Many with mental illnesses don't believe they're sick


If there is one single obstacle to treating people with mental illness, it's that a large number of them don't believe they're sick at all.

It's not everyday defensiveness that makes them this way, said Dr. Xavier Amador, a clinical psychology professor at Columbia University. It's because their brains are broken.

In his book, "I am Not Sick, I Don't Need Help!" (Vida Press, 2007), Amador said he and his colleagues had to get past the idea that schizophrenia patients' resistance to hospitalization and medication was rooted in stubbornness, defensiveness or ignorance.

"The fact is that the brain circuitry responsible for recording and updating self-concept is not working properly in such patients," he wrote.

Working from that point of view, the key is not getting patients to admit they're sick. Rather, it's a matter of getting them to admit they could use some help.

"It's a huge problem," said Pete Snyder, director of the Eastern Idaho Regional Medical Center's Behavioral Health Center and chairman of the Regional Mental Health Board. "There's a saying in the mental health field that the patient is often the last to know he's sick. It's hard to see it from the inside."

Amador cites poor insight as the reason about half of people with mental illness don't take their medication.

"(When) the patients enrolled in our study were asked whether they had any mental, psychiatric or emotional problems, about half answered 'no,'" he said. "Usually the 'no' was emphatic and followed by sometimes bizarre explanations as to why they were inpatients of a psychiatric ward. ... (Their) main complaint was usually feeling victimized by their family, friends and doctors who were pressuring them to accept treatment for an illness they didn't have!"

There are other reasons why it's hard for someone with a mental illness to admit something is wrong.

One of the biggest is that a person's mind decides what reality is. People who believe they have special powers or insights are going to consider their delusions normal.

Medication is one way to bring a person back to the real world.

But Snyder has met patients whose delusions included the belief that people were out to poison them, and their medications were part of the sinister plan.

"That creates a whole other challenge," he said.

Both State Hospital South and BHC have the power of treatment override, which allows them to force medication. But once a person is stabilized, they have to decide reality is more palatable than the delusions.

Treatment is much easier in the early stages of an illness. Several studies have shown that with every psychotic episode, a person's ability to recover and gain functionality becomes weaker.

"It's important to get help early on in the process," Snyder said.

He recalls a patient who, over time, got so used to his delusions of grandeur that he came to view medication as his enemy.

"Being nondelusional wasn't comfortable for him," he said.

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