Treating Schizophrenia: A Collaborative Approach
This second SharePost of the month features a guest blogger writing on the topic of helping a loved accept treatment. My last guest blog featured a recreational therapist blogging on the topic of recreation. I offer today's entry in connection with the 10th Anniversary edition of Xavier Amador's book I Am Not Sick, I Don't Need Help (Vide Press, Perfect paperback 2010).
People diagnosed with schizophrenia and other mental illnesses face a number of obstacles in this regard. Some of us get to the point where we're doing so well that we think we can live without the medication and stop taking it. A lot of us don't like the side effects of the drugs.
And up to 50 percent of us have a symptom called anosognosia-the lack of awareness that we have an illness. A person who doesn't think he's sick will not take the medication because after all if you're not sick you don't need to take pills. This last group of people who are resistant to treatment will possibly never come around to accepting they have schizophrenia.
Techniques like motivational interviewing and LEAP [listen-empathize-agree-partner] are discussed in detail in the 10th Anniversary edition so I urge you to buy the book and read it because it's been greatly updated and has helped thousands of family members.
My guest blogger is David Wilson, L.M.S.W. who is a member of the Volunteers of America ACT team. His question is: What would you do?
What would you do? You are in an airplane that's going down fast. The pilot gets on the radio and tells you to put on your parachute and jump. Your son, sitting next to you, tells you he does not want to put his parachute on. What would you do?
The case is similar to a problem that families face when they have a loved on with mental illness. What would you do? You know that there is a good chance he can lead a better life, but your loved one just flat out refuses to try a new medication. Often, the denial is a symptom of schizophrenia. He hasn't been helped by previous medication trials and he hates the side effects of all of them. The situation is made even worse.
There are some things you could do. Develop a plan. Convince, don't force. Try to build a loving, safe, trusting relationship. Try to convince your loved one to put on the parachute and jump. Forcing people to take psychotropic medications just doesn't work. Talk to your loved one about what he wants. What is it about his life that he wants to change? Does he want to get his own place? Does he want a job? Maybe he wants a romantic relationship. Explain that these things are attainable with the help of medication.
Peer support works. People who "have been there" offer friendship as well as personal solutions to similar problems. NAMI Connections group meetings for people with mental illness are invaluable in this regard. [Log on to NAMI web site for information.]
When trying a new medication, tell your loved one he has choices. Ask him to try the medication for a month and if some symptoms don't improve perhaps some changes could be made.
Sometimes people with mental illness need to hit rock bottom, mentally speaking, before accepting any treatment at all. Then an in-patient hospital stay might be the only solution. Medication changes are carefully monitored and controlled.
Unfortunately psychiatric medication management is still an art of hit and miss. There are many medications to try and what works for some may not be "right" for others. Dr. Peter Weiden uses the example of a locked door. The illness is the "lock" and the medications are the "keys." Try all the keys until you open the lock. A good doctor will agree to this type of approach.
Understand that there are certain psychiatrists who may be a better "fit" for your loved one than others. Choose a psychiatrist carefully just as you would a cardiologist or pediatrician. If you think your loved one is not improving in any way, do not think "this is all there is." A good psychiatrist could make all the difference.
A good social worker or psychotherapist could make a big difference also. Therapy could be long term and lead to a trusting, holding environment. After a relationship is established, your loved one might be more open to suggestions to try another medication.
Demands and arguments do not work. It is not beneficial to make demands and "tell" your loved one what to do. What is beneficial is to include him into the wider family discussion. This is hard to do but it always helps to say "I love you, let's talk about the things you want and what is available to help you get them."
Recovery from mental illness is possible with the help of family, doctors, therapists, peers, treatment medications.
The best way to travel the road to recovery is with trust, understanding and conversation.