When the brain fools itself

The Treatment Advocacy Center’s advocacy is based in large part on the increasing evidence of the role that anosognosia, or lack of insight, plays in causing patients with schizophrenia and bipolar disorder to believe they are not ill and therefore refuse needed treatment.

It is sometimes easier to conceptualize the impact of the neurological deficit, anosognosia, as it occurs in other brain disorders. In a fascinating article about the brain, Shelby Martin describes a famous case of anosognosia:

In his book “Descartes’ Error,” neurologist Antonio Damasio describes the 1975 case of Supreme Court Justice William Douglas. A debilitating stroke left him confined to a wheelchair, paralyzed on his left side. Against medical advice, Justice Douglas checked himself out of the hospital, dismissing reports of his paralysis as “a myth,” and publicly invited reporters to go hiking with him.

Douglas, like other patients with anosognosia, was completely unaware of his injury. He went so far as to claim he was kicking 40-yard field goals with his paralyzed leg. Clearly delusional, Douglas was forced to retire from the Supreme Court.