Fear Tactics in Advocacy: Anosognosia


Fear Tactics in Advocacy: “Anosognosia”

January 5, 2016 AnosognosiaAssisted Outpatient Treatmentcivil libertiesmental healthpolicy

JoanArnold

By Jean Arnold, National Stigma Clearinghouse

(Original post can be found here.)

Has  “anosognosia” tripled in ten years?

The diagnostic term “anosognosia,” was created in 1914  by Joseph Babinski, a French-Polish neurologist.  The diagnosis is primarily given to stroke patients who have lost awareness of a body part, a condition attributed to brain lesions.

In 2000, intense lobbying by Dr. E. Fuller Torrey and  Dr. Xavier Amador convinced psychiatrists to add anosogosia to the psychiatrists’ diagnostic bible, the DSM-IV.  Anosognosia can be used to justify coercive treatment; this and the uncertainty of its relevance to mental illnesses raises moral and ethical concerns among its critics.

Prior to the brain lesions diagnosis, a “lack of insight” concept had allowed patients at least some voice concerning their treatment and medications.  Now, supporters of involuntary outpatient commitment have reportedly conflated the older term with anosognosia.

It’s worth noting that in 2004, Anthony S. David and Dr. Amador estimated that 15% of people with schizophrenia were affected by anosognosia (source: Wikipedia)  That estimate has increased alarmingly. The 15% has grown to 50% for people diagnosed with schizophrenia, 40% of those with bipolar disorder.  Coercion supporters also consider potential violence to be a hallmark of anosognosia.

An even further escalation of anosogosia has come from promoters of Congressional bill HR 2646, the Helping Families in Mental Health Crisis Act.  When asked by a radio host if mentally ill people are more likely to be violent, Rep. Tim Murphy, co-author of HR 2646, prefaced his circuitous answer by noting that “we’re dealing with 60 million folks…”  (10 million is the typical estimate of people diagosed with schizophrenia and bipolar disorder.)  The Murphy statement suggests a flexible approach to diagnosing anosognosia.   

How times have changed since 2000.  In Dr. Amador’s book. I’m Not Sick, I Don’t Need Help, he considered coercive treatment to be counter-productive. The book makes a convincing case that a treatment partnership is more effective than coercion and its results are more lasting.

For more information:

  • Anosognosia: How Conjecture Becomes Medical Fact” by Sandra Steingard, MD, concerning the rise of the term “anosognosia” in psychiatry
  • Read more about insightul awareness in “The Issue of Insight” by Larry Davidson, Yale University Medical School
  • Here’s a brief description of the source of the word “anosognosia:”
    June 11, 1914: In a brief communication presented to the Neurological Society of Paris, Joseph Babinski (1857-1932), a prominent French-Polish neurologist, former student of Charcot and contemporary of Freud, described two patients with “left severe hemiplegia” – a complete paralysis of the left side of the body – left side of the face, left side of the trunk, left leg, left foot. Plus, an extraordinary detail. These patients didn’t know they were paralyzed. To describe their condition, Babinski coined the term anosognosia – taken from the Greek agnosia, lack of knowledge, and nosos, disease.
  • Is an Ominous New Era of Diagnosing Psychosis by Biotype on the Horizon?By Michael Cornwall, PhD, com
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