Any advice on how to use LEAP properly?

[Itsastruggle]

That is so wonderful that your son is doing so much better!

I think confusion also occurs because in a way, there are (at least) two things that could be considered “lack of insight” to consider:

1. The psychotic experience itself, which almost by definition leads to “lack of insight” (i.e. the belief in the auditory hallucinations, etc.), and
2. The ability to reflect on the experience later on (when the brain is in a different state) and to make the assessment that “Those experiences weren’t real” (which is probably due to other brain pathways, most likely in the prefrontal cortex)

The term “anosognosia” could be used for both of these states, which makes it confusing.

I think Dr. Amador’s work tries to address situation #2 (people who never have “insight”, even when in a different mental state such as achieved by medication).

If you think about it, though, both states potentially can vary quite a bit, which I’d think can lead to the changes in insight Maggotbrane mentions. Some people might have completely “normal” (i.e. neurotypical) wiring/development of the brain circuits that allow good self-monitoring while in a non-symptomatic or mildly symptomatic state, some might have some mild structural differences here (that allow a degree of self-monitoring) and some might have significant structural differences.

So I think we are dealing with two different categories (the severity of symptoms as well as the ability to self-monitor).

Severity of symptoms can vary within an individual (i.e. symptoms can wax and wane over time with an overall course that is improving vs. deteriorating) as well as between individuals.

And the ability to self-monitor varies a lot between individuals (and probably is relatively “set” by adulthood, although brains are amazing things, so I’d say that improvements in the ability to self-monitory certainly are theoretically possible and potentially [we don’t really know] facilitated by activities that develop/strengthen these abilities, such as CBT and other psychosocial [i.e. non-medication based] treatments).

It has been interesting watching my husband experience auditory hallucinations vs. ideas of reference, as he can become quite upset with me due to both processes but he manifests it differently.

When he experiences an auditory hallucinations of me saying something critical, he will just glare and me and does not try to address it.

When he misperceives something I actually say as an attack (e.g. when he is more symptomatic, he thinks that if I accidentally come up with the wrong word for something, that I am doing this to bother him and/or to “set him up” somehow), he will glare and me but then will say something about it to me.

So although he has never had any awareness of auditory hallucinations and although both of these experiences (the auditory hallucination of my saying something vs. me actually saying something) clearly trigger some auditory circuits in his brain, it is obvious to me that he does experience inner vs. outer voices in different ways. My guess is that these differences are one of the things that people with “insight” are able to recognize when their symptoms are not too severe. Sadly, my husband can never tell the difference.

I have a pretty strong family history of schizophrenia myself and I had the experience of having a fixed delusion when in my 20’s. I had no idea it was a delusion at the time and fortunately I was aware that I was very stressed and I started psychotherapy. I did not share the delusion with my therapist, not because I was trying to hide it but because although it was quite distressing to me, it really did somehow exist in a different place in my mind. Therapy went well, I gained tools for coping with stress, and the delusion eventually (I don’t know when) just went away. I did not even think about it until some experiences a few years later reminded me of it and then I realized if for what it was and felt like perhaps I had had a pretty close brush with a psychotic break myself. But clearly certain circuits in my brain work well, as I was able to recognize the experience as a delusion once I was past it. So my guess is that even if I had had a psychotic break and lost touch with “reality”, I would have had insight into what had happened later one, once my brain was in a different state again. Although clearly, this is just a guess.

[hope4us]

Your experience and observations are very interesting. Thank you for sharing. I am reminded that LEAP can be used in all kinds of situations…it is not limited for use with those who have SMI.

[Maggotbrane]

My, such keen analyses and nuanced observations. Maybe as a dialogue emerges both gain insight in, and dare I say, respect for, each other’s positions on the subject. Maybe some insight in the illness was there all along, but the caregiver couldn’t see it because she wasn’t fully listening. Or insight in the illness grew in the subject, because a trust in a caregiver and their observations grew over time. As a practical matter, all that matters is the results.

I had a colleague and mentor who unfortunately died too young, and we would often have scientific and technical discussions about different approaches to problems. We’d start out debating the merits of competing approaches in his office, and over time, we’d find ourselves switching to the alternate ‘side’ by the end of arguments. In the end we’d just pick one and hope for the best, and if it didn’t work out, at least we had something else we could try. It became less important that one of us was ‘right’ than to solve the problem. I owe a lot to him. He taught me troubleshooting methods, how to collect accurate data, test and formulate hypotheses, interpret often confusing data, and draw valid conclusions. He probably had no idea I was employing his methods inwardly on myself.

I’d always felt, with no data of course, that I’d somehow wired around whatever deficits in my brain to lessen my symptoms. Certainly my symptoms either decreased by my efforts or on their own, or I learned coping behaviors to lessen their impact. I did so many different things in recovery, it’s hard to pin down the secret to my apparent success. My colleague would say I ‘shotgunned’ the problem which was his derogatory term for changing multiple things at once. It can be a quicker way of solving a problem as long as the things you try don’t counteract each other, but it has a major flaw— you have no idea which action(s) got you the desired result.

As far as looking back on a situation or a cluster of symptoms and saying it wasn’t ‘real’, for me it’s a bit nuanced. I can say it felt or seemed real, and still be both agnostic and skeptical about it. As in, it felt and seemed real, but I don’t know about it, it doesn’t seem probable so maybe I shouldn’t act on it, or give it too much importance. It’s bit like weighing evidence or building a case for a scientific hypothesis. You see if you can get multiple repeatable readings by independent sources, knowing each person collecting data may have a bias or faulty ‘instrumentation’. It can be a tedious process that you often can’t apply to real world situations. So you do your best to ignore what might be faulty data, but make note of it in the back of your mind. Unfortunately this can lead to avolition or inaction, because you are so afraid of making a mistake that it’s safer to do as little as possible. Over time you can learn what risks you can and can’t take, but at first it isn’t easy. I can understand why some people stay home— it’s safer that way.

[Margi]

My son has been on medication for over a year now he is doing quite well. But every day he complains that the medication is poison and he doesn’t feel well and can’t do anything. I try not to answer him I didn’t know if this is the correct thing to do. This is causing me so much stress I don’t sleep much at night. Thanks everyone for listening

[hopeisahead]

In addition to listening and emphasizing, your agreement may come from him wanting to be close to you. Wondering if pushing for treatment so that you both can be together would work and thinking together abt how to do that.

[oldladyblue]

Hi @Margi . I am glad that your son has been on medication for some time now. I understand that he doesn’t like taking it, and that there may be side effects, but overall you know that medication has helped him. I think you can answer him back when he complains, without agreeing that meds are bad. Then you won’t feel so stressed by not answering at all.

The A part of LEAP (agreement) is sometimes a matter of “how do you agree to disagree?” He doesn’t like to take his meds, but you know he needs to take his meds, so you both can agree that there is a disagreement. BUT still continue the meds because …

Lots of people smoke, yet tobacco is a poison. Lots of people drink, yet alcohol is a poison. Lots of people drink too much coffee, or Red Bull, or Gatorade with that horrible strong red or blue or purple food coloring chemical in it… and there is a bit of poison going in them. Lots of people have some type of enjoyment in something that really isn’t that good for them, but yet IS good for them in some way, purely from the enjoyment factor. Others take medicine that is good for them in some way, but really isn’t great for them overall, as it has some bad effects also. People have to undergo surgeries, which contain lots of risk, to hopefully gain a benefit. Life is a balance of plus and minus, good and bad, healthy and unhealthy, etc.

Perhaps a simple statement to your son when he complains like: “I know you don’t like taking medicine, thank you for continuing to take it.” would help. Or adding on to that “I believe that is the best thing for you (and me) as the good outweighs the bad.”

What do you think?

[Wisdom]

It keeps occurring to me that often we are so focused on the disease and the side effects of the meds that we often forget the whole… our loved ones still get mild sicknesses and bugs the same as we do, and their perception of this may not be as accurate, same as our perceptions of their overall health may be too focused to see the big picture (remember to get regular checkups). Perhaps maybe it’s mild depression, like I’m venturing many of us have also felt at some point, regardless of any other diagnosis we may be living with in tandem…? Hard to know… I guess staying vigilant and objective in observation and Listening is the best we can do?

[Margi]

Thank you oldladyblue, I try and tell him how good he is doing now. He keeps telling me that he can’t do anything or even take a walk because of the needle. He says that if doesn’t take the needle that I will put him back in the hospital. This is so frustrating. I think he might be depressed. I will try and respond like you said.