Does anosognosia make them think their behavior is normal?

I understand that anosognosia makes someone basically physically incapable of recognizing that they’re mentally ill. I’m not sure if my loved one has it, but I’ve decided to move forwards as if he does because arguing about it has only damaged the relationship. But given that they believe that the delusions are some degree of real, will they also always believe that their actions based on the delusions are okay? I can accept intermittent terrifying/cruel episodes as a symptom of mental illness, but I don’t know if I can keep on going with someone who can’t express real remorse once he’s calmed down a bit. More simply, is he capable of realizing that I don’t actually deserve it?

Great question; hoping @Maggotbrane can offer some insight on this.

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It’s a tough one. My MI partner suffers anosognosia. I’m not sure that saying they are physically incapable of acknowledging the illness as I’ve heard others report that once medicated many peoples’ loved one gained some level of what we call ‘insight’ and understood that they were ill with a brain disease that causes hallucinations or delusions. So they are actually physically capable it’s just a matter of where their mind is at the time maybe. As far as I think what you were referring to was the confabulation, the tendency after acting outwardly and behaving in response to a delusion or hallucination to fill in a story that justifies or validates that delusional belief is something I see ALL THE TIME in my partner. And yes, I feel personally that he sucks as a human being when it happens because I’m so often if not always the target and it can be so cruel and so violent. And then to have them not think they’ve done anything wrong? It’s hurtful beyond the initial assault. Like insult to injury. So I get what you’re going through. It’s like getting slapped after you’ve been spit on just for wanting an apology. But if they don’t believe they did something that deserves an apology, what are we left to do really? I don’t have any good techniques for it yet after all these years of hurt and injury and oh god the slander. My partner would have a whole explanation for coworkers about how I was doing something to him the night before and that’s why he slept at the garage. When in reality, he’d had an episode and had come out of the bedroom after being by himself for five hours sometimes and start screaming and raving that I was hurting him and sometimes even be extremely physically violent. I’m left with black eyes and bruised thinking WTF?? AND worried and terrified that he’d be out on the road all at the same time during an episode. Beaten then slandered. It’s just the bizarre reality we live I guess. Sorry. That was probably not helpful at all. Xx

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Thank you, Wisdom. What you’re saying is of course horrible to hear and I’m so sorry that you’re going through it, but it is comforting to be reminded that this is happening because of a disease, and it isn’t like a situation that I’ve somehow created that’s totally unique to me. I’m lucky that my boyfriend doesn’t beat me. When he’s that kind of violent, he is only incidentally touching me because I’m getting between him and something of mine that he wants to destroy. He mostly doesn’t believe me when I say it happened, and when I show him the bruises he believes I gave them to myself to frame him.
I think for me the slander is the worst part. I would be able to put up with a lot more abuse if I’d never have his friends threatening to come beat me up over things that he’s said. I hope for both of us that our partners will someday be able to see how hard we’re trying.

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I think it’s a little murky whether anasognosia is a separate condition, a specific delusion that’s part of a overall disease that makes you prone to delusions or perhaps something else. I think you may be conflating some or all parts here. This may be a question of semantics, but I’ll try to tease some components apart:

If you have anasognosia, then you don’t believe you have a mental illness in the face of others presenting evidence that you do. That evidence is typically the contents of a delusional system which may be informed by “voices” or perceptions of other factors real or imagined. How you behave can be informed by these delusions, but also core values and principles, and social, societal or cultural influences. Regardless I think you have a choice in most behavior. Whether thoughts or feelings compel you to action and when you act, those actions have consequences. And then it becomes a question whether you believe your actions are justified. What’s “normal” is relative to this context, and the content of the delusions. Anasognosia only plays a part as an explanation for why the delusions are thought to be true— it doesn’t normalize the actions.

Taking slander as an example: a delusional person might justify it by stating they believe it to be true. However, they could have just as easily chosen not to speak it, or when or how or to whom. A LEAP style interaction would focus not on the content of the slander, but the venue, the language or emotional content of it. And I think the person being “slandered” who’s aware of the anasognosia is justified in saying how these choices of expression made them feel, regardless of whether the content was true or not. A pitfall in these interactions is the accused has to take care to focus the discussion about how the expression made them feel without contradicting the delusional content and injecting too much emotion into the exchange. Unfortunately this puts all the heavy lifting on the caregiver, and I know well how things can escalate when delusional accusations touch emotional nerves. In those cases, can be helpful to apologize for any similar actions on your own part, if only to model how it should be done.

Now any actual violence is always unjustified, and I feel I need to be clear about this. I feel both you and @Wisdom appear a little too casual with physically abusive rhetoric or metaphors, and as a recovered diagnosed person, I find it ambiguous and confusing. You’ll want to more careful with such rhetoric with people with an active diagnosis.

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Thank you for the response, Maggotbrane! I see what you mean about how delusions don’t automatically lead to behaviors. I think I have trouble with that concept because if someone was actually doing these things to him, I do believe he would be right to defend himself much more aggressively than he has with me. And I think he also thinks he’s being very lenient, which is the core of my problem.
I’m going to think a lot about what you said, especially how to incorporate LEAP style communication into it. I’ve been watching a LEAP video a day since I learned about it earlier this week and I do think it will help.
I’m not sure what you mean about me using physically violent metaphors, though. I absolutely believe you, I’m working on fixing up my language and I know I have a long way to go before I even realize what all the problems are. I’m sorry it was confusing. Can you show me where I did so I’ll know what to watch out for in the future?

My apologies for the confusion, less so you using such metaphors as you reacting to what @Wisdom wrote. Best I can tell, the bruises you speak of were actual, but accidental. I found it difficult to follow what was actual, figurative or speculative (of mindset) of @Wisdom’s partner’s behavior as described.

This seems rhetorical or metaphoric:

While I’m confused here whether the partner delusionally claimed that @Wisdom was physically violent but this was untrue or if actual violence was inflicted on @Wisdom intentionally or otherwise.

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This is a good question. I hope you have read, or plan to read, Dr. Amador’s book “I Am Not Sick; I Don’t Need Help”. Without being able to completely understand the difference between a delusion and anosognosia, the importance of communication is important, regardless. In the book, the use of L.E.A.P. is explained as a psychological approach to help effectively communicate with someone who “sees” things differently than you do. My experience has been with my loved one who seemingly had anosgonosia for several years, but once he was on a medication that worked for him and his brain healed, he has been medication compliant for 3.5 years, he acknowledges his diagnosis, and he has just re-started counseling. It’s far from perfect, but he lives with meaningful recovery. Much of his severe illness he does not remember.

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Maggotbrane, I appreciated your input. The inappropriate behavior should not to be tolerated. Our daughter in psychosis was not violent but after medication experienced a lot of remorse and sadness over how she talked to her friends and others. She actually apologized to them but of course it did harm the relationship. She also made an interesting statement one time that she felt good when in psychosis and seemed to enjoy that state of being. She is recovering again and deals with her emotions as hard as it is. Melody and Wisdom setting boundaries for a loved one can hard but is necessary.

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Thank you for explaining! Yeah, I was referring to literal bruises that he doesnt believe me about. This is a really good language reminder, though. I know one of the issues for him is the possibility of me implying that he’s being violent, so I definitely need to keep evaluating the turns of phrase that I use. Thank you for your insight!

I’m about halfway through the book and I’ve been wayching his videos. I’m definitely learning a lot about ways that my communication around his beliefs has led to him feeling unsafe. Thank you for sharing your experience, it made me feel hopeful to read it. Hopefully my partner can get there too.

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I’m reading the book, and it’s helpful. But how did you get him to even start taking the medication or even get therapy? Thanks