SchizophreniaConnection is pleased to present an interview Dr. Xavier Amador, who discusses the thorny dilemma of how to convince someone who doesn't believe he has schizophrenia to accept treatment. Dr. Amador is an internationally sought-after speaker, clinical psychologist, professor at Columbia University in New York City, and author of eight books.
Dr. Amador's expertise has made him a regular contributor to the Today Show and a featured guest on ABC Good Morning America, Prime Time Live, CBS This Morning, NBC Nightly News, 60 Minutes, CNN-Dateline, ABC's World News Tonight, Fox News, New York Times, Wall Street Journal, USA Today and many others.
Dr. Amador is a consultant to numerous companies and government agencies including the National Institute of Health and Department of Justice.
His forensic cases include the Unabomber, PFC Lynndie England, Elizabeth Smart kidnapping, and Zacarias Moussaoui trials. Dr. Amador has over 25 years experience working with adults, families and couples. He lives in New York. www.XavierAmador.com
Christina Bruni interviews. The following is the first of the two-part series.
SC: Talk about anosognosia; what it is, and what causes it. Can it be prevented?
XA: Research shows that about 50 percent of persons with schizophrenia (about 1.5 million in the U.S.) do not know they have an illness, and this unawareness does not improve with education, time, or treatment. I purposely did not use the term "denial" in the previous sentence because this problem is not denial. Denial is a coping strategy, a way we deal with painful knowledge. People in denial know something deep down inside (unconsciously), but they lie to themselves about it. But the research indicates that this is not what we are dealing with when, after months and years of evidence, the person still does not believe she or he is ill. What we are dealing with here is anosognosia (AH-no-sog-NO-sia)-a neurological syndrome that leaves patients unaware that they are ill.
According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), "A majority of individuals with schizophrenia lack insight ... Evidence suggests that poor insight is a manifestation of the illness itself, rather than a coping strategy ... comparable to the lack of awareness of neurological deficits seen in stroke, termed anosognosia."
As co-chair of the last revision of the DSM-IV text on schizophrenia, I was asked to propose changes that would better reflect scientific consensus. Every change considered had to be peer-reviewed by other scientists. The quote above reflects scientific consensus in the field (as of 1999) that poor insight is common in schizophrenia and is linked to executive (or frontal lobe) dysfunction. In the seven years since this update in the DSM, many new studies have replicated this finding.