Family and Caregiver Schizophrenia Discussion Forum

Anosognosia: Lack of Insight Into Mental Illness

Some people afflicted with schizophrenia have bouts of psychosis with long periods of “normalcy,” while others are in a constant psychotic state, regardless the anosognosia may remain constant, and neither medication nor aging may make a difference.

Has anyone overcome anosognosia?
If so, are you willing to share what it is that you found helpful? Thank you.

One person helpfully shared that that he got over anosognosia, with time.
He made notes on delusions and revisited them, two weeks later, to see which ones panned out to be true.
After getting enough evidence to disprove his paranoid thoughts, he moved on.
This took a long time.
He suggests some people may get lucky with meds, and some with psychological talking therapies.

Maybe it also has something to do with how open and sharing you are as a person? If your personality tends to be more closed and private, it may be harder to be receptive examining the delusions … My mother never wishes to discuss it.

@Lily1 recommended that caregivers keep a daily journal, documenting:
Mood, Hygiene, Sleep patterns, Communication patterns, Eating patterns, Bizarre behaviour
That helps if your loved one is living with you.
You can still keep a journal if they are not, but it may have different details.

The journal may be helpful for the doctor, etc. It may be less helpful for the loved one, as they didn’t write it themselves.
Even so, my mother writes down what she ‘sees’, but still considers it real despite any evidence to the contrary.

The problem is when the impaired ability to interpret new information leads to false perceptions or misguided beliefs, and that leads to poor judgement and detrimental actions.

According to psychologist and schizophrenic sufferer, Frederick J. Frese — convincing a schizophrenic of their condition can sometimes be accomplished by a trusted individual who can “… gradually chip away or ‘defreeze’ the rigid cognitive defensive structure that constitutes the denial.” This could involve giving the sufferer examples of their psychotic behaviors, during their most rational moments (when they are able to reason more accurately).

Strong, positive social ties can help people develop more accurate evaluations of the external world, serving as surrogates or validators for the person’s own perceptions.

However, even with strong, positive social ties, this may not be enough.
I’m interested in learning what has worked for people and welcome all comments.
Thank you.

I wouldn’t say I had full-on anosognosia, but my insight certainly improved over time. Rather than go into detail and repeat much of what I’ve said, I’d advise you to go over my post history. Mine is an unusual and atypical case, so I’m not sure how applicable it would be for a more typical expression path of SZ/SZA.

The best way to describe my recovery is I rolled-my-own LEAP, CBT and occupational therapies. For LEAP, I faithfully saw a Jungian Psychologist for a year who listened to and emphasized with my symptoms without passing judgement. At this time I was unmedicated and I eventually was hospitalized after a very stressful period. All this time I was employed part-time and going to school. This was part of my occupational therapy regime. At work and school I learned coping mechanisms to hide and deal with my symptoms as well as various social and work skills.

After hospitalization I came to the conclusion that if I didn’t start medication, I was likely to lose my job because I was losing my ability to focus on my work and mask my symptoms. I also agreed and partnered with my psychologist to find a psychiatrist and improve my social skills by joining a singing group, taking voice and acting lessons and eventually participating in musical theatre productions. This was a second part of my occupational therapy and something I continue to be active with today. I also started attending NAMI meetings with my parents.

On the CBT front, I employed bits a pieces of philosophy I learned in college classes to my situation (logic and epistemology) and synthesized them with scientific and troubleshooting methods I learned at work and school to help me process information like hallucinations, misperceptions and delusions. Reality checking and verification of methods and testing of hypotheses as well as understanding limitations of your ability to understand or know things were part of this self-taught CBT program. I also used my own dime store psychology and internal monologues and mantras to reinforce these methods.

Eventually I became quite adept and confident in my abilities and synergies of medication, occupational, Jungian Therapies and my own study about the disease made much of this second nature. Eventually I advanced in my career, finished school, and became somewhat accomplished as a singer, actor and at stagecraft, and as a result gained a social network. I occasionally have symptoms, but they are very mild and I feel confident I know how to deal with them when they arise. I’m now self sufficient, own my own home and have friends and some long-term relationships. To most eyes I have recovered and most people do not know I have an illness.


Wow, that’s impressive! Thank you for your detailed and thoughtful response in sharing your success. We can all learn something from this, neurotypical and sz/sza, alike.
It’s very encouraging that with your own persistence and thirst for knowledge, combined with a supportive psychologist and psychiatrist, along with the leap and cbt, you have achieved your goals. I’m going to share this with my cousin, who’s son is in his early 20’s, suffering psychosis and currently refusing to continue injections and anosognosiac - so unaware he needs the medication. It may give her some comfort to know what has worked for you.
Congratulations and thank you for the inspiration. :smiley:
I hope to hear about some other personal journeys as well.

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Thank you. I also recommend ‘The Center Cannot Hold’ by Elyn Saks. If you are not aware of her, her journey is similar to mine, but she is much more accomplished. She is a doctorate of law and tenured professor at USC. She also was granted the McArthur ‘genius’ prize. The main differences between us are: she is more of an advocate of an offshoot of Freudian rather than Jungian Analysis; Her expertise is in Law rather than Science and Technology; and to my knowledge she did not pursue the Arts as psychosocial rehabilitation.

Edit: P.S. the length of her hospitalizations and her symptoms were also more profound than mine.

Every path is unique. I will look that up, thanks for the recommendation!
I’m a firm believer that a well rounded approach is preferable to only medication.
Medication is a key component, but that alone will not allow people to reach their potential.
You utilized many different tools in concert with one another, and the results are impressive — you’ve accomplished a great deal. Everyone’s goals will be different, and we can’t compare ourselves to one another, but certainly we can try to emulate what we think might work for us as individuals. Sharing is caring. I really appreciate your input.

Here’s Elyn Saks’ TED talk…

Thank you — I will watch the Ted Talk tomorrow.
Had a look at the book on Amazon, and got to read a few pages, I’m going to order it!