People who are in the midst of a psychotic break often do not think anything is wrong with them. In recent years, this lack of insight has been described as anosognosia (a word that does not roll off the tongue easily.)  It means that a person isn’t aware that he/she is sick.

Two years ago, there was a push to add anosognosia to the the APA’s  DSM which is currently being revised. I wrote about that campaign on my blog and it attracted a number of divergent comments.

The Treatment Advocacy Center, which lobbies for passage of Assisted Outpatient Treatment laws, has released a video this week about anosognosia.  Dr. E. Fuller Torrey argues that anosognosia is a key reason why it’s important for family members and mental health professionals to be able to intervene when someone — who has a history of going off their medications or a history of violence — begins showing signs of psychosis. 

Critics argue that anosognosia isn’t a real medial condition and that most people are capable of making their own decisions without intervention even if they have a mental illness and may be in the midst of a breakdown. 

What do you think of anosognosia and this new video? I’m especially interested in personal stories.

Thank you for sharing your experiences and thoughts.

Failure of Leadership at Abbott Breaks Its Promise

Yesterday’s announcement that the global pharmaceutical giant Abbott Laboratories had agreed to pay $1.6 billion to state and federal agencies in criminal and civil fines made me furious. This is not the first time that a large drug manufacturer has been caught illegally promoting unapproved uses for one of its medicines.  But the Abbott case is especially egregious because it executives  exploited two vulnerable groups: persons with mental illnesses and the elderly.

The settlement ends a four-year investigation into a wide number of calculated moves by the Illinois-based company to push sales of its neurological drug Depakote into so called “off label” markets where it didn’t belong.  One of the more scandalous admissions was that executives created a special sales force to promote Depakote in nursing homes.  The sales force was told to push Depakote as a substitute for proper staffing since one of its side effects was turning grandma and grandpa into compliant zombies thus reducing the need to hire employees and provide decent care.  “Abbott essentially preyed on…the most helpless patient populations,” one attorney noted.

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“Psychiatry’s Bible: The DSM is doing more harm than good.”

This was the headline of a guest opinion piece printed in yesterday’s Washington Post. The editorial was written by psychologist Paula J. Caplan who argued that “hundreds of people  [are being] arbitrarily slapped with a psychiatric label and are struggling because of it.”  As an example, Caplan recounted the story of a “young mother” who had been told after a quick assessment by an emergency room doctor that she had bipolar disorder. The woman was committed to a psychiatric ward and started on dangerous psychiatric medication.

  Over the next 10 months, the woman lost her friends, who attributed her normal mood changes to her alleged disorder. Her self-confidence plummeted; her marriage fell apart. She moved halfway across the country to find a place where, on her dwindling savings, she and her son could afford to live. But she was isolated and unhappy. Because of the drug she took for only six weeks, she now, more than three years later, has an eye condition that could destroy her vision.

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We need better laws and  improved mental health services.