Even though he was holed up in a backwoods cabin containing piles of his feces, writing a manifesto against technological society, in moldy pants he had worn constantly for a year, Dr. Kaczynski was entirely unaware of his mental illness. In fact, he refused treatment of any sort over the better part of his life. At his capitol murder trial, he attempted to fire his lawyers when they moved the hideous cabin by tractor trailor to the court room for the jury to see, and understand, the state of mind he had during the time in which he murdered people.
I had just assumed that people who do this are in denial, they are ashamed, they don’t want people to know, they are egocentric and want to be “right”, they are gaming the system, they are manipulators. At some level, I rationalized that people with bipolar who stop taking their meds are sick of the side effects or enjoy being manic — some “rational” reason.
No, there seems to be a part of the brain that is unplugged which prevents insight into one’s own illness. This condition has been studied and is called “anosognosia.” It is a total or partial lack of self-awareness.
In going through videos for Psychoanalyst.tv, I came across an interesting video which is a lecture by Dr. Xavier Amador (yikes, almost 2 hours long) discussing this in detail. (Click above or here for the video.)
A lack of awareness of your own mental illness is itself a symptom of the illness — and not a psychological coping mechanism, like denial.
Anosognosia is most easily understood with physical unawareness — like, people paralyzed after a stroke, who have disturbed “limb-ownership” perception. There is a neurological basis for beliefs and uncertainties, although research is at an early stage. (I’m looking into the white matter aspects).
Here’s a chart from research done with people who have schizophrenia — the bars indicate total unawareness of different aspects of the disease — like, about 40% are unaware that they hallucinate.
Source: Amador, Andreasen, Yale & Gorman, Archives of General Psychiatry, 1994
Halluc. = Hallucinations; Del. = Delusions; Tht. Dis.= Thought Disorder; F.affect = Flat Affect; Anhed. = Anhedonia (i.e, loss of pleasure); and Asocial. = Asociality.
“There are approximately six million people in the United States with serious mental illnesses, and the results of recent studies indicate unequivocally that about 50% of all people with these disorders don’t believe they’re ill and refuse to take the medications that have been prescribed for them. That amounts to three million seriously mentally ill Americans who don’t realize they’re ill. You probably already had some idea of how widespread these illnesses are, but did you ever stop and think about how many family members there are? If we count only the parents of these individuals, there are twice that number of family members! Add just one sibling or offspring, and the number becomes truly staggering. Now here’s the real headline: More than ten million Americans have a close relative with mental illness who is in denial and refusing treatment.” (From, “I am not sick and I don’t need help” by Dr. Xavier Amador).
The concept of anosognosia for “mental” illness as manifested in “ideas” (as opposed to, say, limb ownership) is a real paradigm shift. This changes the moral valence of things completely. Can we really judge “character”? Or are we judging “neural connectivity allowing insight into one’s own behavior?”
Instead of obstinacy or some sort of “evilness”, there is an organic, tangible reason why people lack insight into their objective actions, and instead rely on their subjective reality. Just like the stroke patient who is surprised to see the video of themselves with a paralyzed limb, the mentally ill person is surprised to see themselves when compared to objective fact. They do not have any cognition problems, but rather seem to be forming a coherent reality based on the premise of facts surmised with the total lack of insight into themselves.
I’m not sure what all this means at present, but it seems to me to be a pretty big concept. This explains “negative attributional bias” — even ignoring all objective fact otherwise, some people assume others have negative intent. Paranoia seems to fall into this category — all objective fact refuting a paranoid theory is ignored or explained away using confabulous theories — because that is the coherent reality based on a total lack of insight into one’s own mental state.
I’ve seen this, I’m pretty sure — a man who owned a series of small businesses would pitch temper tantrums, and his employees would quit. I listened to him complain about this, and asked him, “what did you think they would think when you screamed at them?”
He was stumped. I think he knew other people think things (theory of mind), but I don’t think he had insight into his own behavior well enough to consider that perhaps his tantrums were not well received. I sensed something of a minimizing or trivializing of the employees’ responses — like, “I’m not that bad, what’s their problem?” — except this conflicted with the objective fact that his employees quit and joined up with his competitor after he had spent the money to train them, and after his customers got comfortable with them.
Not being in the neuropsychology biz, I’m pretty sure I’m late to understand this — but if anosognosia can be determined by white matter tensor imaging or otherwise, that may give us basis for predicting which people are likely to stay with treatment, and which people are likely to decline.
Does this explain psychopaths? This needs another post, but I think there is a white matter disconnect which may be the unified field theory for this from a neurological point of view.
A footnote: This is very similar in concept to the “second personality” theory postulated by Gertrude Stein’s early psychological studies in 1896.
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