Anosognosia: When You Can’t See Your Own Illness

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Disclaimer

This article is for educational and awareness purposes only. It is not intended to provide medical advice, diagnosis, or treatment. If you or someone you love is experiencing a medical or mental health crisis, please seek help from a qualified healthcare professional immediately.

If you are in the United States and are struggling with thoughts of suicide, you can text HOME to 741741 to connect with the Crisis Text Line and speak with a trained counselor right away. If outside the U.S., please check local hotlines in your area or call your local emergency number.

What if someone had an illness — but their brain simply wouldn’t let them see it? This isn’t stubbornness, pride, or denial. It’s a condition known as anosognosia, and it changes the way people experience both medical and mental health challenges. For families, friends, and communities, understanding anosognosia isn’t just about knowledge — it’s about compassion, safety, and even suicide prevention.

What is Anosognosia?

Anosognosia is a medical term that means “without knowledge of disease.” It describes when a person genuinely cannot recognize that they have an illness or disability.

Doctors first noticed anosognosia in people recovering from strokes who insisted they could move a paralyzed arm or leg. Today, it’s also recognized in mental health conditions like schizophrenia, bipolar disorder, and dementia.

This isn’t about being in denial. It’s about the brain being unable to process the reality of the condition.

How is it Different from Denial?

It’s easy to confuse anosognosia with denial, but they are not the same:

• Anosognosia is caused by brain changes. The person is genuinely unaware of their illness.

• Denial is a psychological defense mechanism. The person is aware on some level but avoids the truth because it’s too painful.

  
  

Think of it this way: denial is emotional, anosognosia is neurological.

What Causes Anosognosia?

Scientists believe anosognosia happens when parts of the brain involved in self-awareness and error-detection — especially the frontal and parietal lobes — stop functioning as they should.

• After Stroke or Brain Injury: Someone may insist they can move a limb that is paralyzed.

• In Mental Health Conditions: Changes in brain chemistry and circuits (dopamine, glutamate, frontal lobe networks) can prevent insight in disorders like schizophrenia or bipolar disorder.

• Error Detection Breakdown: Normally, the brain notices when something doesn’t work as expected (“I tried to move my arm, but it didn’t move”). In anosognosia, this error detection doesn’t fire correctly — so the person’s self-map doesn’t update.

  
  

Anosognosia & Suicide Prevention

When we think about suicide prevention, we often picture hotlines, medication, or therapy. But anosognosia is a hidden factor that can block access to all of these.

• Unrecognized illness = untreated risk. If someone doesn’t believe they’re ill, they may stop medication, skip therapy, or avoid medical care — all of which increase the risk of suicide.

• Families often misinterpret it. Loved ones may think the person is being stubborn or defiant, when in reality their brain cannot see the illness. This misunderstanding fuels conflict and isolation.

• Compassion saves lives. When we understand anosognosia as a brain-based condition, we can shift our approach from argument to empathy. Instead of “Why won’t they accept help?” we can ask, “How can I support them safely until they’re ready?”

  
  

What Helps:

• Gentle approaches like motivational interviewing or “LEAP” (Listen, Empathize, Agree, Partner).

• Focusing on safety, trust, and connection rather than confrontation.

• Educating families so frustration turns into patience.

• Using peer support, community programs, and crisis planning to build safety nets.

  
  

Nuance & Challenges: When Medications Make Things Worse

It’s important to acknowledge not everyone with anosognosia — or with a mental health condition — benefits from medication. Some try medications and feel worse. Others are medication-sensitive or carry genetic variations (like in CYP2D6 or CYP2C19 enzymes) that affect how their bodies metabolize drugs.

For these individuals, even when they do try treatment, the medications may cause severe side effects or simply not work. This can increase despair and hopelessness — especially if their concerns are dismissed.

Suicide prevention in these cases must expand beyond medication:

• Beyond Pills: Therapy, peer support, safe housing, and meaningful community programs can be lifesaving.

• Listening to Experience: If someone says a medication makes them worse, that truth must be honored.

• Personalized Care: Genetic testing (pharmacogenomics) and trauma-informed care can guide safer alternatives.

• Building Trust: Relationships rooted in respect and patience are often the strongest form of prevention.

  
  

Key takeaway: Suicide prevention must never be one-size-fits-all. For some, medication is life-saving. For others, it is unsafe. Our role is to provide a circle of safety and hope that meets each person where they are.

Conclusion

Anosognosia reminds us that not all barriers to care are visible. Sometimes the biggest obstacle isn’t refusal — it’s the brain itself. By understanding anosognosia, we can replace frustration with compassion, reduce conflict within families, and build pathways toward safety and hope.

And when we acknowledge that treatment looks different for every individual — whether through medication, therapy, peer support, or community care — we expand the ways we can save lives.

Because at the heart of it all, suicide prevention is not about forcing compliance. It’s about walking beside people, honoring their experience, and reminding them that hope still exists — even when they cannot yet see it.

References

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

2. Orfei, M. D., Robinson, R. G., Prigatano, G. P., Starkstein, S., Rüsch, N., Bria, P., & Caltagirone, C. (2007). Anosognosia for hemiplegia after stroke is a multifaceted phenomenon: A systematic review of the literature. Brain, 130(12), 3075–3090. https://doi.org/10.1093/brain/awm106

3. Amador, X. F., & David, A. S. (Eds.). (2004). Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders (2nd ed.). Oxford University Press.

4. Shad, M. U., Tamminga, C. A., Cullum, M., Haas, G. L., & Keshavan, M. S. (2006). Insight and frontal cortical function in schizophrenia: A review. Schizophrenia Research, 86(1–3), 54–70. https://doi.org/10.1016/j.schres.2006.06.005

5. National Alliance on Mental Illness (NAMI). (2021). Anosognosia. Retrieved from https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Anosognosia

6. Velligan, D. I., & Lam, F. (2016). Insight and adherence to medication in schizophrenia: An update. Current Psychiatry Reports, 18(8), 1–7. https://doi.org/10.1007/s11920-016-0704-1

7. Meyer, U., & Feldon, J. (2010). Neurodevelopmental origins of schizophrenia. Psychiatric Clinics of North America, 33(1), 35–57.

8. Weinberger, D. R., & Harrison, P. J. (2011). Schizophrenia (3rd ed.). Wiley-Blackwell.

9. Phillips, M. L., & Kupfer, D. J. (2013). Bipolar disorder diagnosis: Challenges and future directions. Lancet, 381(9878), 1663–1671.

10. Phillips, K. A., et al. (2001). Pharmacogenetics and mental health: The role of cytochrome P450. American Journal of Psychiatry, 158(9), 1442–1451.