ANOSOGNOSIA AND LACK OF INSIGHT

Abstract

I present an empirical review and theoretical discussion of the two types of lack of awareness as it relates to mental illness: anosognosia and lack of psychological insight. Anosognosia results from damage to the brain either through external events or natural degradation. Its psychogenic counterpart, lack of psychological insight, results from defense mechanisms such as intellectualization, rationalization, or denial. In addition, lack of psychological insight may be the result of delusions, defined as fixed, false beliefs. The areas of the brain associated with anosognosia include whole hemispheres or specific regions such as the orbitofrontal cortex or the superior frontal gyrus. These brain regions are primarily associated with self-monitoring, self-referencing, self-control, and decision-making. The right hemisphere of the brain, associated with "big" picture thinking, was found to be impaired in several studies of patients with anosognosia, while the left hemisphere remained functionally normal. There are a wide array of treatments available for anosognosia. These range from medications such as Clozaril, to ocular stimulation, to simple reporting of cognitive discrepancies. The efficacy of these treatments is questionable. The brain regions associated with anosognosia are found to be associated with lack of psychological insight as well. However, since anosognosia results from physical damage and lack of psychological insight results from defense mechanisms, it cannot be concluded that they have the exact same causes. Lack of psychological insight can have devastating consequences for mentally ill individuals. The efficacy of treatment for lack of psychological insight relies on empathy and connection to solve the emotionally challenging process of diagnosis. In order to lessen anosognosia and lack of insight, new treatments should be developed that combine the solutions for both. A simple, straightforward process of revealing cognitive discrepancies, which has been shown to be effective for anosognosia, should complement an empathic psychotherapy style that makes these processes less worrisome.