Sunday, April 29, 2018

A Conflict Theory Perspective of Anosognosia or "Lacking Insight"

In medicine once a person is diagnosed with a psychiatric illness it is set in stone. Usually the person is considered permanently mentally ill and their illness is expected to last the rest of his or her lifetime. There are situations where a person is said to be misdiagnosed. However, these situations are rare and usually due to another more serious condition being discovered that can explain a person’s mental health symptoms, like a brain tumor.

The diagnosis of mental illness is so irrefutable that if a person were to question whether or not they actually have a mental illness the doctor will diagnosis them with an additional mental illness. This illness is known as Anosognosia also referred to in psychiatry as lacking “insight.” Anosognosia is an illness in which a patient cannot understand or recognize that he or she has a psychiatric disorder.

In reality, questioning if you really have a mental illness is understandable. There are many alternative ways of thinking about and viewing mental illness. Consider the following:
  • There is little to no empirical (scientific) evidence that psychiatric disorders are really illnesses. Because of this, mental illness could be conceptualized as a social construction, something that only exists conceptually through shared consensus among individuals, like currency.
  • Mental illness could be viewed as a reaction to stressful experiences or a stressful social environment which would not necessarily mean that it involves an underlying pathology or defect. Rather, it is a normal reaction to a person’s environment or circumstances.
  • Mental illness is only viewed as illness in Western Society. Historically, other cultures have viewed mental illness as a religious or spiritual problem.
  • Some view mental illness as part of the human experience and best understood on philosophical or existential terms.

Patients are likely to have their own view of what is causing their experiences and behavior which may contradict the view held by a psychiatrist. Because of this, inevitably, there are going to be some mental patients that disagree that they have a mental health diagnosis for one reason or another. When a mental patient rejects their diagnosis it creates a problem for psychiatrists. It undermines the validity of the mental health diagnosis they give a patient and, therefore, their work as psychiatrists.

In my opinion, diagnosing someone with Anosognosia or stating they lack “insight,” is really just a way for psychiatrists to solve this problem. It gives psychiatrists not only a convenient explanation for what causes a person to think and feel this way but also a way to eliminate it. If the person disagrees with their diagnosis the psychiatrist can just increase the medication they are on or put the person on a new treatment until the person agrees that they have a mental illness.

A Conflict Theory Perspective of Anosognosia or “Lacking Insight”

According to conflict theory in sociology, laws are created in society to support the interests of dominant groups at the expense of less powerful groups (Gottschalk, 2015). To illustrate this principle imagine a society where one class of people rules the entire society and owns all the food. Naturally, other classes in this society are hungry and want some of the food, so they start stealing it from the ruling class. The ruling class wants to keep all the food so they invent a law against stealing. In this imaginary society stealing is outlawed not because it is morally or philosophically wrong but because it maintains the interests of the ruling class.

This picture provides a visual aid to show the relationship
between psychiatrists and patients. Psyhciatrists maintain
there powerful position at the top of the pyramid by diagnosing
patients  who question them with "Anosognosia."
This idea could easily be applied to psychiatry and mental illness. Mental disorders are also created and maintained due to the interests of certain groups. For example, homosexuality was once considered a mental illness. At the time when this was the case there was widespread prejudice against homosexuals and homosexual behavior. One could argue that homosexuality was considered a mental illness because viewing it as such represented the interests of individuals and groups that had prejudice against it. Homosexuality lost its official status as a mental illness in 1973 (Drescher, 2015) because attitudes about it changed.

I propose that psychiatrists have invented Anosognosia not because it is an illness but because it supports their interests, similar to the manner in which powerful groups impose laws in society. When a mental patient disagrees with a psychiatrist about their diagnosis it undermines the validity of the patient’s mental health diagnosis. Consequently, psychiatrists label this perspective an illness.

Conflict theory is based on the works of Karl Marx. Marx explained that in a capitalist society the ruling class also known as the bourgeoisie constructed social institutions in a way that supported their interests (Spitzer, 1975 p.643).Thus, everything from the education system to the legal system was tailored to promote the bourgeoisie at the expense of the proletariat or working class. The bourgeoisie could do this because they owned the means of production or the infrastructure to produce goods and services. Thus, they had the power and wealth to create social institutions in their image.

Similar in the way that the bourgeoisie own the means of production psychiatrists have the power to decide what is and is not considered mental illness. The text that contains all officially recognized mental disorders, known as the DSM or Diagnostic and Statistical Manual of Mental Disorders, is created through consensus and voting by a large prestigious group of psychiatrists (Davies, 2016). It’s likely that many psychiatric disorders and symptoms are created to promote and maintain the interests of psychiatrists.

A Final Word

In reality, there are strong philosophical arguments against viewing problematic behaviors and experiences as mental illness. However, if you explained these arguments to a psychiatrist he would probably suggest that you had a psychiatric disorder and needed mental health treatment. Diagnosing someone with Anosognosia or stating they lack “insight,” is really just an underhanded way for psychiatrists to suppress a view that contradicts their own.

What distinguishes a mental illness from a different point of view? In my opinion, separating the two is not possible. Over time in our society, problematic behaviors and experiences are increasingly medicalized, meaning they are seen as mental illness. Because of this, in the future it could be that all kinds of perspectives are considered illnesses. Imagine a world where disagreeing with the government is an illness. Unfortunately, This could become a reality.


Davies, J. (2016). How Voting and Consensus Created the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). Anthropology & Medicine,24(1), 32-46. doi:10.1080/13648470.2016.1226684
Drescher, J. (2015). Out of DSM: Depathologizing Homosexuality. Behavioral Sciences,5(4), 565-575. doi:10.3390/bs5040565
Gottschalk, P. (2015). Social Conflict Theory and White-collar Criminals: Why Does the Ruling Class Punish their Own? Pakistan Journal of Criminology,Vol. 7, P.4-P.4. Retrieved April 27, 2018, from https://brage.bibsys.no/xmlui/bitstream/handle/11250/298089/GottschalkBystrova_2015_PJC.pdf?sequence.
Spitzer, S. (1975). Toward a Marxian Theory of Deviance. Social Problems,22(5), 643-643. doi:10.2307/799696

1 comment:

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