Orrin Onken
4 min readJul 8, 2022
Photo by Mark de Jong on Unsplash

Anosognosia: A neurological condition where a person is unable to perceive, or is unaware of his or her own illness.

When practicing probate law, I was on the court bailout list. Judges used the list to put probate lawyers on cases that needed them but didn’t have them. Due to being on the bailout list, I represented many clients with mental illnesses, usually people who’d had guardianship petitions filed against them. I was a once-you’re-a-client-you’re-always-a-client kind of lawyer, and guardianship cases never truly end until the protected person dies, so I represented some of those clients for decades.

I ran into anosognosia in its most virulent form while representing young men on the schizophrenia spectrum. I had one client named Chuck, a delightful and maddening client, who had lived in group homes for so long that he had become as expert as the doctors in diagnosing and evaluating people’s mental illnesses, mostly others in his group home. But he was completely unable to see that he exhibited the same symptoms and behaviors he saw in them.

Chuck was adamant. They were mentally ill. He was wrongfully detained.


I am alcoholic. At the end of my drinking, I exhibited all the symptoms for Alcohol Abuse Disorder listed in the DSM 5, which meant my condition was severe. My friends knew I was alcoholic. My family knew I was alcoholic. I didn’t see it.


My sister, the doctor, says I didn’t have anosognosia. I had denial. A person in denial, she claims, rejects reality because it’s unpleasant or distressing. A person with anosognosia doesn’t reject the reality of his condition, his brain doesn’t let the information in at all. She says the proof I didn’t have it is that I eventually acknowledged my condition and took the cure. That doesn’t happen when you have anosognosia.

“So If I’d drunk myself to death,” I asked, “would I have had it then.”


“Why not?

“Because substance abuse disorders are different,” she said. “Now quit bothering me.”

So I quit bothering my sister and made up some answers on my own. I decided she was wrong. The distinction between denial and anosognosia is a fake distinction…

Orrin Onken

I am a retired elder law attorney who lives near Portland, Oregon. I write legal mysteries for Salish Ponds Press and articles about being old.