I’ve posted before about Dr. Amador classic book, I’m Not Sick I Don’t Need Help, and I will continue to post in the future. It’s a brilliant book that deserves much more attention. Dr. Amador begins by explaining how a lack of insight is not due to denial, defensiveness, or stubbornness. Rather, denial is a symptom of chronic mental illness.

The specific symptom is called anosognosia. It’s a neurological condition similar to the denial seen in some stroke patients. After a right-hemisphere stroke, for example, some people completely ignore everything on their left side. They may eat only the food on the right side of their plate, or put makeup on only half their face. They are not doing it on purpose. Their brain no longer processes that side of space. Similarly, some stroke patients who become paralyzed on one side insist there is nothing wrong with them. As them to hand you something, and they might say “I don’t feel like moving my arm right now.” People with schizophrenia and other illnesses who genuinely believes they are fine are exhibiting the same kind of symptom. Understanding this changes everything about how we respond to loved ones (and clients) who refuse treatment.

Dr. Amador also shares a practical methodology for connecting with people who have lost the ability to see their illness objectively. He calls it LEAP.

The LEAP Method

LEAP stands for Listen, Empathize, Agree, and Partner. The cornerstone of LEAP is reflective listening: “if you want someone to seriously consider your point of view, be certain he feels you have seriously considered his.” He points out that a common ground exists, even between the most extremely opposing positions and that it is tremendously important to find it. He illustrates the example of a patient who disagrees about the need to take medications but is able to agree to a goal of staying out of the hospital and how consistently taking medications can help to achieve that. Another principle, which relates to LEAP, is called the “three As.” I’m Not Sick I Don’t Need Help encourages readers to

Apologize for a difference in opinion

Acknowledge the existence of different perspectives, and

Agree to disagree.