Some Thoughts on Denial of Mental Illness
Elyn R. Saks, M.Litt., J.D.
The psychological impetus behind denial of mental illness is readily understandable. Mental illness carries a huge stigma. Even people who do not purposely deny the illness they know they have may unconsciously do so for the very same reason as the conscious deniers. One brings shame upon oneself, so to speak, by admitting to the illness. Also, quite apart from what others think, mental illness is a huge narcissistic injury. One feels lesser, damaged. So there are very understandable reasons to deny one is mentally ill. Note, too, that such feelings of injury may be present and coexist with any biological correlates. (Many today want to conceptualize denial as "anosognosia," which they assert to have a biological basis. But doesn’t all mental activity?)
The question arises, though, of how a person really could deny her illness in the face of flagrant symptoms. What does she tell herself?
Here I will draw on my own experience as a person with schizophrenia who denied for decades that she was ill, even in the face of many, many episodes of clear psychosis. I completely recognized that the things I was saying and doing and feeling would be thought to amount to a diagnosis of schizophrenia; but I thought that it was not true—I didn’t really have the illness.
