Public Comment

Anosognosia. In a psychotic person, it is the absence of the basic insight that they are ill and need help, and it is nearly intrinsic to the nature of the disease. If we knew we were psychotic, it would be an indicator that we had a partial grip on reality. And this, in turn would mean we'd have a good chance at moderating our actions and getting back into treatment. When in the grips of psychosis, it is effectively by definition that we don't know or understand we are psychotic.

When I've become ill in my past, I suffered from short-term anosognosia. It was resolved after being adequately medicated a few weeks. I have some guesses concerning how this condition might behave in those less fortunate than I, and what could be done to resolve it. But they are only guesses, no more--a clinician should know more.

Here are my thoughts: 

Anosognosia probably has a time factor. A patient is released from the hospital too soon, at a stage of recovery before gaining the insight they are ill. If kept longer and kept medicated, by force, if need be, it might take a little while (weeks to months, or maybe longer for some) to gain essential insight. The insight becomes possible upon sufficient time following restoral of meds and being kept in a safe, supervised environment. 

The time factor of anosognosia is crucial. (Again, I am only taking educated guesses.) Patients are very often released far too soon. This too early release of psychiatric patients is often a financially based policy mistake on the part of hospitals. They have limited funds, limited bed space, and they assess people in too quick a manner. Psychiatrists might only spend fifteen minutes a day speaking directly to a psychiatric inpatient, again because of economic reasons. 

It’s a dumb policy for hospitals to have, but it is common practice. It is bad for the patient because they can't get well. This produces far more economic ramifications compared to helping someone truly get well by giving them the attention and the time they need. It is the actual cause of "the revolving door syndrome"--in which the patient is blamed. 

Too quick and too easy a release can have devastating outcomes. I'm not going into details here because I don't want to disturb the readers. 

Thus, I am saying, part of the cause of what we call "anosognosia" consists of policy and is not necessarily caused by the patient. Yet patients are punished for it by being forced into excessive restrictions. This is all about the taxpayer's money. 

Anosognosia is a popular term to toss around. In some cases, it is not specifically caused by the patients' brains at all; instead, the origin is environmental, and points to inadequate treatment. I question its existence apart from hospital policy. This is not to say it never exists as a medical condition. But as a standalone medical condition it could be rare, and the label of it could be applied far too often. 

If inpatient care became more thorough, we could keep people inpatient longer and give them the attention they need, and this could go a long way toward addressing this condition, in which, once again, we are given an unflattering and hurtful label.