Anosognosia, despite the hyper-scientific sound of the word, is a very common occurrence that most of us have witnessed firsthand. In short, it is when the mentally ill deny their own mental illness.
The crossover between this phenomenon and homelessness is obvious—those who deny their own mental illness, which is keeping them on the streets, will not accept help from their loved ones or the government, either for their illness or for their living situation.
Anosognosia should not be confused with simple denial—while denial is psychologically based and is common with addiction, anosognosia is considered biologically/neurologically based. Despite this distinction, there are notable ties between mental illness and substance abuse, which not only makes the two phenomena similar in outcome (homelessness), but also could exacerbate one another, making their self-destruction that much more extreme. The National Institute of Mental Health includes bipolar disorder and schizophrenia—the two mental disorders which most commonly lead to anosognosia—as two mental disorders that can contribute to SUD (substance abuse disorder).
One might propose that those denying they have a problem perhaps do not have a problem, that people have the freedom to live how they choose, and that those who choose to be homeless have a right to do so. There is no question that protecting freedom is an important role of the government, and that inhibiting someone’s freedom would be ignoble in most scenarios. However, safety is also a major question. Mental illness—especially with hallucinatory mental disorders such as schizophrenia and behavioral disorders such as bipolar disorder—can cause a cycle of self-inflicted hardship, which can lead to intense suffering and a shorter, more painful life.
The threat to themselves is apparent. The streets are no safe haven, and according to a study conducted in 2008, the rate of homelessness among those incarcerated is 7.5 to 11.3 times the annual rate in the general population. In the 2020/2021 Annual Report on Homelessness, the Maryland Interagency Council on Homelessness found that Maryland’s homeless death rate is approximately three times the rate of the general population, and the average life expectancy for someone experiencing homelessness is 30 years less than the average person.
For those experiencing anosognosia, since voluntary treatment is out of the question, the only option towards living a stable life is involuntary treatment. See post “Maryland Policy on Involuntary Treatment” for more information on how Maryland falls behind other states with the absence of long-term solutions for mental health patients experiencing anosognosia.