Encouraging Treatment in Reluctant Individuals by Dean A. Haycock, Ph.D.
A major challenge for you may be persuading the person you care about to take his medicine and attend therapy. It is not unusual for people with schizophrenia to discontinue treatment. There are many reasons, one of which is the nature of the disease itself. It often prevents the patient from realizing he is ill, a condition psychiatrists call anosognosia, a lack of insight or awareness about their condition.
“There Is Nothing Wrong with Me!”
If someone you know is clearly suffering from a psychiatric illness but is unable to realize it, consult Xavier Amadors's book I Am Not Sick, I Don't Need Help! for useful advice on what to try. Also get advice from mental health care practitioners in your area.
Table 13-1: Reasons Patients Stop or Won't Accept Treatment
Reason |
Possible Solution |
Lacks knowledge of illness (anosognosia) |
Education, therapy |
Denies illness |
Education, therapy |
Medical side effects |
Adjust dose, change medications |
Irrational fear of medicine |
Education, therapy |
Fear of medicine dependency |
Education, therapy |
Dislike of doctor |
Find new doctor |
Confused, disorganized, cognitively impaired |
Therapy, training |
Adapted from E. Fuller Torrey's Surviving Schizophrenia.
Other patients may realize something is wrong but may deny it to themselves and others. The disease can disrupt rational thought so much that a patient may not possess the discipline required to stick to a treatment plan. In this case, you or another caregiver will have to take action to ensure treatment is provided. In extreme cases, it may require getting the courts to order the person to undergo treatment.
<B>Other Reasons for Medical Noncompliance</B></h2>
<p>If a person with schizophrenia is convinced that the side effects of medication are worse than the disease, it is unlikely he will take his medication. Abuse of drugs and alcohol can also contribute to medical noncompliance by lessening the effectiveness of medications and therapy. The patient's friends and even other members of your family who know little about the disease may hinder recovery by giving bad advice or even encouraging the patient to stop treatment “because it does more harm than good.” This is not true; in the majority of cases, stopping treatment leads to renewed psychotic symptoms.</p>
<div class="npsb">
<h2>
Essential</h2>
<p>It can be very challenging to treat the patient as an independent, self-directed adult, but it is important to try. Respect for the person is not only her basic right; it can be very useful in building a basis for a joint collaboration for managing this disease.</p>
</div>
<p>In the face of these and other difficulties, helping someone resume or stick to a treatment plan requires flexibility. There is no failure in having to change treatment, whether pharmacological, psychological, or both. The only failure is in abandoning treatment completely. If you are doing your best to maintain continuous care, you are doing a tremendous service to someone who needs it very much.</p>
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