Forthright Magazine

Lack of insight (Part 1)

Ever heard of anosognosia? No? The medical community estimates that 3 million Americans suffer with this affliction each year.

I found Harold sitting in the foodcourt of a retail chain. His unkept beard, odor and disheveled clothing exuded a singular message. Harold was homeless.

As he sat staring at the four plastic cards on the table before him, he lamented,  "This is everything I own." Among those four cards was his driver’s license. At least he still had that – even if the car was gone.

To the question "what happened?," he blamed AI and an economic downturn for eliminating his high tech employment.  To prove his point he cited two other engineers out of work. In his mind, AI was replacing engineers. He coupled this with the high salary cost of professionals like himself. These were the fundamental reasons why he was unemployed and homeless.

His hands and fingernails were dirty from the grime of rummaging through trash. So why hadn’t he acquired another job? To each question about why he was homeless, he pointed to problems in the world. Harold was convinced the sources for all of his problems were external: other people, AI, economics, social structures and so forth.

Reality check: Harold had stopped taking his medicine because he didn’t think he needed it. Then a mental health episode had erupted preventing him from thinking clearly and working. The company eventually terminated him for failing to show up for work. Howard’s unemployment had nothing to do with his high salary, an economic downturn, AI nor his particular engineering field becoming irrelevant.

The root of Harold’s problem was an untreated mental illness. He needed to take his medicine in order to return to health. But he refused to do so, because he was just fine. Why should he take medicine? No one was going to force him to take medicine! He was just fine.

Harold was not in denial. Rather he exemplified "the lack of insight" which medical professionals call anosognosia. Among those with certain diagnoses of severe mental illnesses, some estimate the percentage range of anosognosia to be from 50% to 60%. Other sources will cite that certain diagnoses have percentages as high as 98%.

Does this sound unreal? To assist us in experiencing what it is like to be trapped in their world, imagine someone telling you that you are not married to your spouse. Rather, you are sick and have been stalking this person for 5 years. Furthermore, you need to take some medication or there would be civil consequences for stalking.

But you counter that you remember your wedding day. You remember vacations. You know that this person is your spouse!

How would you respond to allegations that your memories are false delusions? Would you take the medicine? Or would you continue to insist you are married? Would you claim there is nothing wrong with you? Would you object? Those with anosognosia are just as confident about what they know and their health.

Around 3 million Americans suffer with "lack of insight." This horrible condition can not only ruin their lives, but it also impacts the lives of those around them. Yet, there is another lack of insight that is far greater and far more dangerous. Next week – part 2.


 

Barry Newton
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