Anosognosia: Curing the disease of not knowing about effective interventions for, and prevention of, serious mental illnesses

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I am sitting in the Capital Hyatt Regency, with a bottle of wine for people I don’t know. I’ve just spent $1,500 to meet some people on a quest to prevent, reduce and even heal serious mental illnesses that many believe is Quixotic. Folks seem to wander into the lobby bar, looking a bit like the motley crew I am to meet rather than standard issue Washington suits. One spiky-blonde dude is wearing a Google Glass, decidedly NOT DC standard issue, along with a very straight-arrow guy. The women are bubbly and warm. All these folks must be my people.

Our convener host, Scott, appears. He’s a cross between an evangelical pastor and boy-scout leader, who runs the Children’s Mental Health Network. The evening is fun and interesting. We learn the RULES for the next day. We have about 10-15 each to speak from the heart in a fishbowl arrangement, while the powers-that-be from the Congressional Office look on while we emote. It’s an enjoyable evening of interesting people.

It’s the next morning. I am lost trying to find my way walking to the meeting place, but find it. Stories of crisis, drama, challenge, despair, resilience and uncertainty move me. Our straight-arrow friend tells an equally compelling story of having to draft Kendra’s Law, leading up to the idea of Assisted Outpatient Treatment (AOT).  I am sure the legislative aids think they have landed in the middle of an alien EST group.

My story is both as a child survivor of craziness and that of a clinician-scientist who dares to speak heresy: Mental, emotional, and behavioral disorders—including very serious ones are likely preventable. I get the notion of mandated treatment. My brother and I had to commit our parents, not that it worked out so well. Why? The court-ordered treatments, themselves, were inane at best and iatrogenic at worst. I could not save my father from cancer that grew in him from toxic addictions. From my growing skills in graduate school, I was able to cobble together some contingency management protocols to give my mother more than a decade of life.

I don’t have anosognosia about the need for court-ordered treatment, nor did anyone in the room. Now outside the room, I fear that there is a scientific and spiritual anosognosia, amongst the beltway denizens about the prevention of and/or recovery from mental illnesses, including serious ones like schizophrenia and bipolar.

In 1840s, Ignaz Semmelweis told the Viennese medical society that childbed fever mortality could be prevented by hand washing. The Viennese medical society promptly developed a serious case of anosognosia about the very possibility, since God had decreed that women should suffer in childbirth—as a consequence of eating the Biblical apple. Thus was the fixed idea of the era. Semmelweis was declared mad, and he eventually died as a result of their court ordered treatment. Let us not be guilty of anosognosia of prevention, early intervention and recovery from major mental illnesses.

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enbryDennis D. Embry, Ph.D., is a prominent prevention scientist in the United States and Canada, trained as clinician  and developmental and child psychologist. He is president/senior scientist at PAXIS Institute in Tucson and co-investigator at Johns Hopkins University and the Manitoba Centre for Health Policy. His work and that of colleagues is cited in 2009 the Institute of Medicine Report on The Prevention of Mental, Emotional, and Behavioral Disorders Among Young People. Clinically his work has focused on children and adults with serious mental illnesses. He was responsible for drafting of the letter signed by  23 scientists, who collectively represent scores of randomized prevention trials of mental illnesses published in leading scientific journals. In March 2014, his work and the work of several signatories was featured in a Prime-TV special on the Canadian Broadcast Corporation on the prevention of mental illnesses among children—which have become epidemic in North America.


  1. Laurie O'Reilly's avatar
    Laurie O'Reilly
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    Thanks for all you do!
    Early intervention is key. Mainstreaming a broader/expanded definition of "treatment" could be helpful. Many parents I work with believe that the most important part of "treatment" is medication. Many times there is not enough buy in to the idea that understanding, awareness, positive skill building, positive modeling, relationship building etc. can be the most important factors in their child's emotional well-being.
  2. Bonnie Jean Smith's avatar
    Bonnie Jean Smith
    | Permalink
    I totally agree with you! Prevention, prevention, prevention! It works, I have seen it in action. I have also seen, " the blind leading the blind" sending a young person straight into serious mental illness, that was preventable.
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