Doubting the Diagnosis

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People with serious mental illnesses don’t always believe that the conditions are real. In fact, many times the most serious illnesses come with a lack of insight. Severe bipolar disorder Type I, for example, where symptoms cycle on and off, commonly leaves people wanting to believe that they don’t really have an illness, something just went haywire for a little while, but the symptoms won’t be coming back.

People with psychotic symptoms from underlying schizophrenia or schizoaffective disorder might have delusional (false) beliefs, but insist that the beliefs are absolutely real: “The FBI is monitoring me, and you just don’t believe me!”

If your mental health condition causes false beliefs, it makes sense that one such false view could be about the presence of the condition itself.

An illness that distorts reality doesn’t stick neatly to the territory of beliefs about the FBI; it affects beliefs about the illness itself too.

In psychiatry, this lack of understanding or belief in the illness is so pervasive, it has many names: lack of insight, treatment resistance and anosognosia. These terms all mean one simple thing, that the person with the symptom doesn’t believe that they are in fact having a symptom.

But why does a lack of insight affect so many people with mental health diagnoses? Well for one, the disease processes themselves may be to blame. If your mental health condition causes false beliefs, it makes sense that one such falsehood could be about the presence of the condition itself. But that‘s not the sole underlying reason for a lack of insight about mental illness. Some conditions affect trust in other people, and some affect intuitions or the ability to read facial expressions and emotions.

When your primary goal in life is to claim independence and find yourself, it can be hard to accept anyone’s claim that you’ve got a problem that might affect those goals.

Aside from the biology of mental illness, there are psychosocial factors that affect the ability to accept the illness’s veracity. For starters, many mental illnesses begin right around the time a young adult is attempting to break away from his or her parents. It may be the parents or other members of the family who step in and identify that something is wrong, and this may coincide with attempts to claim independence and separate from the family to start life on one’s own. When your primary goal in life is to claim independence and find yourself, it can be hard to accept anyone’s claim that you’ve got a problem that might affect those goals. And it can be even harder to grab some control from parents just to give it back to them a short while later.

Posted on October 15, 2018 by Melissa Deuter.