Dr. Richard Schweizer on Anosognosia

On Anosognosia

Schizophrenia can be a terrible disease. It can affect perception, behaviour and cognition. Typically, the person with schizophrenia experiences delusions – unrealistic beliefs about the world – and/or hallucinations – perceptions of things that are not there. It is estimated that around 1% of the population will experience schizophrenia.

As bad as the disease is, there are treatments. These are called anti-psychotic medications. Although they don’t work for everyone, they can often dampen unpleasant symptoms. In some cases they can leave a person symptom-free, although they often have unpleasant side-effects.

But what happens when the person with schizophrenia does not realise or believe that they are sick? What happens if they don’t perceive their illness accurately?

This is called “anosognosia”.

It is estimated that up to half of people with schizophrenia experience some level of anosognosia. And, typically, that anosognosia is felt strongly. You can’t argue with the person, reason with them; no matter how strange their delusions or hallucinations are. For the person with the illness, these delusions and hallucinations can appear very real.

Anosognosia can be difficult, for a number of reasons. The primary problem is that it can stand in the way of the person getting help. It can prevent them taking medication, or seeking more unconventional therapies. It can divide families who may feel alienated from a loved one with disturbing beliefs and perceptions and behaviours.

So how do you approach anosognosia?

That’s a tough question.

First of all, it is probably best not to become too confrontational. Accept that the delusions and hallucinations seem very real. Make it clear that you love and support the person. Avoid antagonising the loved one.

Researchers in the field, Lehrer and Lorenz, write that:
“Cognitive behavioural therapy, adherence therapy, and psychoeducation were found to have small-to-moderate effects on insight, though not statistically significant. Social skills training and video self-observation may be beneficial in treating insight; however, more evidence is needed to evaluate the efficiency of these treatments. Comprehensive treatments involving multiple treatment modalities have also shown promising results” .

Which is to say, we have some ideas, but we don’t know the answer.

Perhaps a gentle approach is best. Perhaps we may subtly include our concerns; suggest to the loved one that the content of their delusions or hallucinations may be addressed by seeing a professional. Perhaps we should make it clear that we have the best intentions for our loved one’s wellbeing.

Unfortunately, there are no easy answers to this particular problem and, as the research quoted above reveals, we don’t yet have a failsafe solution. In the meantime, it is important to remember that the person close to you who is sick still needs love and support, just like any other person.


Dr. Richard Schweizer, Policy Officer at One Door Mental Health richard.schweizer@onedoor.org.au.  

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 Dr Richard Schweizer

Dr Richard Schweizer (Richard..."van Gogh")