreeing with a diagnosis is not in and of itself a lack of insight. Someone might recognize that they are experiencing symptoms of an illness, but disagree with their physician on what condition best accounts for those symptoms. Someone with partial insight might recognize that they’ve had a decline in functioning, but have no idea why. Partial insight could also be manifested as awareness that certain symptoms are due to illness, but believing that others are not. As an example, someone with schizophrenia might recognize that hallucinations are probably due to their illness, but remain firmly fixed in their belief that a delusional idea is reality-based.
Lack of insight related to the need for treatment isn’t the same as declining a particular form of treatment someone doesn’t believe is the right fit for them. It involves the effects of the illness diminishing one’s capacity to recognize that treatment would be helpful and reasonably consider the pros and cons. This is where involuntary treatment may come into play.
The Beck Cognitive Insight Scale was developed to evaluate the extent to which people experiencing psychosis were able to integrate reality-oriented feedback about their delusions. Some of the items on the 15-item scale are:
- “My interpretations of my experiences are definitely right.”
- “Some of the ideas I was certain were true turned out to be false.”
- “If something feels right, it means that it is right.”
- “I cannot trust other people’s opinion about my experiences.”
- “If somebody points out that my beliefs are wrong, I am willing to consider it.”
While a standardized test might be helpful to quantify variations over time, in my work as a mental health nurse, it’s usually fairly easy to determine the level of insight someone has without using any form of structured test.
With my own illness, I’ve generally had pretty good insight. I haven’t always agreed with treatment providers, but that had more to do with my opinion of them than any lack of awareness of my symptoms.
What has your insight been like over the course of your illness?
You can find the rest of the what is… series in the Psychology Corner.