There are multiple reasons why a person with schizophrenia might stop engaging with treatment – such as medication side effects or poor relationships with the professionals involved in their treatment. However, one of the biggest reasons why people with serious mental illness stop taking medication and refuse treatment is because of a lack awareness that they have a mental illness.
Anosognosia is a symptom of mental illness that describes when someone does not know they have an illness, also known as lack of or impaired insight. Xavier, R.M. & Vorderstrasse, A. (2016), reviewed current research into the neurobiological causes for impaired insight and found there may be changes in brain structure that are associated with this lack of insight for people with schizophrenia. However, more research is needed to better understand why or how this occurs.
More than 50% of people who have schizophrenia experience anosognosia (Lehrer, D.S., & Lorenz, J., 2014). Anosognosia can also be selective, allowing the person with mental illness to recognize and understand some symptoms, but not others. This is important for caregivers to know as it helps them better understand why their loved one may be refusing treatment and increases compassion and empathy toward their loved one.
Families and caregivers can become frustrated as impaired insight is often the reason why people with mental illness stop taking medication, relapse and need to be hospitalized. To continue to help those with schizophrenia, it is important to remind oneself that the person is not in denial, but truly believes that they are not ill. Judgment from family members and caregivers can result in the person withdrawing from any kind of help. Instead, working together is key in helping the person cooperate with treatment and prevent relapse.
Since the exact cause of anosognosia in schizophrenia is not known, there is currently no intervention guaranteed to reduce the effects of this symptom. Even with medications that reduce or stop the positive and negative symptoms of schizophrenia, insight into the illness may not return. How can a friend or family member encourage a person with anosognosia to continue engaging in treatment?
Do not confront the illness. This will just create arguments. It is not necessary for one to recognize they have an illness, if they can recognize that treatment is helpful. Determine what may motivate a person to keep up with their treatment, for example, one can point out that when taking medications they are hospitalized less often and miss less time at work. It also helps to acknowledge the side effects of medications such as weight gain, restlessness, sexual side effects and foggy thinking, as these are real concerns that need to be addressed to encourage a person’s continued engagement in treatments. It is most important to maintain a good relationship and ensure that the person feels supported. Join a support group
In addition to maintaining the relationship, family members, friends and caregivers need support and education to be effective in helping. All family members, friends and caregivers are struggling through the same challenges. Join a family support group – this will allow you to see you are not alone in this struggle and help share strategies with other family members about what may or may not work. Family support groups are available online and across the province, offered by various organizations. You can find one near you by visiting http://www.bcss.org/events
It is equally important to learn as much as possible about the latest information on schizophrenia. Education allows family members to make informed decisions. For example, read about and talk to people who live with schizophrenia who have been able to find success managing this challenging disease. This can be done by reading books such as Erin L. Hawks’ When Quietness Came: A Neuroscientist’s personal Journey with Schizophrenia. Erin Hawks’ book shows that there is still hope while living with this disease.
The following is an excellent TED talk by psychologist Dr. Xavier Amador explaining anosognosia. Dr. Amador is also the author of “I’m Not Sick, I Don’t Need Help.”
Here is another video by Dr. Xavier Amador about engaging and encouraging a person to take medications for their illness:
- https://www.youtube.com/watch?v=X_KGEkzA7wUAdditional References
Xavier, R. M., & Vorderstrasse, A. (2016). Neurobiological basis of insight in schizophrenia: A systematic review. Nursing Research, 65(3), 224-237.
Lehrer, D. S., & Lorenz, J. (2014). Anosognosia in schizophrenia: Hidden in plain sight. Innovations in Clinical Neuroscience, 11(5-6), 10-17.