When the Mind Cannot See Itself: Understanding Anosognosia and Why It Matters
- Leilani Amores
- Jan 29
- 3 min read
Updated: Feb 2
Many people assume that if someone refuses help for a mental health crisis, they simply “won’t” get help. But for some individuals living with serious mental illness, it isn’t a choice — it’s a neurological condition called anosognosia, where the brain itself prevents the person from recognizing their own illness.
Anosognosia is more than denial. It is a true lack of insight — a brain-based inability to perceive one’s own symptoms, even when others can clearly see them. This isn’t a matter of stubbornness or avoidance; it is a neuropsychiatric phenomenon that makes voluntary engagement with care incredibly difficult, and often impossible without compassionate, appropriately trained support.
This condition is a major reason why people in crisis may not seek help on their own, resist treatment, or appear to be “uncooperative” — because in their mind, there is no illness to acknowledge. Understanding this is critical not only for clinical professionals and families, but for policymakers and communities advocating for better crisis response systems.
Why This Isn’t Just a Clinical Term — It Is a Matter of Life and Death
Anosognosia impacts not only treatment adherence but also how crisis response systems engage with people who are suffering. Without insight into one’s own mental illness, individuals are more likely to experience severe outcomes because they may refuse help, interpret symptoms as normal, or be mischaracterized by responders and systems that don’t understand this condition.
This is not a fringe concept — it is well recognized in both neurology and psychiatry, and yet it remains poorly understood by many, including some professionals who should know better. That lack of understanding contributes to crisis pathways that too often lead to harm instead of help.
Anosognosia and Miles’ Story
Miles Hall’s life and death illustrate the human cost of a system that did not fully account for the realities of serious mental illness. Miles was experiencing a profound psychiatric crisis when police were called — a crisis shaped by symptoms no less real to him than any physical pain. Because anosognosia affects insight, someone in crisis may genuinely believe their hallucinations or delusions are real, not symptoms of illness.
Instead of receiving the care he needed, Miles encountered a system that treated his crisis as noncompliance or aggression. When the brain cannot recognize its own illness, responses grounded in coercion or force are not only ineffective — they are dangerous.
That outcome did not have to be inevitable. More compassionate, informed approaches could have met his needs sooner, with dignity and safety.
What Experts Say About Insight and Treatment
Professionals who work with people diagnosed with psychotic illnesses emphasize the centrality of insight — and how its absence affects both the person and their support system. Insight means understanding that hallucinations and delusions are symptoms, not reality. Without that understanding, individuals have no internal reason to accept treatment, even when it could help them.
In practical terms, this means:
Training responders to recognize anosognosia
Offering education, not judgment, to individuals in crisis
Shifting systems toward care-first responses that presume illness instead of criminality
These shifts can literally save lives.
Experts in the field have also developed evidence-based tools to help families and professionals communicate more effectively with individuals experiencing anosognosia.
The LEAP Institute, founded by clinical psychologist Dr. Xavier Amador, offers training and strategies that emphasize listening, empathy, agreement, and partnership as ways to build trust and support engagement with treatment, even when someone genuinely can’t recognize their own illness.
Dr. Amador’s book, I Am Not Sick, I Don’t Need Help! (20th Anniversary Edition), expands on decades of research into poor insight and provides practical guidance for navigating these deeply challenging situations — making it a valuable resource for families, caregivers, clinicians, and anyone who wants to understand why traditional approaches often fail and what can help instead.
A Call to Care
At The Miles Hall Foundation, we advocate for systems grounded in humanity, not punishment — where people in crisis get support, not force. Recognizing conditions like anosognosia reminds us why this mission matters.
Miles’ death was not just a tragedy — it was a symptom of a system that prioritizes control over care. Until we understand the realities of conditions like anosognosia, families will continue to suffer avoidable pain, and communities will continue to lose loved ones to misunderstanding instead of healing.
This is why we fight. Because mental illness is real. Because insight can be impaired. Because care should always come first.
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