Anosognosia (Not the truth, but not lying…)
There are times when you know the person you are caring for is not telling the truth. You may be right yet at the same time they are not lying.
About half the population living with Schizophrenia, and some with Bi-Polar disorder,
Alzheimer’s, Dementia, Stroke and Traumatic Brain Injury (TBI) may exhibit this clinical feature. According to information from NAMI (www.NAMI.org) on the topic, the current thinking is that this is a “core feature of the neurobiology” of the mental dysfunction.
Neurobiology is the study at the level of the cells of the nervous system and the organization of these cells into functional circuits that process information and mediate behavior. Your loved one isn’t “lying” - they really believe what they are saying. To lie is to convey a falsehood with the intent to deceive. That is not what is going on with Anosognosia, or an unawareness of decline or difficulties. This compounds an already difficult problem for caregivers.
One presentation may be Confabulation. That is making up an answer that links pieces of information, time, places, and people that are not linked in reality. This may include combining memories from different events and insisting that the event happened in that manner. Events may be described as recent while they happened long ago with different participants.
Anosognosia is NOT denial. Denial may be psychological. Anosagnosia is physiological, and seems to result from physical changes in brain cells often in the right front part of the brain (right pre-frontal lobes, located in the front and top part of the brain) as well as in part of the parietal lobes (just behind the frontal lobes). (note 1.)
Some researchers have developed an Anosognosia Rating Scale used by for health practitioners to use in order to rate the level of awareness in people. (note 2.)
The scale considers four levels of self-awareness and is summarized below with the example of rating self-awareness of memory loss:
1. easily admits memory loss
2. admits (sometimes inconsistently) to small amount of memory loss
3. not aware of any impairment in memory
4. angrily insists that no memory problem exists
Your author has had personal experience with it and it can defy all logic – quite literally. Your own experience tells you that there is no way that a breathing person can “see this and believe that”, but it does happen. Based on that experience and backed up by the advice of professionals, the best approach may be a non-confrontational and supportive one. Remaining connected with your loved one can be the most constructive path: “What are you trying to do, and how can I help you be successful at it?”
Often behaviors exhibit a “Lack of Insight”. These may be displayed as everything is dangerous, with expressions of fear and paranoia. Conversely, they may also present as unwarranted trust and lack of fear. For caregivers, life may become a series of attempts to keep their loved one from running with scissors. It can be absolutely exhausting and frustrating.
NAMI has active and often local support groups and information on outreach service. Caregivers need to know that they are not facing a completely unique situation and that there are people who care about their success and have experience in finding pathways to understanding the issues and making the best of a very difficult situation.
What about when the loved one becomes a danger to self and others?
1. Is it time to take the car keys away?
2. Can the person handle “activities of daily living” and survive.
3. Do they have more Limited Insight and behave dangerously while unaware.
Assistance varies legally State by State, but patient rights can lead to some challenging situations when an unaware person can refuse needed care. Engaging with the family doctor, local social services department, or perhaps law enforcement are some of the avenues that can be taken. This is not something that is intuitive to caregivers and getting help on your approach may be the only way to succeed. Confrontation has a very low probability of success and may cause a disconnection response from the person requiring care. Supportive and positively framed statements and actions are more likely to succeed. Simplifying daily activities will make this less daunting.
Note 1. Heilman, K.M. (1991).Anosognosia: Possible neuropsychological mechanisms. In G.P. Prigatano & D.L. Schacter (Eds.), Awareness of Deficit After Brain Injury, NY: Oxford University Press, 53-62.
Note 2. Reed, B.R., Jagust, W.J., & Coulter, L. (1993). Anosognosia in Alzheimer’s disease: Relationships to depression, cognitive function, and cerebral perfusion. Journal of Clinical Experimental Neuropsychology, 15(2), 231-244.
Copyright 2018 AGIS Network, Inc.