Family and Caregiver Schizophrenia Discussion Forum

How can I educate someone with schizophrenia?

Hi
My sister is in denial about having schizophrenia she says she doesn’t have hallucinations and that she is perfectly normal even though she is believing her family really isn’t her family and that we are other people who are after her. Even though she thinks this, she still asks for favors from us which can be kind of convenient but she is very rude and aggressive toward us when she wants to be. She takes medication for schizophrenia but she thinks she’s taking medication for anxiety or depression. She says she’s not crazy and she doesn’t have anything. How can she educate herself on the illness, I feel that if she does she will help herself and us as well. I feel that it would be a huge beneficial first step. We ask her if her psychiatrist has told her about her diagnosis and she says no. I don’t know if to believe her or not but if it’s true shouldn’t the psychiatrist let her know?

Your sister appears to have anasognosia (lack of insight into her disease). It’s possible she may never gain insight into her disease. It’s far more important she gets and continues treatment than gaining insight into her disease, so forcing this agenda may be counterproductive. Her brain likely doesn’t function properly, and she may no longer be capable of understanding the nature of her illness. Insight can improve over time, it did in my case, but I would view this as a secondary desire or ‘stretch goal’ rather than a necessity.

It may be difficult to understand or accept, but understanding or insight into an illness isn’t necessary to treat a disease or live a better life. A person with diabetes or epilepsy or dementia doesn’t necessarily need to fully understand all aspects of their illness as long as they follow treatment regimes.

I had psychotherapy for a year and vowed not to take medication after expressing reluctance to medication to a psychiatrist who proceeded to attempt to prescribe five separate medications. I walked out of the office and never returned again. I was never handed a diagnosis by my psychologist or this psychiatrist and I think it would have been counterproductive until I was ready to accept it. Somewhere along the line, I declared I had schizophrenia to my psychologist and she calmly asked what that meant to me, she never actually said I was ‘right’. Labels are only helpful to the sufferer if they are willing to accept them, otherwise they are often a barrier to progress. It’s far more important to have trust in caregivers and doctors than any underlying understanding— this disease isn’t particularly well understood by experts either other than certain drugs seem to help. Insight can be helpful later on in recovery, but in the beginning— not so much in my opinion.

The following video should help explain anasognosia and methods to work around it. The speaker, Dr. Amador, wrote a book describing the LEAP method he used to help his brother with medication compliance called “I’m not sick, I don’t need help”. It’s often recommended to caregivers in your situation.

Disclaimer: While I am a part-time caregiver of my brother and father with SMI, I was diagnosed with SZA over thirty years ago. I’m an advocate of appropriate drug treatments for SMI, but I feel they are incomplete treatments and additional CBT, supportive talk and psychosocial therapies are helpful where feasible. Any drug advice is from personal experience or research and not a substitute for qualified Psychiatric care.

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I agree with what @Maggotbrane has said. That book and the TED talks explain anosognosia in a great way. A large percentage of those with schizophrenia never can see that they have delusions or hallucinations. They have rational (to them) explanations of their beliefs or voices. I read that book 3 times, and use parts of it to this day.

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It’s probably a long shot, but could you request to attend her next psychiatry appointment with her? Maybe you could condition one of the favors she asks to going to the appointment – e.g. need to have a meeting about how best to manage the favor.

I think the name for this is “psychoeducation”. I did some research about it this morning and it seems to often be combined with family involvement, since the family or other carers can provide feedback to the person and therapist about what they see going on with the person. Also, the family needs to know how to better help the relative.

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What a great statement it’s so true

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I am having a similar issue with my brother, who also seems to be experiencing anosognosia. Although he is taking his medication, he is only doing it because my parents and I are basically “making” him take it. He does not believe he is mentally ill, nor does he believe the medication is helping him whatsoever. The medication is in fact helping him–up until a couple of months ago before he was hospitalized, he was experiencing severe psychotic symptoms; since he’s been on the medication, he’s been stable. But he either cannot remember how bad he was before the hospital and denies everything when we try to remind him or has an explanation for his behavior and thoughts. It is such a challenging situation and certainly not sustainable for anyone involved–I fear it’s only a matter of time before he outright refuses to take his medication and ends up in the hospital once more.

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Hi SuzyS, Welcome to the forum:)

Its not unusual for our family members to take psych meds for other reasons than believing they need them. My Family to Family teacher said the best way to keep them on meds was to have them journal so they could read in the their own writing what their experiences were on and off meds. Maybe if you could somehow get your brother to start journaling now - or you could journal for him and see if he agrees with what you write each day?

Some will take meds just to stay out of the hospital, others take meds by court order, there are lots of reasons. The trick seems to be finding the reason that will keep our individual family members on meds.

Those explanations he is doing are called confabulations, of course, its the disorder that is providing those “explanations”.

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Thank you, that’s such a great idea. He has trouble focusing, so perhaps me doing the writing for him at first would be a good way to start. I’ll try it with him and see how it goes!

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There is also something called the Capgras Syndrome that makes people believe someone else has taken over the bodies of their family and/or friends. They then become very paranoid about dealing with them. WebMD has a pretty good explanation: https://www.webmd.com/mental-health/impostor-syndrome-capgras#1 My son is SZ and it used to surface quite often years ago. Now he believes he is related to Andre the Giant (a long since deceased wrestler) and talks of himself in third person. After about 30 years of this, you think I’d become more accustomed to it, now I realize it just provokes him to try to talk him out of it.