Anosognosia means unawareness of illness. When Mrs. Jones says she is "fine, thank you" she really means it; even though, as a patient with a substantial right-hemisphere lesion, she is actually paralyzed down the left side of her body. Although they cannot walk and need to use a wheelchair to get around, these patients claim to be fine and insist that there is nothing wrong with them. Their lack of awareness of their incapacities and their rationalizations concerning their problems extends to the point of delusion (see Ramachandran, 1994; Ramachandran and Blakslee, 1998; and Turnbull, 1997, for detailed examples). If, for example, you question a patient who claims that she is able to run why she is in a wheelchair, she might respond, "there was nowhere else to sit."

When you ask her why she is not moving her left arm, she might say: "I exercised it a lot earlier today, so I'm resting it." These patients seem prepared to believe anything, so long as it excludes admitting they are ill. Not uncommonly these patients make bizarre claims about their paralyzed limbs, such as denying that the paralyzed arm belongs to them, and saying that it belongs to someone else, a syndrome called somatopara-phrenia. They also frequently express intense dislike and hatred toward the paralyzed limb, beg surgeons to amputate it, and may even physically assault the limb themselves (misoplegia). Milder cases suffer from anosodiaphoria, where patients do not frankly deny that they are ill but seem indifferent or unconcerned about it. They acknowledge their deficits intellectually but seem unaware of the emotional implications.

0 0

Post a comment