When Severe Mental Illness Strikes a Loved One

Book Review: “I Am Not Sick, I Don’t Need Help” by Xavier Amador, PhD.  (Vida Press, 2012)

For the last 20 or so years, brain research has helped doctors and therapists understand that the serious mental illnesses of schizophrenia and bipolar disorder are diseases of brain function. During the century before the “Decade of the Brain (the 1990’s)”, these rare and frightening mental diseases were blamed on bad or inadequate mothering (the “schizophrenogenic mother”), thanks to the early theories of Freud and subsequent generations of psychology, puzzling over the cause and treatments of such life-altering and permanent mental illnesses.

In his wonderfully personal and helpful book “I Am Not Sick,” Dr. Amador explains that the primary feature of these severe mental illnesses is the core belief that the sufferer is “not sick.” In medical terms, this disbelief in their illness is called “anosognosia”  (ã-nõ’sog-nõ’sê-ã). Sufferers may be homeless, talking to voices in their head, unable to sleep or put together a clear sentence, believing that aliens have made inroads to their cells, but to these ill brains, the beliefs and thoughts are as real as sunlight and gravity.

If you have ever been in a relationship with a loved one who has become mentally ill and whose illness has this feature of anosognosia, you know that trying to convince them to get to the hospital for treatment or to take their medication is a futile, frustrating, and relationship damaging exercise. But this is how almost everyone attempts to get their loved one’s the help they need to be safe and recover.

In his best-selling book, Amador explains the model of engagement that he has developed over 30 years of living with his older brother, who was a schizophrenic, and working as a professional forensic psychologist and therapist. He walks the reader through this counter-intuitive but effective model that listens, understands and collaborates with the sufferer, who, in the end, must participate in their care in order to get better.

He calls this program “LEAP,” which stands for Listen, Empathize, Agree and Partner. Utilizing the tools familiar to therapists of Client-Centered/Active Listening, Cognitive-Behavioral, and Motivational Interviewing models, Dr. Amador provides tools, examples, and scripts as examples of learning to use this strategy with loved ones who need help.

I read this book as a way to help one of my clients, whose loved one is beginning to demonstrate marked personality changes, delusions and strange behaviors. As we talked about how to be helpful short of calling 911, this book has become a welcome addition to my library and therapeutic models. If you have someone in your life you are seriously worried about and wonder how to help. I urge you to get this book or log onto his website, LeapInstitute.org.

 

Willing to Risk Again

Several times this week I have found myself talking to new couple clients about their relationships, and how hurt has caused them to feel withdrawn from their partners. Sometimes this distance has lasted for years, the human need for support, connection and understanding no longer expected from their spouse. 

One of the most important aspects of relationship repair is the willingness to risk being open to a partner who has been months or years at odds with our needs and hopes. Couple therapy at its best keeps both people focused on their individual efforts, while being confident, through actions and words in the therapy room and out, that the partner is doing the same hard work. 

It can feel like being open to injury. Like you are just asking for your partner to hurt you again. Many people resist, and for every right reason! But repairing such pain means turning toward your partner and feeling what you feel, expressing your hurt and disappointment, asking for what you need again, and being willing to see if your openness can be met with a similar effort of apology, repair, and affection by your partner. That’s what a good couple therapist does every day with couples, with compassion, encouragement and patience. It’s not a free-for-all in therapy sessions. If it is, run in the other direction. 

When deciding whether to go to couples therapy, this is one question you will need to answer: am I willing to be open again to this person, this one I once loved, and see what I feel, what they have to say, what they have experienced, and work together for new, common ground?