A majority of times, families dealing with serious mental health conditions experience the problem of denial. The person with the conditions denies having any mental problem. There is actually a term for this – anosognosia.
While the term was initially used by neurologists, it applies very well in cases of psychoses, especially schizophrenia. It essentially means not accepting the diseases/illness you have. In case of psychiatry, this is often called lack of insight.
According to wikipedia:
Anosognosia is a condition in which a person with a disability is cognitively unaware of having it due to an underlying physical or psychological (e.g., PTSD, Stockholm syndrome, schizophrenia, bipolar disorder, dementia) condition. It can result from physiological damage to brain structures, typically to the parietal lobe or a diffuse lesion on the fronto-temporal-parietal area in the right hemisphere.
Although largely used to describe unawareness of impairment after brain injury or stroke, the term anosognosia is occasionally used to describe the lack of insight shown by people who do not seem to recognize that they have a mental illness. There is evidence that anosognosia related to schizophrenia may be the result of frontal lobe damage. E. Fuller Torrey, a psychiatrist and schizophrenia researcher, has stated that among those with schizophrenia and bipolar disorder, anosognosia is the most prevalent reason for not taking medications.
For people living with schizophrenia, it’s not uncommon to have a lack of insight for their condition. In essence, it’s part of the condition itself and often puts up a challenging question for families: how to help a loved one who is not willing to accept that (s)he needs help in the first place?
Let’s talk about practical ways to navigate this situation.
1. Educating yourself
To help someone living with a serious mental health condition, the first step you can take is to educate yourself about their condition. Be it schizophrenia, bipolar or schizoaffective disorder, learning what people experience would help you understand your loved one better and develop empathy instead of resentment towards their behaviour. This includes learning and understanding that sometimes lack of insight is part of their mental health condition itself and no amount of logical reasoning or argumentation helps in convincing them.
2. Establishing a trustworthy relationship
To convince someone about anything, you need the person to trust you. This is applicable in any aspect of life not just serious mental health conditions. To establish a good relationship with the concerned person, it’s important that you acknowledge their problems.
When they are experiencing delusions or hallucinations, telling them that they are imagining things is not going to help you in developing a trustworthy relationship with them. They would most likely stop sharing with you if you keep telling them that they are ill or they are seeing/hearing unreal things. Instead of building a trustworthy relationship, you may develop a rather challenging relationship with them which may include more abusive language towards you, more aggression coming your way, more mistrust for you and so on.
Instead of telling them or trying to make them believe that their belief is unreal, listen to them.
Ask them why it bothers them to hear the voices they hear or see things they see (that others don’t see). Even though it’s not suggested that you agree with them, you can can listen to them, probe them further about what bothers them and acknowledge that their pain is real. For example, if someone is mentioning that they hear about themselves in TV, ask why it bothers them. They may tell you then that it bothers them that people in the TV are talking about them. Acknowledge- ‘yes, if that happened to me, I’d be bothered too’.
The next important point is to reassure them that they are safe. Help them feel that you are there to support them and ensure that no harm will come their way.
Listen 👉 Acknowledge pain 👉 Reassure safety
When you build a stronger trustworthy relationship with the concerned person, they might gradually start opening up to you. They may share other problems they are experiencing, say, headaches or sleeplessness, etc. and might eventually be willing to visit a doctor or seek treatment to get help with these problems. In such cases, encourage them to seek treatment.
3. Involve a trusted third party
Sometimes involving another trusted family member, friend, or even a mental health professional can help. People are often more willing to listen to someone they trust. If it’s harder for you to establish yourself as someone that they can trust, bring in someone who they already trust. This might still require multiple interactions and nudges.
4. Be patient and persistent
It may take some time and multiple attempts to convince the person to seek treatment. Be patient and keep the conversation going. Avoid aggressive confrontations as much as possible and keep practicing Listen ⇒ Acknowledge ⇒ Reassure.
5. Seek external help in emergency situations
It has been found in multiple cases and over various researches that treatment itself helps with insight building. While in some cases, the lack of insight continues forever. People still agree to take medication for different reasons, irrespective of their insight level. Trying to make someone believe that they are ill only increases their mistrust and worries. A better way is to be more mindful of their experiences, acknowledge their pain and nudge them to seek treatment for the pain/concerns they have, not for any illness per se. Please note that this is not the same as manipulation. Manipulating someone to take treatment in the name of something else does not help either. What we suggest is to acknowledge the concerns they have and encourage them to seek treatment for these real concerns.