PSYCHIATRIC AGNOSIA / the inability to grasp reality
Agnosia is a neurological term not found in general psychiatric usage. The word comes from the Greek ‘a’ meaning without and ‘gnosis’ meaning knowledge. The neurologist who coined this term in 1891 was a little-known Jewish neurologist from Austria known as Sigmund Freud. His main claim to fame at the time would have been that due to the racism inherent in Viennese and Austrian society he was barred from becoming a professor in Neurology and was consigned to the murky depths of a hitherto unknown psychiatric discipline called psycho-analysis.
Agnosia is a neurological disorder characterized by an inability to recognize and identify objects or persons using one or more of the senses. This happens even though the patient has senses and sense-perceptions that are entirely normal in function. An example may be that a person who knows what a dog is can see a dog in a room but is unable to explain what that animal actually is. Although agnosia means without knowledge we know that the person actually does have the knowledge as in does know what a dog is but is unable to connect the perception of the dog (seeing the dog) to the understanding of what a dog is.
Usually in neurology agnosia reflects damage or dysfunction in one of the areas or lobes of the brain. Focal dysfunction can occur by damage by stokes, tumours or trauma in particular areas of the brain. More generalised dysfunction occurs in diseases affecting wider areas of the brain such as infections, inflammations and degenerative neurological disorders. Cerebral dysfunction is caused by damage to brain networks that function together usually involving several cerebral lobes, most often the parietal, temporal, and occipital lobes of the brain. The parietal and temporal lobes are invariably involved in the more complex agnosias. Agnosia usually affects only a single information pathway in the brain. If you have this condition you can still think, speak, and interact with the world.
Given that the adjective from agnosia is agnostic it might be worth looking at the derivation of that word. The word agnostic also comes from the Greek a and gnosis meaning without knowledge. The English biologist Thomas Henry Huxley coined the word agnostic in 1869, and said "It simply means that a man shall not say he knows or believes that which he has no scientific grounds for professing to know or believe. Agnosticism, in fact, is not a creed, but a method, the essence of which lies in the rigorous application of a single principle .. Positively the principle may be expressed: In matters of the intellect, follow your reason as far as it will take you, without regard to any other consideration. And negatively: In matters of the intellect do not pretend that conclusions are certain which are not demonstrated or demonstrable.”
Huxley believed that a hypothesis with no supporting, objective, testable evidence is not an objective, scientific claim. As such, there would be no way to test said hypotheses, leaving the results inconclusive. In that he was similar to Karl Popper who would also describe himself as an agnostic.
The term agnosia and the related agnostic essentially means ‘without knowing’. Agnosia in neurology suggests not knowing when the evidence suggests there is no substantive reason for this not knowing. As pointed out above the actual problem is in connecting what the perception actually means.
After a lifetime of working in psycho-therapy with patients with anxiety the one thing that strikes me above all else is how they live in a sphere of their own, both replete with multitudinous aspects of ‘not knowing’ as well as clearly exhibiting a ‘not connecting’ of their perceptions and experiences to their understanding of reality involving the actual world that they live in. In other words to all intents and purposes they suffer from what might be termed psychiatric agnosia involving ‘the inability to see’ or understand what lies directly before them.
What causes psychiatric agnosia?
There are many reasons why we do not see reality. Most relate to the fact that our assessment of life is far more subjective than most of us imagine. In fact the entirety of it is entirely subjective. We just do not realise this. We believe everyone sees what we see, believes what we believe and thinks what we think. And when they do not they are clearly mistaken!
Dissociation
When we are insufficiently engaged with life we begin to think excessively. Then we begin to associate emotion with these thoughts. These emotions drive us into a spiral of loosely interconnected thought patterns every thought amplifying the emotionality of the past thoughts leading to a greater stream of thoughts which in turn greatly increase the emotionality. When this process raises the emotional tone to a certain level which varies between individuals as a result of genetics, experience, environment and social expectations a threshold is crossed. There is then a process which defends us from what to us is an intolerable stress. This process involves defensive cognitive measures such as denial (this is not really happening) or projection (blaming others). If the stress reaches past our tolerability levels as noted which vary in different people then we split reality or in psychiatric terms dissociate. Dissociation literally cleaves our consciousness into different compartments. Some of the compartments (the safe ones are allowed to remain in consciousness but the ones that stress us and are considered unsafe are banished into unconsciousness and locked away in a safe enclosed box where our awareness of it is either diminished or completely absent. Then consciousness occurs in a calm unawakened sphere literally an alternative state of consciousness where unpleasant reality lies dormant. This level of consciousness can be unaware of the existence of the other but more often has an uneasy sense of an alternate presence a disconcerting aura of ‘something else’.
This need to remain calm leads to a process of denial which maintains it in ignorance so even if one wished to perceive this other self one might be thwarted in one’s efforts. In this state the person basically thinks as little as possible and will actively resist any attempt to become influenced into critical or rational thought.
Hiding from the truth
It is commonly noted that people when anxious talk too much and listen too little. People who interview people for a job know this because it is their everyday experience. When someone raises their voice and speaks more quickly they recognise this as a sign that that person is exhibiting anxiety. When this happens in a legal context it may be considered that this is because they are not telling the truth. When people are avoiding the truth they generally speak in a more agitated or accelerated fashion. When people consistently do not tell the truth then they often consistently speak in this fashion and it may be considered part of their personality. People who consistently talk too much may legitimately be considered to be hiding something. What they are hiding is often their true selves. What you are then talking to is their constructed or socially acceptable or approved self. Their true self is hidden deep within. This is commonly referred to today as ‘the imposter syndrome’.
For people doing this the truth becomes a distant land, more and more distant from their experienced lives. Initially they are aware of this but as time and the practice continues they lose that awareness and become convinced that they are actually telling the truth. Eventually the truth becomes an alien field. They become completely unaware that they are no longer telling the truth. This has become a defensive mechanism that is automatic and unconscious. If confronted they often can be adamantly aggressive that their version of reality is reality and they are convincing because they believe it themselves.
Painful apprehension
A seeming eternity of chronic persistent and painful apprehension is the life that many anxiety sufferers will be familiar with. The apprehension appears to be unconsciously driven and caused by factors outside our control. We seem to have no power over it. We know that something bad is about to happen to us but we don’t know why or why we have been chosen for this fate.
Agnosia is a neurological term not found in general psychiatric usage. The word comes from the Greek ‘a’ meaning without and ‘gnosis’ meaning knowledge. The neurologist who coined this term in 1891 was a little-known Jewish neurologist from Austria known as Sigmund Freud. His main claim to fame at the time would have been that due to the racism inherent in Viennese and Austrian society he was barred from becoming a professor in Neurology and was consigned to the murky depths of a hitherto unknown psychiatric discipline called psycho-analysis.
Agnosia is a neurological disorder characterized by an inability to recognize and identify objects or persons using one or more of the senses. This happens even though the patient has senses and sense-perceptions that are entirely normal in function. An example may be that a person who knows what a dog is can see a dog in a room but is unable to explain what that animal actually is. Although agnosia means without knowledge we know that the person actually does have the knowledge as in does know what a dog is but is unable to connect the perception of the dog (seeing the dog) to the understanding of what a dog is.
Usually in neurology agnosia reflects damage or dysfunction in one of the areas or lobes of the brain. Focal dysfunction can occur by damage by stokes, tumours or trauma in particular areas of the brain. More generalised dysfunction occurs in diseases affecting wider areas of the brain such as infections, inflammations and degenerative neurological disorders. Cerebral dysfunction is caused by damage to brain networks that function together usually involving several cerebral lobes, most often the parietal, temporal, and occipital lobes of the brain. The parietal and temporal lobes are invariably involved in the more complex agnosias. Agnosia usually affects only a single information pathway in the brain. If you have this condition you can still think, speak, and interact with the world.
Given that the adjective from agnosia is agnostic it might be worth looking at the derivation of that word. The word agnostic also comes from the Greek a and gnosis meaning without knowledge. The English biologist Thomas Henry Huxley coined the word agnostic in 1869, and said "It simply means that a man shall not say he knows or believes that which he has no scientific grounds for professing to know or believe. Agnosticism, in fact, is not a creed, but a method, the essence of which lies in the rigorous application of a single principle .. Positively the principle may be expressed: In matters of the intellect, follow your reason as far as it will take you, without regard to any other consideration. And negatively: In matters of the intellect do not pretend that conclusions are certain which are not demonstrated or demonstrable.”
Huxley believed that a hypothesis with no supporting, objective, testable evidence is not an objective, scientific claim. As such, there would be no way to test said hypotheses, leaving the results inconclusive. In that he was similar to Karl Popper who would also describe himself as an agnostic.
The term agnosia and the related agnostic essentially means ‘without knowing’. Agnosia in neurology suggests not knowing when the evidence suggests there is no substantive reason for this not knowing. As pointed out above the actual problem is in connecting what the perception actually means.
After a lifetime of working in psycho-therapy with patients with anxiety the one thing that strikes me above all else is how they live in a sphere of their own, both replete with multitudinous aspects of ‘not knowing’ as well as clearly exhibiting a ‘not connecting’ of their perceptions and experiences to their understanding of reality involving the actual world that they live in. In other words to all intents and purposes they suffer from what might be termed psychiatric agnosia involving ‘the inability to see’ or understand what lies directly before them.
What causes psychiatric agnosia?
There are many reasons why we do not see reality. Most relate to the fact that our assessment of life is far more subjective than most of us imagine. In fact the entirety of it is entirely subjective. We just do not realise this. We believe everyone sees what we see, believes what we believe and thinks what we think. And when they do not they are clearly mistaken!
Dissociation
When we are insufficiently engaged with life we begin to think excessively. Then we begin to associate emotion with these thoughts. These emotions drive us into a spiral of loosely interconnected thought patterns every thought amplifying the emotionality of the past thoughts leading to a greater stream of thoughts which in turn greatly increase the emotionality. When this process raises the emotional tone to a certain level which varies between individuals as a result of genetics, experience, environment and social expectations a threshold is crossed. There is then a process which defends us from what to us is an intolerable stress. This process involves defensive cognitive measures such as denial (this is not really happening) or projection (blaming others). If the stress reaches past our tolerability levels as noted which vary in different people then we split reality or in psychiatric terms dissociate. Dissociation literally cleaves our consciousness into different compartments. Some of the compartments (the safe ones are allowed to remain in consciousness but the ones that stress us and are considered unsafe are banished into unconsciousness and locked away in a safe enclosed box where our awareness of it is either diminished or completely absent. Then consciousness occurs in a calm unawakened sphere literally an alternative state of consciousness where unpleasant reality lies dormant. This level of consciousness can be unaware of the existence of the other but more often has an uneasy sense of an alternate presence a disconcerting aura of ‘something else’.
This need to remain calm leads to a process of denial which maintains it in ignorance so even if one wished to perceive this other self one might be thwarted in one’s efforts. In this state the person basically thinks as little as possible and will actively resist any attempt to become influenced into critical or rational thought.
Hiding from the truth
It is commonly noted that people when anxious talk too much and listen too little. People who interview people for a job know this because it is their everyday experience. When someone raises their voice and speaks more quickly they recognise this as a sign that that person is exhibiting anxiety. When this happens in a legal context it may be considered that this is because they are not telling the truth. When people are avoiding the truth they generally speak in a more agitated or accelerated fashion. When people consistently do not tell the truth then they often consistently speak in this fashion and it may be considered part of their personality. People who consistently talk too much may legitimately be considered to be hiding something. What they are hiding is often their true selves. What you are then talking to is their constructed or socially acceptable or approved self. Their true self is hidden deep within. This is commonly referred to today as ‘the imposter syndrome’.
For people doing this the truth becomes a distant land, more and more distant from their experienced lives. Initially they are aware of this but as time and the practice continues they lose that awareness and become convinced that they are actually telling the truth. Eventually the truth becomes an alien field. They become completely unaware that they are no longer telling the truth. This has become a defensive mechanism that is automatic and unconscious. If confronted they often can be adamantly aggressive that their version of reality is reality and they are convincing because they believe it themselves.
Painful apprehension
A seeming eternity of chronic persistent and painful apprehension is the life that many anxiety sufferers will be familiar with. The apprehension appears to be unconsciously driven and caused by factors outside our control. We seem to have no power over it. We know that something bad is about to happen to us but we don’t know why or why we have been chosen for this fate.