This post is different from almost any I have ever written. It is basically a response to some of the responses that I got to the response that I got to a previous post “Psychiatric Anosognosia.” This is almost unheard of for me. I seldom, if ever, comment on other people’s comments. It rarely seems to clear anything up. People who are convinced that you are wrong will find reason in everything you say to congratulate themselves on how right they are and anyway everyone is entitled to their views anyway as long as they are shared in a context of mutual respect.
But this has been a different experience. First of all the amount of response was astonishing. Secondly many people missed the point of the whole article. And finally many people made assumptions about what I believed, where I was coming from etc. that simply were not true. In the end perhaps this response will be unimportant but maybe I am really only writing it for my benefit anyway.
I heard so much about what a proven scientific fact anosognosia was and many people just seemed to marvel that I appeared not to understand that. My major point in the beginning was not to argue the truth or untruth of this, but only to point out, what I saw as obvious. The people promoting this idea had a strong agenda to promote. They cloak everything in “scientific talk” but in reality are no more objective than anyone else. I found the article linked above which examined the validity of the scientific status of anosognosia using the very studies the Treatment Advocacy Center uses to defend it. The article was written by a psychiatrist Dr. Sandra Steingard and it says more about the notion of anosognosia than I could ever say and says it better than I could ever say it. The title of the article is “how conjecture becomes medical fact.” I hope you read it, but a couple of ideas in it really stood out for me.
1. You cannot look at a brain scan and determine who has “anosognosia” and who has not. That makes me wonder about how it is “proved”, but Dr. Steingard has a lot to say about that. Unless I am sadly mistaken (again read the article) I dont think you can look at the brain scan of someone with schizophrenia and see that either. The damage that is “there” is according to current scientific testing sadly invisible.
2. BUT if you look at the scan of someone who has had a stroke and who has anosognosia the damage is real clear. It makes me wonder if this is a true concept or if it is only an analogy with a neurological concept hoping to give it more substance. Concept or conjecture?
Read the article and see what you think. I found it compelling.
There is so much about the concept that gives me trouble it is hard to know where to start. On this whole issue of blindness so many things seemed problematic to me. Many people shared tragic anecdotes of people in their families that were “blind” to their problems and lacking insight lived sad lives with crushing problems. Does that happen?? Yes of course and far too often. But does the existence of any problem prove your explanation of that problem? If so then anecdotes would seem to prove everything and the only question would be who has the best story. Simply put does the existence of people without insight prove some kind of neurological damage preventing them from seeing? NO. The existence of the problem does not prove any certain explanation. That must be done on independent grounds. Perhaps people who are delusional are delusional because they dont know they are delusional.
I confess to a large degree of cynicism about the 50% figure. I kept wondering how they know and have never found anything that explains how they know to me. A couple of people thought I was really naive and obviously have never seen a real live schizophrenic. I have worked in the mental health field for about 35 years now, the majority of it in inpatient settings. I have been everything from a front line counselor to a therapist to social worker to program director. I have worked in places regarded by most as terrible programs and in places regarded as good and even great programs. I have met many people labeled schizophrenic and bipolar. In the thousands I actually believe. Have I known people psychotic and chronically delusional. Yes..Yes….Yes…. Are 50% of them lacking insight?? Do they not know that something is wrong?? I am so sorry but, unless I have just hung with the wrong people, that figure is simple way off the charts.
Obviously there is much to say on the subject, but I have probably said too much to begin with. I dont know that any minds will change. The response of so many people to this and other posts have been truly gratifying to me. Some of the people who disagree with me have been the most impressive. Many people have fought for loved ones in a system that so often offers so little options, so little help, so little resource. Their courage is inspiring. We badly, badly need a new conversation about mental health in this country. People are dying for lack of it. Thanks for so many who gave a few minutes of their time to share their ideas with me.
And I promise these are my last words on the subject