by Emalee Gillis, NAMI Spokane Blog Editor.
At the eight-week training for family members who have a loved one with a mental health condition provided by NAMI Spokane that ended on October 26, 2023, participants learned a variety of ways to help their loved ones including how to help a loved one accept treatment if they don’t believe they have a mental health condition.
Participants learned that the condition which results in people not recognizing they have a mental health diagnosis is called anosognosia. Loved ones are not simply in denial. Everyday defensiveness is not responsible for the gross deficits in insight that are so common in patients with mental health diagnosis. Anosognosia happens because the same area in the brain where the loved one would harbor insight into their illness is affected by mental health diagnoses like schizophrenia or bipolar disorder. Anosognosia is a symptom of the mental health diagnosis.
According to Dr. Xavier Amador, author of the book I Am Not Sick, I Don’t Need Help that was recommended to the participants at NAMI Spokane’s recent Family to Family course, “There are approximately eleven million people in the United States with serious mental illness… The results of recent studies indicate unequivocally that about 50% of all people with these disorders don’t believe they’re ill and refuse services and to take the medications that have been prescribed for them. That amounts to more than five million seriously mentally ill Americans who don’t realize they’re ill…More than fifteen million Americans have a close relative with mental illness who is in denial and refusing treatment.”
Dr. Amador noted in his book that when things are calm, it is tempting to back off and not work with the loved one regarding the treatment for the medical condition that they don’t believe they have. However, Dr. Amador stressed that research has shown that early and consistent treatment is a major indicator of how severe the progression of a mental health condition will be. Delays in mental health treatment and longer periods of psychosis lead to a worse prognosis over the long run. Dr. Amador stated, “When we ignore the problem, it not only doesn’t go away—it gets worse…The good news is that scientists have learned a lot in recent years about the nature and causes of poor insight in serious mental disorders, and the findings themselves suggest specific methods for dealing with the problem.”
From that research, Dr. Amador developed a method called LEAP. LEAP is based on his advice to family members that they stop trying to convince their loved ones that they are ill. He stated, “when you accept your powerlessness to convince him…, you will begin to open doors you didn’t even know existed.” He continued, “The first step, therefore, is to stop arguing and start listening to your loved one in a way that leaves him feeling that his point of view—including his delusional ideas that belief that he is not sick—is being respected…If you can relate to your loved one is this way, you will be much closer to becoming his ally and working together to find the reasons he may have to accept treatment—even though he feels is not sick.”
In Dr. Amador’s work he has helped many people accept treatment for reasons other than an acceptance that they have a mental health condition. His patients have accepted treatment for reasons like staying out of the hospital or being able to keep a job. A critical element is reflective listening to the person with the condition to discover reasons why they may be willing to accept treatment.
The “L” in LEAP is for reflecting listening. Dr. Amador said that the key to LEAP is listening without judgment. He suggested that family members “listen with only one goal: to understand the other person’s point of view and reflect your understanding back to him without judgement…You don’t comment on what he said, point out ways in which you think he’s wrong, judge or react in any way.”
The “E” in LEAP is for empathy. Dr. Amador argues, “If you want someone to seriously consider your point of view, be certain he feels you have seriously considered his…That means you must empathize with all the reasons he has for not wanting to accept treatment, even those you think are “crazy.””
The “A” in LEAP is for agree. Here is where you find common ground and stake it out. Dr. Amador explained, “He doesn’t think he’s sick, so why in the world would he accept treatment for an illness he doesn’t have? To avoid coming to an impasse, you need to look closer for common ground and for whatever motivation the other person may have for changing. Common ground always exists, even between the most extreme opposing positions.” Dr. Amador said that you may find possible motivations to accept treatment like “sleep better” or “feel less scared.” He continued, “These may be reasons that have nothing to do with the belief he or she has a mental illness… With this knowledge, you will now be able to present the idea that treatment might help him achieve his goals.”
The “P” in LEAP is for partner, Here, the loved one and the one with the mental health condition form a partnership to achieve shared goals. Dr. Amador explained that this step “involved both of you making an explicit decision to work together, to become teammates striving for the same goal. You may call the prize “recovery from illness,” while your loved one calls it “getting a job,” but the names are irrelevant to arriving at a shared plan of action that will, more often than not, include accepting treatment and services.”
Dr. Amador also encourages family members to respectfully delay giving contrary opinions, to give recommendations and non-judgmental opinions in a manner that communicates respect, and to apologize for words and actions that harmed the relationship.
In the recently held NAMI Family to Family course, participants practiced using reflective listening and discussed the meaning of empathy. While comments made by participants in NAMI courses are strictly confidential, one participant in the recent course offered to share her experience in the class. She said, “This course has given me new communication tools to use with my son. I am feeling optimistic that these techniques will open new doors with him and lead to a healthier life for all of us.”
LEAP takes practice to learn well. To learn more about LEAP refer to the book I Am Not Sick, I Don’t Need Help by Dr. Amador or learn of training opportunities through the Leap Institute. To register for the next free Family to Family eight-week course through NAMI Spokane or to learn more about the program, send an email to Amanda Kaplan, Program Coordinator.
Dr. Xavier Amador is an internationally renowned clinical psychologist and leader in his field. His books, published clinical research, worldwide speaking tours and extensive work in schizophrenia, bipolar and other disorders have been translated into 30 languages. He is also the CEO of the Henry Amador Center on Anosognosia and a family caregiver of two close relatives with serious mental illness.
Emalee Gillis is a writer and blog editor. She is the author of the memoir Adventures on the Path to Living Well with a Mental Illness and has a related TEDx Talk.