Denial of having Bipolar Disorder

How can you help someone understand or even believe they are suffering from Bipolar Disorder when they think that you are the one with the problem? I have tried many different approaches, but no chance. I believe he has what they call Anosognosia (Doesn't recognize that he has an illness). It has been three years in and out of hospitals and therapies, but no chance of acceptance. Any suggestions or even a referral?

Thank you.

Sister

Ben's Answer:

It's true that many people with Bipolar Disorder experience Anosagnosia - essentially a denial of their deficits or of their illness. This sort of denial is not a psychological denial, but is actually caused by brain damage in the frontal and right-parietal lobes.

Each time a person has a manic episode it has a damaging effect on the brain. A person with severe manic episodes requiring psychiatric hospitalization is more likely to experience
this type of damage. Each time a manic episode occurs, it takes a period of time, (in my experience, as much as a year for some people) to recover full functioning.

Anosagnosia causes a person to have no ability to look objectively at him or herself.

The practice of Mindfulness Meditation and other self-awareness practices is one of the best ways to develop the brain's ability to overcome these sorts of deficits.

(If you want to try an introductory guided meditation for depression, (and a good general meditation for devoping self-awareness and stability), there is one available here.)


For someone with a lot of severe symptoms and denial of their illness, they may never even get to the starting line of dealing with their problem. Some people go in and out of denial, or anosagnosia. Between episodes they may have good insight and self-awareness. It is at those times that loved ones are most likely to be able to influence them positively. At those times, reminding him that he was doing better while on medication, and that when he stopped, he ended up in the hospital again, may help him to gain insight.

It takes an average of 10 year for a person to even get an accurate Bipolar Diagnosis - partly because of denial or anosagnosia in some cases.

Perhaps influencing him to do other self-care measures, like exercise, good diet, or meditation, may be more acceptable to him and meet with less resistance than the "Bipolar" label and the pushing of medication that he refuses.

Contact with others who have Bipolar Disorder (like a Bipolar Support Group) are enormously beneficial because they provide reassurance and connection, while making it hard to stay in denial, since you can identify so easily with the other group members. Of course, even getting into such a group would mean that the person has at least some acceptance, or curiosity about their diagnosis.

Just as it is frustrating and difficult to reason with a person who has Alzeimer's, it can become very tiring to try to influence someone going through denial or anosagnosia. Don't take anything personally. Don't beat yourself up when you feel powerless to help him. And just keep providing gentle, loving reminders of the truth and the benefit of treatment.

I have seen miraculous breakthroughs, even after long periods of denial. So don't give up -- but do take care of yourself first.

Best wishes,
Ben Schwarcz

Santa Rosa Psychotherapist