Psychiatry’s Ultimate Catch 22 Diagnosis

     The author Joseph Heller coined the term “catch 22” with the 1961 publication of his satirical novel of the same name which sold over ten million copies. A catch-22 is a circular, inescapable dilemma. It’s represented in Heller’s book by a WWII pilot who claims to be insane to avoid dangerous combat missions, but the military rules is sane because no sane person would not want to avoid the danger of air combat.

     The newly coined psychiatric catch 22 diagnosis is “anosognosia,” a multisyllabic, Greek root word – literally, “without knowledge of illness” – that sounds appropriately erudite for use in the next DSM. The word was first proposed in 1914 by French neurologist Joseph Babinksi to describe someone unaware of an area of paralysis in the body after suffering a stroke or brain injury. Babinski studied under Charcot and shared the French hypnotist’s belief that female hysteria had a biological cause.

     Over time the term shifted its meaning to describe a lack of awareness or insight into various mental health conditions which were then thought to stem from physical changes in areas of the brain. The term has since become a standard psychiatric diagnosis since Dr. Xavier Amador wrote in the early 1990s that a patient’s inability to recognize his or her own schizophrenia was a biological deficit of the brain’s frontal lobe. He thus moved the cause of the “behavior” from one of mental denial to one of physical abnormality, conforming with the biological causes behind mental states that psychiatrist used in that time period to
legitimize themselves as “real” doctors.

     Today anosognosia is used as the ultimate catch-22 diagnosis that offers no rebuttal by a patient so diagnosed. “Your ignorance of your own craziness is the final proof that you are indeed crazy and therefore nothing can be done for you. You are utterly treatment resistant.”

     That staggering evaluation sets up endless prescriptions of mind and emotion numbing psychiatric drugs, often coupled with repetitive electroshock sessions that erase memory.

     The final catch-22 of psychiatry’s anosognosia? “As you are obviously  incurable, the only ‘cure’ is for us to destroy you.”