As much as people make that classic joke about denial being more than just a big river in Egypt, it’s also a real medical condition and the first stage of the grief process. Deliberately deciding, for whatever reason, to not believe something that is factually true, can be a comfortable place for people not yet emotionally ready to deal with something unpleasant, such as their own health, although they’ll eventually have to start to deal with reality.
The team at Accredited Home Care is familiar with the different ways that denial can show up and why clients may experience it. We are always happy to work with family members, caregivers, and health providers to find the best way to work with a client who is happy in their place of denial.
However, there’s another mental condition that’s similar to denial in some ways but quite different in others. It’s called anosognosia, and it’s a mental health disorder where someone truly doesn’t believe they have a certain medical condition.
This goes beyond denial, which is a condition where someone chooses not to believe. Anosognosia is more of a place where their brain tells them that everything is fine and anyone who tells them otherwise simply is incorrect or inaccurate, including their health provider or family members.
Who can get it
Anosognosia may be caused by a stroke or trauma to a certain area of the brain, including some forms of dementia which attack and damage the brain.
Researchers believe the condition comes from damage to the part of the brain that regulates your self-image and normally refreshes when new facts are presented, everything from a new haircut to a new medical condition.
WebMD reports at least 50 percent of people with schizophrenia may have anosognosia, as well as 40 percent of those with bipolar disorders. Essentially, those who have these types of mental conditions may simply believe their reality is correct.
It can lead to confusion and frustration when someone’s damaged brain tells them their body is in good shape, and then something isn’t working as it’s supposed to. Perhaps a stroke could cause problems with coordination, weak limbs or poor range of motion, or people with Alzheimer’s disease or other forms of dementia can blame other conditions like being tired of behaviors like forgetting details.
This type of condition can also cause people to not want to take their medications. Their brain may tell them they feel fine and the medication may have helped, so there’s no need for more prescriptions. Cutting back or stopping medication can quickly cause a variety of negative effects, especially if it’s supposed to help whatever condition that person is dealing with. It may lead to a cycle of feeling and good and feeling bad.
How to help
As expected, people with anosognosia can make it challenging for those around them. If their brain tells them that they’re doing well, it’s natural to want to contradict others, even get angry or frustrated when people tell you otherwise.
Well-meaning family members, providers or even caregivers may consider confronting them and forcing them to admit that there’s something wrong with them, much like an intervention. Mental health experts say this sort of ‘tough love’ might work in some cases for matters of denial, but may not necessarily work well for anosognosia, since people may truly feel fine and don’t know what the fuss is all about.
Add into this the feelings of fear, confusion, and paranoia that people with Alzheimer’s may have, even if they don’t know they have it, and a confrontation can make things more difficult and emotional.
Instead, Daily Caring suggests that caregivers and loved ones find subtle ways to help them without directly acknowledging the condition that they don’t know they have. This can include:
- Make it about other people. If you want someone to go on a walk to provide some exercise and build up muscles, suggest it as something the whole family needs to do more of. Or if they want to go on a walk and may no longer remember directions, offer to accompany them. This won’t disrupt their reality or add restrictions that they don’t understand.
- Make medication a group experience. If you need them to take certain important medications that they don’t think they need, you can have ‘vitamin time’ together and everyone takes something each morning. Or put theirs in a different bottle so they may think it’s for another condition.
- Get advice from their medical team. Nurses, home health care specialists and providers likely have had experiences working with clients who may not know they have certain health conditions. They can provide advice in talking to them and helping them without upsetting them.
Overall, these situations can be challenging since their trauma may be more due to physical damage to the brain. They may even have periods where they are aware that something isn’t working right, but it may go away. But generally, a good strategy is to encourage them to find ways to let them do what tasks they can and keep them safe.