When a
person cannot appreciate that they have a serious psychiatric illness, a
tremendous challenge to family members and caregivers follows. About one-half
of people living with schizophrenia, and a smaller percentage who live with
bipolar disorder, have this clinical feature. Individuals with Alzheimer's
disease and dementia also often have this feature. The medical term for not
seeing what ails you is anosognosia, or more commonly known as a lack of
insight. Having a lack of awareness raises the risks of treatment and service
nonadherence. From the person's point of view, if they feel they are not ill
why should they go to appointments, take medication or engage in therapy?
Why can't
a person see what is so apparent to those around them? The best thinking
indicates this is a core feature of the neurobiology of the conditions. Frontal
lobes organize information and help to interpret experiences. In conditions
like schizophrenia and Alzheimer's disease, frontal lobe difficulty is central
to the neurological processes that underlie the disorders. Psychological denial
is not the reason for the lack of insight in these illnesses.
There are
situations where a person's lack of insight can, at times, create dangerous situations.
This combination of no insight and dangerous acts often requires intervention.
In more than 40 states, there are laws for Assisted Outpatient Treatment (AOT),
also known as outpatient commitment. AOT status requires a person to engage in
treatment and gives the state authority to bring the person to a treatment
center if they do not. All states that have these laws have protections and a
process for assessing whether this intervention is appropriate. In most states,
doctors are required to submit an affidavit of the person's state and the
reasons for the requested AOT status and a judge decides.
NAMI: www.nami.org
AOT:
For a list of current state laws see www.treatmentadvocacycenter.org
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