I Am Not Sick I Don’t Need Help, by Dr. Xavier Amador, is  terrific reference for those of us who work with people who live with mental illness.

Some interesting facts I learned from reading the book:

1. Bipolar disorder and Schizophrenia are as lethal as diabetes (about 10 to 15% of all who suffer from them die from the illness via suicide)
2. More than 10 million Americans have a close relative that is not only living with severe and persistent mental illness, but is also refusing treatment.
3. Side effects play a very small role in treatment refusal.
4. Poor insight into having an illness and into the benefits of treatment is the biggest predictor of who will refuse to take medicine.
5. It’s a myth that the sicker one is, the worse the insight. Studies find that is not true. Those with poor insight have lower levels of insight even when they are 100% stable. Whether their symptoms are under control or not, they persist in the belief that they don’t need medication.
6. People who lack insight are not “being stubborn” or “defensive” – they are not “in denial.” Studies show that poor insight into having an illness and into the benefits of treatment is a symptom of the disorder itself. It stems from the same brain dysfunction that is responsible for other symptoms, and is comparable to the lack of awareness of neurological deficits seen in stroke victims, termed anosognosia. Here is an interesting study about stroke victims who are unaware of their inability to move a paralyzed limb.
7. Specifically, the brain circuitry responsible for recording and updating self-concept is not working properly in such patients. Biologically, they are “stuck” in a time before they got sick and are “stuck” with their self concept from that time.

Stay tuned for future blog posts about Dr. Amador’s system for helping people in this situation accept treatment.