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“I don’t need medicine there's nothing wrong with me.”

What is anosognosia?

Anosognosia means that the person does not recognize that he/she is sick. This "lack of insight," is a symptom of severe mental illness which impairs a person’s ability to understand and perceive his or her illness. It is the single largest reason why people with schizophrenia or bipolar disorder refuse medications and treatment. Without awareness of the illness, refusing treatment appears rational, no matter how clear the need for treatment might be to others.

What Causes Anosognosia?

Someone with anosognosia isn't simply in denial or being stubborn. Their brain can't process the fact that their thoughts and moods don’t reflect reality.

Anosognosia results from damage to an area of the brain involved in self-reflection.

Everyone updates their mental image of themselves. Whenever you gain new information about yourself -- a haircut -- it factors into how you think about yourself. In order for it to go smoothly, your brain’s frontal lobe has to take in the new info, organize it, use it to edit your self-image, and remember that latest version.

Brain imaging studies have shown that the brain’s frontal and parietal lobe can be damaged by schizophrenia and bipolar disorder. When the frontal lobe is damaged, a person may lose—or partially lose—the ability to update his or her self-image, which happens often with illnesses like schizophrenia and bipolar disorder,

Without an update, we’re stuck with our old self-image from before the illness started. Since the perceptions feel accurate, the conclusion is that loved ones are lying or making a mistake.

How big a problem is it?


Anosognosia is common in people with serious mental illness. Doctors think about 40% of people with bipolar disorder and 50% of those with schizophrenia have it. Some psychiatrists believe the numbers are even higher. They estimate that anywhere from 57%-98% of people with schizophrenia have it.

“That proves you mad because you know it not"

Is this a new problem?

Impaired awareness of illness in individuals with psychiatric disorders has been known for hundreds of years. In 1604 in his play “The Honest Whore,” playwright Thomas Dekker has a character say: “That proves you mad because you know it not.”

Are there ways to improve a person’s awareness of their illness?

Studies suggest that approximately one-third of individuals with schizophrenia improve in awareness of their illness when they take antipsychotic medication. Studies also suggest that a larger percentage of individuals with bipolar disorder improve on medication.

Why is impaired awareness of illness important in schizophrenia and bipolar disorder?

Impaired awareness of illness is the most common reason individuals with schizophrenia and bipolar disorder not take medication.

They do not believe they are sick, so why should they? Without medication, the person’s symptoms become worse. This often makes them more vulnerable to being victimized and committing suicide. It also often leads to rehospitalization, homelessness, being incarcerated in jail or prison, and violent acts against others because of the untreated symptoms.


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