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Phoney Anosognosia

Formerly the way psychiatric staff discounted the ontological being of their wards was through the concept of ‘denial’. The patient who claimed not to be ‘mentally ill’ was perceived as being more ‘mentally ill’ than the patient who claimed to be ‘mentally ill’. Claiming not to be ‘mentally ill’, or claiming to be ‘mentally well’, were grounds for keeping the patient in the facility awhile longer. The patient who claimed to be ‘sick’ had acknowledged he or she had a ‘mental illness’, and thus he or she was felt to be farther along in their treatment than the patient who ‘denied’ this assumption.

The patient has few options in these instances but to go along with the staff. If he or she doesn’t go along with the staff, he or she isn’t discharged from the hospital. This Catch 22 is what hospitalization so often is all about; giving the staff the response they want to see. If giving them a lie gets you out of the place, well, then you must give them a lie. There is no middle ground here. One group has the power, and the other group doesn’t have the power, and that’s the deciding factor.

The reverse situation doesn’t happen. The staff is seldom, if ever, asked to question their diagnostic presumptions. The staff cannot be ‘in denial’ about a patients mental condition because the staff, unlike the patient, are not bound to the legalistic and symptomatic criteria that permits hospitalization in the first place. As long as patients as a rule can’t be kept any longer than 6 months, without violating the Olmstead Act, those mistakes that might be made can be relatively easily swept under the rug.

Now the staff has another weapon in their arsonal to use against their prisoners with the recent introduction of the term Anosognosia into the field of mental health care. Anosognosia is a very real condition that strikes victims of brain injury and stroke. Anosognosia occurs when a person with a disability, such as blindness or deafness, is unaware or ‘in denial’ about having that disability. In psychiatric terms this translates into a ‘lack of insight’ regarding the seriousness of one’s condition. If it has a real basis when it comes to brain injury, this is a problem with communicating between hemispheres of the brain, in psychiatry, it’s a purely bogus designation. It is a fabrication. It is bunk.

E. Fuller Torrey, psychiatrist and founder of the Treatment Advocacy Center, a group that lobbies for forced outpatient treatment laws, and a number of his cronies, came up with the idea of appropriating this term that applies to a neurological condition into the world of mental health treatment. Now the patient who ‘denies’ he or she is ‘sick’ is not simply ‘in denial’ about his or her ‘mental illness’, but he or she exhibits a ‘lack of insight’, another symptom of his or her ‘disease’.

You get a lot of talk about the stigma attached to mental illness these days. What you don’t hear about so much is the extent of the oppression under which patients and former patients operate. How is what is thought of as mental stability supposed to be achieved when any claim to stability is seen as a sign of instability? Much ink has been spilled over the concept of recovery in recent years, but many patients use this concept of recovery merely as a ruse to continue in mental health treatment indefinitely. What’s more, there will always be those who will perservere in their ‘denial’ and their ‘lack of insight’ until the rest of the world agrees with them.