Anosognosia: Who is Lacking the Insight?

Patient Expert

This is an opinion piece. Please bear with me.

Perhaps you have heard the term, "anosognosia." Dorland's Medical Dictionary defines it as "unawareness or denial of a neurological deficit." Apparently, many people with neurological conditions may lack an awareness of their paralysis.

Back in 2001, in the book, "I'm Not Sick, I Don't Need Help," Xavier Amador argued for the expansion of the term to include people with mental illness who lack insight into their condition.

NAMI immediately embraced Dr Amador, and in no time its spokespersons were using the term in this context, as if they were referring to a scientifically validated psychiatric condition. According to the NAMI website:

When a person cannot appreciate that they have a serious psychiatric illness, a tremendous challenge to family members and caregivers follows. About one-half of people living with schizophrenia, and a smaller percentage who live with bipolar disorder, have this clinical feature.

Talk to any parent who has been looking after someone with serious mental illness, year in, year out, and you get real-world validation. One cannot help but identify with the tremendous sacrifice and hardships these parents have endured. But hard cases make bad science, in this case pseudo-science.

Survey any population of people with severe mental illness, and you are sure to find the lack of insight you are looking for. But here is the $64,000 question: Is lack of insight restricted to the mentally ill?

The Dunning-Kruger Effect is a form of cognitive bias. It tends to refer to people who are too stupid to recognize they are stupid. More loosely, we can apply it to all those who think they drive better than average, which is just about everyone.

We all like to believe we are superior. But those with true insight experience self-doubt. Perhaps you see a major irony in the making, here: Some of those who use of the term, anosognosia, could be experiencing their own lack of insight. Call it anosognosia. Call it the Dunning-Kruger Effect.

The last thing we need is so-called normal people with no insight using anosognosia as a term to beat us over the head with a stick. I have seen it happen.

As I said, I have great sympathy for parents of kids with severe mental illness. I am also prepared to cut NAMI a little slack. But the latest edition of the DSM, published by the American Psychiatric Association, now includes in its glossary the term anosognosia, with a definition that nearly matches NAMI's.

This is plain wrong on every level.