Anosognosia
When someone rejects a diagnosis of mental illness, it’s tempting to say that he's “in denial.” But someone with acute mental illness may not be thinking clearly enough to consciously choose denial. They may instead be experiencing “lack of insight” or “lack of awareness.” The formal medical term for this medical condition is anosognosia, from the Greek meaning “to not know a disease.”
When we talk about anosognosia in mental illness, we mean that someone is unaware of their own mental health condition or that they can’t perceive their condition accurately. Anosognosia is a common symptom of certain mental illnesses, perhaps the most difficult to understand for those who have never experienced it.
Anosognosia is relative. Self-awareness can vary over time, allowing a person to acknowledge their illness at times and making such knowledge impossible at other times. When insight shifts back and forth over time, we might think people are denying their condition out of fear or stubbornness, but variations in awareness are typical of anosognosia. Read more on National Alliance on Mental Illness website
For example most people familiar with anorexia know that anosognosia is one of the most troublesome and dangerous symptoms. It is the patient’s conviction that they are not ill even though they may be dying of malnutrition. Reference. Anosognosia is also very common with some people when early dementia progresses starting with minor forgetfulness and worsening over time. It is certainly a hallmark of the disease in full-blown dementia. Reference.
Anosognosia and psychological denial are different phenomena.
Psychological denial is the primary defense mechanism that has been identified in psychology. It often involves blocking external events from our conscious awareness. Essentially, if a situation is too much for us to handle, then we simply refuse to experience it at all. That does not make the facts or reality of the situation go away but allows us to pretend that it isn't real and therefore, doesn't have any impact on us.
While using denial might reduce your anxiety for a short period, the reality is that it is not an effective way to deal with a situation in the long-term. Eventually, the reality of the circumstances kicks in, and then you may turn to blame to address your feelings of anxiety or guilt, trying to put the responsibility for your feelings onto someone else.
However, not dealing with situations or assigning blame can have a negative impact on your relationships in the long run, so denial can prove to be an unhealthy defense mechanism over time. Reference
I haven’t found any good references on what happens when someone who has used denial in the past eventually begins to develop anosognosia. My hunch, and this is just a hunch, that basically one of two things can happen.
One is that someone who hasn’t used denial as a primary defense mechanism perviously develops anosognosia because of a neurological condition. This is a fairly straightforward situation.
The other is that the person used denial as one of their primary defense mechanisms (to stave off anxiety and self doubt in many instances) for most of their adult life, and then anosognosia comes on because of cognitive dysfunction. This would seem to be a far more complex phenomena to understand.
Is this what we are observing in Donald Trump? The only way to tell is for him to have a complete neuropsychiatric assessment as numerous mental health professionals have suggested. Most recently in “Fluctuations, Exacerbations, and Decline in Functioning — Where is Trump Headed?”
This is all I have for today.
Note: I am not a neurologist, I am just a retired clinical social worker and psychotherapist who for the past 2 ½ years has been trying to understand Donald Trump and writing about the subject here (scroll down for most recent Daily Kos stories).
Friday, Sep 6, 2019 · 10:00:42 PM +00:00 · HalBrown
What If President Trump Is In Cognitive Decline? No, Seriously
Excerpt:
To be clear: nobody knows for sure if our sitting president is experiencing cognitive decline, which is why so many psychiatrists and mental health experts have called for him to be tested.
What I do know is that if you examine the Trump presidency through the lens of cognitive decline, some of its more bewildering aspects start to make a lot more sense.
Observers — particularly those troubled by the cruelty of his regime — tend to view Trump as lazy, incompetent, demagogic and mendacious. But it seems increasingly possible that the president’s behavior is also a function of his desperate attempts to mask serious cognitive struggles.
Anyone who has dealt with a friend or relative in cognitive decline can tell you that the person in question almost never admits to their struggles. Instead, they go to elaborate lengths to hide their impairment.
Maybe the reason our president is reported to spend up to nine hours per day engaged in “unstructured executive time” isn’t just because he’s lazy. Maybe he’s trying to duck parts of the job he can’t handle. Maybe the reason he doesn’t read anything — including briefings — is because he can’t absorb or retain complex concepts.
Maybe the reason his unscripted speech is so often incoherent and littered with vagaries (relying on placeholder words such as “thing” and “they”) is because he cannot summon the specific vocabulary he wants to use.
Excerpt:
President Donald Trump’s deteriorating mental state is worrying White House aides, Business Insider reported Friday.
“President Donald Trump’s aides and confidants are growing more and more concerned about his mental state after days of erratic behavior, wild outbursts, and bizarre fixations,” Business Insider reported.
Trump has spent all week repeating his lie that Hurricane Dorian threatened Alabama. Despite his own government fact-checking his lie within 20 minutes of him first tweeting it on Sunday morning, Trump dragged the scandal its sixth day on Friday.
“He’s deteriorating in plain sight,” the GOP strategist warned.
At the Toronto Global Forum, former White House press secretary Anthony Scaramucci also worried about Trump’s fitness for office.
“I think the president is in severe mental decline, and I’m not saying that now because I’m a political adversary or I disavowed him, I’m saying that objectively just looking at what’s going on,” Scaramucci said.