The One Word That Can Explain Why Your Loved One Refuses Mental Health Treatment
By Mike Higbee, PA-C
“Drugs don’t work in patients who don’t take them.”
-Former US Surgeon General C. Everett Coop
After many battles, your loved one finally agreed to get mental health treatment. You’ve gone to the psychiatrist with them and together, although with reluctance on your loved one’s part, you all agree on a medication regimen that’s expected to help. Several weeks go by and despite starting medication, no improvements are noticed. You confront your loved one and they assure you that they’ve been taking medications every day. More time goes by and still no improvement. And that’s when you discover the reason; you find the medication bottle, completely full. You again confront them, this time with the evidence in hand, and the response will usually go something like this: I told you a hundred times, I don’t need medication, nothing’s wrong with me, I’m not sick! You may want to scream, you may want to give up, but however you react, you feel hopeless. Why won’t he/she just take the medication and stop being so stubborn, you think to yourself.
So what is the reason for this inflexibility? The answer is one hard to pronounce word: Anosognosia. This long, fancy word that makes us mental health professionals SOUND smarter, is a common part of certain mental illnesses, and is most frequently encountered in bipolar disorder and schizophrenia, where those affected believe, with the greatest of conviction, that they are not sick. The word comes from ancient Greek and means “Without disease knowledge.”
While this reluctance to participate in mental health treatment is often perceived as willful ignorance, there have been numerous studies using brain imaging that have implicated various areas of the brain that may be biologically responsible. For example, several studies have shown changes in an area of the brain known as the prefrontal cortex (sits just behind your forehead), an area involved in decision making and self-reference. In essence, it appears that this unwillingness to take medication is part of the organic brain disease itself.
In his book, I Am Not Sick, I Don’t Need Help, clinical psychologist Xavier Amador focuses on this all-too-common part of certain mental illnesses, specifically schizophrenia. He recommends something called the LEAP approach. This approach consists of Listening, Empathizing, Agreeing and Partnering, the end goal of which is to find common ground with your loved one and enhance medication compliance. If you have a friend or family member that you’re trying to help and understand, I highly recommend this book.
Another option to increase adherence to medication is the use of long acting injectables. These medications can be given bimonthly, monthly or even as little as once every three months. Without the need for daily dosing, compliance will naturally be improved.
In the end, it’s important to remember that this refusal for help is part of the mental disorder itself. With the proper professional guidance and treatment, this understandably frustrating issue can be addressed and explored and a comprehensive treatment regimen can be put in motion.
Mike Higbee is a nationally certified physician assistant specializing in psychiatry. Mike graduated from St. John’s University in New York City in 2003 with honors. His guiding philosophy in practice is not only to alleviate the burden of psychiatric illness, but also to guide his patients on where certain aspects of the disorder may be useful. Mike has experience in outpatient psychiatry, substance use treatment as well as crisis psychiatry. He is an active member of the Association of Physician Assistants in Psychiatry. He is also in the process of writing the chapters on psychotic disorders and anxiety disorders for a medical textbook in collaboration with Yale Medical.