Q. Have you noticed any patterns in types of schizophrenia and the afflicted person’s insight into there mental illness?

A. Yes. Studies estimate that approximately fifty percent of people with schizophrenia are unaware of their illness. This phenomenon has existed for many years. Typically, those who are not aware of their illness continue to believe they are not ill despite much evidence to the contrary. Often times, they will go to great lengths to prove they are not ill and formulate other theories to explain away their situation.

It is thought that the lack of insight has its basis in a neurological deficit. To date, researchers have not confirmed this to be true but have found evidence of neurobiological brain abnormalities in the frontal lobe of people who have schizophrenia. Scientists believe this damaged area may play a part in lack of insight.

More recently, Dr. Xavier Amador has studied the phenomenon of lack of insight. He believes there are striking similarities to a condition neurologists call anosognosia. Anosognosia occurs in brain injuries where a specific part of the brain is afflicted. Interestingly, brain injured patients have shown extremely similar symptoms to patients who have poor insight. Like mentioned above, both do not believe anything is wrong with them, both will try to prove they are well and also, create alternative explanations to explain their symptoms. To learn more about poor insight, I would recommend Dr. Xavior Amador’s interesting book entitled I am not sick I don’t need help. Another good resource to read more about lack of insight in people with schizophrenia is www.psychlaws.org. The websites’ founder, Dr.E. Fuller Torrey, writes extensively about the personal and social ramifications of not helping people who do not know they are ill.

I am familiar with a case of a woman with schizophrenia who has been ill over twenty years. Each time, she becomes extremely delusional and ultimately has to be hospitalized against her will. Despite being hospitalized over thirty times, she absolutely refuses to believe she is ill. She had an alternate explanation for each time hospitalized and even today refuses to believe she is or was ever ill. With the help of medication however, she has remained symptom free and out of the hospital for the first time in her twenty years of living with schizophrenia. She still never believes she was ever ill.