ANOSOGNOSIA AND ANOSODIAPHORIA

ACADEMIA Letters DISSOCIATION IS A FORM OF ANOSOGNOSIA AND

ANOSODIAPHORIA

Francisco Orengo García

We have a problem in Medicine. Especially between the fields of Neurology and Psychia- try. Often, the same or similar signs, symptoms, and/or phenomenological descriptions of deficits in the nervous system and the psyche are described using completely different terms, expressions, even words.

This fact that enhances with time creates a disrupted impression: we speak as neurologists or as psychiatrists from same o equivalent symptoms as unrelated or even completely different phenomena.

In my opinion, one of the” best errors” created by this artificial division of the language of describing semiology is the field of DISSOCIATION (Psychiatry) and ANOSOGNOSIA AND ANOSODIAPHORIA (Neurology).

Generally speaking, a neurologist will think that a psychiatrist that speaks about Disso- ciative Identity Disorder or Complex Posttraumatic Stress disorders, etc. is in another world far from the “real” world of clinical neurological “facts”. On the contrary, a psychiatrist that is found in the field that we call Psychotraumatology will think that anosognosia or even the often-coupled phenomenon of anosodiaphoria is an ancient description of the last century neuropsychiatry, generally related to ictal or similar neurological deficits.

Two different clinical worlds, two different doctor types.

But I myself, as a neuropsychiatrist, trained as such in Spain and Germany 40 years ago, I suspect that the works of Otto Pötzl and his colleagues like von Ehrenfeld in the German psychiatric clinic in Prague or the same work of Goldstein and Gelb or even from Luria and his colleagues are completely forgotten. In Spain, the work of Bartolomé Llopis, Justo Gonzalo, or José M. Sacristan belongs to a past so ancient as the pyramids in Egypt, I would say.

Academia Letters, July 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0

Corresponding Author: Francisco Orengo García, franciscoorengo@gmail.com

Citation: Orengo García, F. (2021). DISSOCIATION IS A FORM OF ANOSOGNOSIA AND ANOSODIAPHORIA. Academia Letters, Article 1795. https://doi.org/10.20935/AL1795.

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But the fact that we do not study and get trained as “real” neuropsychiatrists does not mean that the patients to be treated do not present anosognosia, dissociation, etc. at the same time. Just clear-minded colleagues like the unique Oliver Sacks followed these lines of crossing between neurology and psychiatry writing many books that offer an open window to watch at the whole landscape without been interrupted by the “Berlin wall” that separates neurology and psychiatry.

In his book “A leg to stand on” (1) where Sacks describes the symptoms and sufferings he had as a patient as a result of an accident in Norway, been at the same time a wonderful clinical neurologist and psychiatric patient in his past, there are excellent comments and pas- sages around the issue I try to bring here now. It is the question of the equivalence between anosognosia symptoms and dissociation.

The lack of a real, “conscious” knowledge from the side of the patient of a neurological deficit like a paresis is what we call anosognosia. The emotional side of this symptom is what Babinski called at the same time anosodiaphoria. On the other hand, when we detect once and again that a patient does not have a real, “conscious” suffering of a traumatic, terrible experience, we speak from hysteric “belle indifference” using the excellent French terms.

This form of “not knowing” of a very special type of ignorance, of denial and distancing from evil and trauma, all of them are just the same clinical phenomena in my view. Psychi- atrists and psychologists called them dissociative disorders, neurologists anosognosia symp- toms. Psychiatrists see these types of patients for much longer periods of time, even their whole life, neurologists just the first hours or days after neurological deficits. That is a main difference in clinical practice.

My point now is to call for a new interest from sides of neurology and psychiatry for these types of clinical manifestations that exist but are seldom referred by patients. They simply get undiagnosed many times.

Especially in times of COVID pandemia, where patients begin to refer about the most complex clinical syndromes after having suffered the illness, is time to reconsider the presence of new appearing old dissociated and anosognosia symptoms and syndromes that lied hidden under the curtains that anosognosia, denial and/or dissociation offers. In that sense, such a huge catastrophe is an opening of many wounds at the same time. Wounds in the body and soul that were not cicatrized but silenced under decades of post-traumatic dissociation and anosognosia.

From this point of view, it is mandatory that, despite the paramount role of virologists and epidemiologists, neuropsychiatrists come to the frontline of medicine and explain to the people how important all these issues are.

The problem is that we do not have neuropsychiatrists anymore…perhaps colleagues in Academia Letters, July 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0

Corresponding Author: Francisco Orengo García, franciscoorengo@gmail.com

Citation: Orengo García, F. (2021). DISSOCIATION IS A FORM OF ANOSOGNOSIA AND ANOSODIAPHORIA. Academia Letters, Article 1795. https://doi.org/10.20935/AL1795.

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general practice or family medicine can take this quite important role and try to separate what are new symptoms, i.e., issues related to a new illness and old ones that we do not know anymore were they came from…but are here again.

Are we prepared for such a paradigm change?

(1) Sacks, Oliver (1998). A Leg to Stand On. New York, NY: Simon & Schuster, 1984.”

Academia Letters, July 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0

Corresponding Author: Francisco Orengo García, franciscoorengo@gmail.com

Citation: Orengo García, F. (2021). DISSOCIATION IS A FORM OF ANOSOGNOSIA AND ANOSODIAPHORIA. Academia Letters, Article 1795. https://doi.org/10.20935/AL1795.

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