“Anosognosia Is Clearly Biological In Origin” Dr. E. Fuller Torrey Argues That Science Proves It

 

(3-13-18) An article entitled The Perplexing Semantics of Anosognosia: Why an obvious phenomena has sparked controversy, written by Dr. Dinah Miller, co-author of COMMITTED: The Battle Over Involuntary Psychiatric Care,  drew strong reactions yesterday after I posted it.  Among them was this reply from Dr. E. Fuller Torrey, who has been described by The Washington Post as “perhaps the most famous psychiatrist in America.”

By E. Fuller Torrey, M.D.

Dear Pete,

Dr. Miller questions the appropriateness of using the term “anosognosia” to describe the lack of awareness of illness in individuals with schizophrenia or other psychosis.  In The Study of Anosognosia (G.P. Prigatano, ed., Oxford University Press, 2010) anosognosia is defined as “a complete or partial lack of awareness of different neurological…and/or cognitive dysfunctions” which would appear to cover psychoses. She contacted the late Dr. Oliver Sacks who in fact had given an eloquent description of anosognosia in The Man Who Mistook His Wife for a Hat: 

“It is not only difficult, it is impossible for patients with certain right-hemisphere syndromes to know their own problems – a peculiar and specific ‘anosognosia,’ as Babinski called it. And it is singularly difficult, for even the most sensitive observer, to picture the inner state; the ‘situation’ of such patients, for this is almost unimaginably remote from anything he himself has ever known.”

Dr. Miller is also incorrect in saying that “we know nothing of the fundamental neural dysfunction” for individuals with anosognosia.  Studies of stroke patients have demonstrated that the inferior parietal lobule plays a critical role, especially on the right side. Since 1992, there have been 25 studies comparing the brains of individuals with schizophrenia with and without anosognosia. In all but three studies, significant differences are reported in one or more anatomical structures. Since anosognosia involves a broad brain network concerned with self-awareness, a variety of anatomical structures are involved, especially the anterior insula, anterior cingulate cortex, medial frontal cortex, and inferior parietal cortex. Three of the positive studies included individuals with schizophrenia who had never been treated with medications, discounting the likelihood that the observed brain changes resulted from treatment.

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Anosognosia: Is It An Accurate Description Of Individuals Who Don’t Believe They Have A Mental Illness?

There’s no controversy here.  People with psychotic disorders sometimes don’t know they are suffering from a mental illness, and there really is nothing to argue about.  And yet, the word “anosognosia”—meaning the patient is unable to see that he is ill—is a charged word.

Why is that?  Let me talk a little about the history of this word and the political meaning it has taken on.

Anosognosia is a term that was coined in 1914 by a Hungarian neurologist named Joseph Babinsky.  Babinsky noticed that sometimes after a stroke, people are unaware of their deficits.  This is presumed to be a result of pathophysiologic changes in the brain, and not the psychological defense mechanism of denial.  There is not a precise anatomical finding that predicts anosognosia: you can’t look a patient with anosognosia and say, “ah, the MRI will show a lesion in X area of the brain.” Though certainly, some deficits are more likely to include anosognosia than others.

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Desperate Mother Pleads For Help In Florida: Mentally Ill Son Charged With Attempted Murder Using A Comb While in Hospital

REARRESTED…again…same crime new charge. MY SON IS MENTALLY ILL AND WAS BAKER ACTED AND LEFT UNSUPERVISED BY STAFF! #FreeElliotthttps://thewayonline.wordpress.com/2018/02/07/his-greatest-fear-came-true-the-government-stole-him/UPDATE : March 5 Elliott is being held without bail. I feel sick, Michelle is crying, my son could be in jail for YEARS before even getting a trial. Gemma’s son sat there for four years before his trial even began. Right now my mind is gone, yesterday the SWAT team learned AFTER they executed the warrant that my son is seriously mentally ill…they learned his “weapon” was a plastic comb…THIS IS WHY PEOPLE WITH MENTAL ILLNESS GET KILLED BY THE POLICE. They have charged Elliott with 1st Degree Attempted Murder AND Attempted Murder with a weapon – FOR THE SAME INCIDENT SAME MAN.Elliott Longworth

Posted by Tamara Lee on Monday, March 5, 2018

To hear her video plea from Facebook, you must turn on the volume in the right corner facing you.

(3-7-18) I receive pleas for help every week from desperate parents, but few are as gut-wrenching as the email that I received from Tamara Lee, telling me about her son.

Pete,

A SWAT team entered my son’s grandmother’s house in Port St. Lucie, Florida this week and executed a warrant for “Attempted Murder With A Weapon.”

This sounds horrific right? Truth be told, this nightmare began on Dec. 6 2017 “officially.” That’s when our family made the decision to call the police because my 21 year-old son’s mental health had deteriorated to a point that he was self harming himself.

Elliott was also trying to clean out the refrigerator to bury it in the back yard to use as a shelter so he could survive an upcoming purge. The police came. They saw he was in mental health crisis back then and took him to a hospital where he was sedated, admitted and shoved in a room with another mentally ill person.

Early in the hours of December 8, my son hurt the man in the room with him.

My son doesn’t even recall the incident he was blacked out.

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New York Times Writer Puts Human Face On Mental Illness & Homelessness

 (3-7-18) My former colleague from the Washington Post, Benjamin Weiser, has written a beautifully told story that is all too familiar for too many of us. Thank you Benjamin Weiser and The New York Times for putting a human face on homelessness and how difficult it is to help someone who has a mental disorder if that individuals doesn’t want it. 

Published by The New York Times, March 3rd, 2018

They met on a rainy morning several years ago, at the base of the Helmsley Building in Midtown Manhattan. As others hurried to work, Pamela J. Dearden, an executive with JPMorgan Chase, noticed a woman, unperturbed by the rain or her surroundings, standing on a 36-square-foot sidewalk grate she had chosen as her home.

Ms. Dearden, known to everyone as P.J., offered her umbrella to the woman, who took it and thanked her.

A friendship blossomed. P.J. would often stop to talk with the woman, who sat amid shopping bags, books, food containers and a metal utility cart. P.J. admired her hardiness, but also her smile, her soft features and her humor. If the woman was sleeping or talking loudly to herself, P.J. held back, but other times she engaged her in short conversations, which could go into unexpected places.

The woman’s name was Nakesha Williams. She said she loved novels, and they discussed the authors she was reading, from Jane Austen to Jodi Picoult. She and P.J. chatted as time allowed, or until Nakesha veered into topics that hinted at paranoia: plots and lies against her. Yet, P.J. realized she knew little about Nakesha, and she wondered about her past.

Nearly three decades earlier, another woman took notice of Nakesha, then an 18-year-old college freshman, and considered her seemingly boundless future.

Sandra Burton, director of the dance program at Williams College in Massachusetts, was struck immediately by Nakesha’s vibrancy and talent as a dancer. She became Nakesha’s teacher and mentor, and she began to closely track her development. Nakesha, she recalled, stood out no matter the setting: the stage, the classroom, even across a kitchen table.

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Why No One Believes Us When We Say Americans With Mental Illnesses Are Not Representative Of Mass Murderers

Two of the ten deadliest killings were known to involve shooters with mental disorders. It was suspected in a third.

(3-5-18) The mass shooting at Marjory Stoneman Douglas High School in Parkland, Florida was horrific and also different for me.

After the shootings at Virginia Tech, in Tucson, Aurora, Newtown and the Washington Navy Yard, I penned Op Eds and did radio/ television interviews during which I spoke about how waiting for someone to become dangerous was foolish and the inadequacies of our current mental health care system.

Editors and reporters were eager to print and broadcast my comments.

This time I tried a different tactic. Armed with a 2016 study, Mass Shootings and Mental Illness by James L. Knoll IV, M.D. George D. Annas, M.D., I explained that Americans with serious mental illnesses were not responsible for a majority of mass murders and, in fact, were much more likely to be victims of violence than perpetrators.

This is what nearly every advocate is expected to say. Perhaps that is why none of the media outlets, with whom I regularly deal, expressed much interest in my argument. (A person is about 15 times more likely to be struck by lightning in a given year than to be killed by a stranger with a diagnosis of schizophrenia or chronic psychosis.)

With the exception of journalist Tim Williams who interviewed me for NewsTalk Florida, I don’t think any of the others believed me.

A Washington Post/ABC poll found – as Slate put it in its headline –  “More Americans Blame Mass Shootings on Mental Health Than on Gun Laws.”  

“77 percent, said better mental health monitoring and treatment would have averted Parkland.”

This is the prevailing attitude even though repeated studies prove otherwise. Why?

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The Third Question After A Mass Shooting: Where Were The Parents?

 

(3-2-18) From My Files Friday:  Whenever a mass shooting committed by a young person happens, the third question asked is about his parents. (The first two are generally about whether the shooter had a mental illness and talk about gun control.)

Alleged Parkland, Florida, school shooter, Nikolas Cruz, and his younger brother were adopted by Roger and Lynda Cruz. Roger died when the boys were young, leaving Lynda to rear her boys as a single mother. She first called the police about Cruz when he was 10 years old. It was one of dozens of calls during the next decade. Lynda died last November.

I’ve read articles blaming her. They are similar to comments after other mass murders, especially those that involve a young shooter with a mental illness. Surely the parents knew. They could have done something. They are to blame.

I don’t know enough about Nikolas Cruz to speak specifically about his childhood, but complaints about his mother reminded me of an Op Ed that I wrote for USA Today in 2011 after Jared Loughner shot U.S. Representative Gabrielle Giffords and eighteen others in a Tucson suburb. In that case, Loughner had a mental illness and there were warning signs.

Don’t Blame Jared Loughner’s Parents, published in USA TODAY, 1-14-11

By Pete Earley
What’s wrong with Jared Loughner’s parents? Why didn’t they do something? They must have known. Just look at the photograph of the Tucson shooting suspect. That grin. They should have raised him better.

These are comments I’ve heard and read on the Internet about Randy and Amy Loughner, whose son has been charged with shooting Rep. Gabrielle Giffords, D-Ariz., and 12 others, and killing six bystanders.

It’s unlikely the parent’s  statement — that they “don’t understand why this happened”— will soothe the criticism and public anger aimed at them. But as the parent of an adult son with a severe mental illness who has been arrested, I can sympathize with the Loughners and testify that there are reasons why a parent can be caught off guard.

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