Anosognosia: What happens when a person is unaware of their mental disorder?

In the US, I've had the privilege of watching several relatives pass away at old ages, all of whom suffered cognitive decline. What a learning experience these were. In every case, doctors did nothing that would have influenced patient autonomy. I can see vividly the challenge this article is presenting.

How can we make mental health screening mandatory without unintended harmful consequences? It can't be threatening to people's identity and rights. Mental health screening should be presented as something valuable and risk free.

The current approach has a built-in assumption that anyone who looks old is already transitioning responsibilities to their other family members. Not every family works like that. The bank did not ask my uncle if he had anosognosia when they foreclosed his house and took all of his equity.

Even years of counseling/therapy could miss anosognosia when there is an expectation the patient wants a specific problem was addressed. Recently I was diagnosed with adult ADHD, so prior to that, I had undiagnosed anosognosia. I had been seeing a therapist to deal with the family death issues and this never came up.

If doctors instituted decent mental health screening as part of their standard practice, then it would help to address a pervasive single-point-of-failure problem (where the patient has failed to adequately identify their mental health issue).

Dr. John Conolly described insanity in 1850 as "A disease of perception combined with an inability to tell whether these changes were real or not."

Anton's Syndrome: Excerpt from https://www.ncbi.nlm.nih.gov/books/NBK538155/ : Though the patient is blind, he will behave and talk as if he has normal vision. Attention is aroused; however, when the patient is found to collide with pieces of furniture, to fall over objects, and to experience difficulty in finding his way around. They may try to walk through a wall or a closed door on their way from one room to another. Suspicion is still further alerted when they begin to describe people and objects around them who do not exist. Mental confusion may also be seen. Patients with ABS may give excuses for their blindness. They may explain that their inability to see is because of the lack of proper lighting, and they may try their best to prove that they are not blind, thereby putting themselves in danger.

One of the earliest descriptions of this syndrome is found in Seneca's "Moral Letters to Lucilius".

bad things happen.