As many of you know, I became an advocate for mental health reform because I could not get my son, Mike, help when he first became psychotic. I had rushed him to an emergency room only to be told that he was not sick enough. He was not considered an “imminent danger” either to himself or anyone else even though he was obviously delusional. Forty-eight hours later Mike was arrested after he broke into a house to take a bubble bath.
I was outraged and that experience caused me to begin campaigning for reforms in our current involuntary commitment laws. I think “dangerousness” is a horrible criteria. It is one reason why our jails and prisons are filled with persons whose only real crime is that they have a mental disorder. It stops loved ones from intervening before an ill person gets into trouble and it contributes to persons becoming homeless and dying on our streets.
While I have focused on changing involuntary commitment criteria, others have turned their attention to other reforms.
Dr. E Fuller Torrey and Xavier Amador sent out an appeal this week on the Internet that involves the American Psychiatric Association’s plan to update the DSM – psychiatry’s official inventory of what’s a mental disorder and what isn’t. Doctors, insurance companies and others have until April 20 to comment on whether binge eating, sex addiction and Internet addiction are in fact true mental disorders.
It’s odd to me that public opinion should play a defining role in determining what is and isn’t going to be recognized as an illness. I don’t remember anyone taking a vote about cancer. But until scientists invent a full-proof medical test that can accurately determine if a person has a brain disorder, there will always be disagreements about what is and what isn’t abnormal behavior.
Dr. Torrey and psychologist Amador want the APA to include anosognosia in the DSM as a symptom of schizophrenia and bipolar disorder. Anosognosia is commonly called a “lack of insight,” meaning that a person who is psychotic doesn’t recognize that he/she has a mental illness and, therefore, doesn’t believe he/she is sick or needs help. I remember reading a study once that suggested forty percent of persons having a psychotic breakdown did not realize that they were ill.
It is no surprise that the Treatment Advocacy Center, which Dr. Torrey started, is throwing its weight behind the campaign. You can read more about TAC’s position by visiting its webpage. I’ve not seen anything from the National Alliance on Mental Illness or Mental Health America about anosognosia. This might be too controversial of an issue for either of them to address, which is a shame. If I am wrong, someone please let me know.
Because I am not a psychiatrist, I do not know the medical basis for anosognosia. But what I do know is that Mike was unaware when he was psychotic that he was sick and needed help. It strikes me that this “lack of insight” is something the APA needs to thoughtfully consider.
As always, these reforms are merely the first step in improving our system. None of them will work if we don’t have adequate community mental health services that can actually help people recover, as well as, modern hospital facilities where people who are severely ill can get emergency care and help before being linked to community care.
Here is the appeal that Drs. Torrey and Amador released.
If you have an opinion on this, please share it.
Dear Friends,
Please see below Dr. Torrey’s note on how you can help to influence the DSM V process. Right now, there is no proposal to measure insight in persons with schizophrenia or bipolar disorder much less require that clinicians diagnose a subtype (with or without insight or with or without anosognosia). Such a requirement will drastically change treatment plans and hospital discharge plans. If a doctor has to diagnosis a lack of awareness of illness, then s/he is ethically obligated to address this problem, this symptom and the nonadherence to treatment it causes. Rather than simply send the person on their way with a prescription they will never fill. I hope you will comment on the website Dr. Torrey reccomends below.
We don’t have much time as the deadline for public comments is less that one month away. Please look at the two articles linked in the column to the right as they will likely be helpful to you .
Best wishes,
Xavier Amador
Dear Friends,
We should encourage Treatment Advocacy Center (TAC) supporters to comment on the inclusion of anosognosia as a symptom of schizophrenia in DSM-V. The briefing paper (“Impaired awareness of illness: anosognosia, attached) on the TAC website is useful as background, as is also the paper by Xavier Amador in the summer 2009 issue of Schizophrenia Digest (attached). Comments can be made on the APA DSM website . Comments must be made before April 20;after that date, the APA will not accept any more comments. I suggest that people who wish to do so should suggest that anosognosia be included under the category “Related Clinical Phenomena in Psychosis,” since it also occurs in bipolar disorder. I would stress that anosognosia is a common phenomenon, occurring in approximately half of all individuals with schizophrenia and almost half of individuals with bipolar disorder. Furthermore, the biological basis of anosognosia has been well established, as has also its association with other psychological abnormalities. In summary, anosognosia is a major symptom of schizophrenia and definitely should be included in the revised DSM, due to be published in 2013. Incidentally, I also agree with the proposed deletions of schizophrenia subtypes; they are not very useful
Dr. Fuller Torrey
