Thursday, August 23, 2012

today's word: Anosognosia

Anosognosia - lack of insight

When a person cannot appreciate that they have a serious psychiatric illness, a tremendous challenge to family members and caregivers follows. About one-half of people living with schizophrenia, and a smaller percentage who live with bipolar disorder, have this clinical feature. Individuals with Alzheimer's disease and dementia also often have this feature. The medical term for not seeing what ails you is anosognosia, or more commonly known as a lack of insight. Having a lack of awareness raises the risks of treatment and service nonadherence. From the person's point of view, if they feel they are not ill why should they go to appointments, take medication or engage in therapy?

Why can't a person see what is so apparent to those around them? The best thinking indicates this is a core feature of the neurobiology of the conditions. Frontal lobes organize information and help to interpret experiences. In conditions like schizophrenia and Alzheimer's disease, frontal lobe difficulty is central to the neurological processes that underlie the disorders. Psychological denial is not the reason for the lack of insight in these illnesses.

Efforts to get people to see that they are ill are frequently fraught with frustration and may be met with denial or anger. Approaching the person in a supportive way will be beneficial for your relationship. Finding out what goals a person has (for instance getting a job, forming relationships, living independently) can be a good place to start engaging in next steps. Check to see if the service system has outreach workers who work on engaging people who lack insight. Working with the person's goals does not mean you have to pretend he or she is well. For example, if the person applies for disability services, encourage the doctor to review the diagnosis; getting a person to agree to disagree can be a first step. You don't need to argue about diagnosis to have a person participate in-or respect-basic household chores and rules.

There are situations where a person's lack of insight can, at times, create dangerous situations. This combination of no insight and dangerous acts often requires intervention. In more than 40 states, there are laws for Assisted Outpatient Treatment (AOT), also known as outpatient commitment. AOT status requires a person to engage in treatment and gives the state authority to bring the person to a treatment center if they do not. All states that have these laws have protections and a process for assessing whether this intervention is appropriate. In most states, doctors are required to submit an affidavit of the person's state and the reasons for the requested AOT status and a judge decides.

NAMI has active support groups all across the nation and local NAMI members may have information on outreach services for service engagement or doctors who are interested in this issue. You do not need to worry alone with this difficult situation.

JACKIE CIRA - intervention NOW



Your Quiet Neighbor said...

Remember, those dogs weren't human killers. They were sweet and lovable. And their victim devoted her life to animal rescue.

Just goes to show you that the expression "animal rights wacko" has a lot of truth to it.

Dayna said...

It's unfortunate, but if these nutters continue on the path they're on, the government will get involved on a large scale. If you can't regulate yourself, the government will be forced to. The result will really give the nutters something to whine about. Unfortunately, there will be truly innocent dogs that get swept up as well. Though if it's a pit or mix, or gripper of any sort, it's not innocent IMHO.

Jim Reeve said...

I guess the important thing is, to recognise dangerous situations before they become too dangerous. People with mental disorder have an excuse for having anosognosia, but pit nutters don't. I wonder if the term "I told you so" has a medical name?

Packhorse said...

These people weren't animal rights activists in any sense of the word. They fought on behalf of breeds that were created by demented human beings for the sole purpose of inflicting and enduring hideous injuries. These breeds should be allowed to become extinct rather than continue to propagate.

Like Merritt Clifton, I am an animal rights supporter who doesn't make excuses for fighting breeds.

scurrilous amateur blogger said...

packhorse, i include myself in that category.

they really should stick to banning the use of animals in the circus, targeting puppy mills, fighting for humane farming practices, putting an end to the use of animals in labs and crushing the fur industry. fighting for canine gladiators is not a good idea.

Packhorse said...

I agree, Dawn. I can't think of anything less "animal rights" than a dog whose sole purpose is mauling other dogs for human entertainment. Just let the incredible suffering they both cause and endure end already.

Miss Margo said...

Thank you, Packhorse.

Pit bull fanaticism seems to be its own phenomenon.

Ummmm....this is totally OT, but I trust the ethical judgement of the posters here:

My aunt left me an old fox fur coat when she died. The foxes died before I was born. The coat is very warm, and sometimes in NYC it gets, like, -10* during the DAY. Deep, deep freeze.

Is it morally okay for me to wear it, or am I still an asshole for promoting the message that real fur is acceptable as a garment fabric?

Please be frank. Thanks.

april 29 said...

Miss Margo,

I would ditch the coat. First, the coat probably needs repair work. If you look inside where the skins are stitched together, this stitching breaks down over time. This work is expensive.

Second, you will never get over the icky feeling you get when you put this coat on. You will be constantly looking at passers by on the street and wondering what they think. Personally, I admit to being disgusted by people wearing fur.

Third, coats have come a long way. Newer materials are very light and very warm. They are also fairly inexpensive, and many of them are washable.

This coat is not worth the moral compromise. But, that is just my personal opinion.

DubV said...

I think Snack is right that you will always feel weird about it. I lived in upstate ny before and did fine with wool and goose down with layers underneath. There might be a few synthetics that surpass down, but I don't think it is by much. You can find down that was produced from living geese on farms but most comes from the food industry (a lot from asia) of geese that are killed for meat. Still an ethical quandary for many. You might like merino wool for something near your skin as it doesn't itch.

DubV said...

neat insulator, i believe it is too insulating for use as a fabric

DubV said...

One last shopping tip for Miss Margo,

are you aware of this site?

They are an overstock website and I buy all my boots and outer wear there during the off seasons for the item because the deals are amazing (I've routinely bought new items for 75% off).

april 29 said...

Like DubV, I give two thumbs up to

I'm also a big fan of goose down.

vintage said...

Article about the Canadian Pit Nutter underground railroad

Wonder if the Canadian public is aware they are trafficking dogs from a state that has had 42 Pit Bull DBRFs?

I guess Nature abhors a vacuum...

Anonymous said...

Hey, that winipeg story has a "fact checker" section at the bottom. If there's someone smarter than me who could give this reporter some facts with references, who knows?

Packhorse said...

Miss Margo--Have you considered donating the coat to a wildlife rehab facility? Old fur coats are used as bedding for orphaned wildlife--and the pictures will melt your heart.

Packhorse said...

Also--ironically, it may be more humane to buy down from birds who have been slaughtered prior to plucking. Live-plucking is very painful and stressful for ducks and geese (imagine tearing the hair off a mammal), and it's normally done repeatedly as new feathers grow back in.