Family and Caregiver Schizophrenia Discussion Forum

Need advice dealing with anosognosia

My husband has been in treatment for a little over a year and we are no longer in crisis, thankfully. I have had a hard time finding support for myself, even through NAMI. One of the challenges I have is that he suffers from anosognosia, and does not recognize that his reality isn’t necessarily real. I’m hoping to get some advice on how to approach the situation when he is upset at me for something that isn’t actually happening.

Specifically, his delusion is that my parents, my brother, and I are trying to turn our 2 year old son into my dad. He says he hears me calling my son by my dads name. All the reading I have done, and advice from my own therapist suggests to try and identify the underlying emotion he is expressing and try to focus on that, but I honestly don’t know where to even start when he says directly, “Can you please stop calling our son your dads name? You do it constantly and it’s breaking my heart.” I know trying to convince him that I am not saying it is futile, but I don’t have any other response.

A couple of thoughts here:

First, what about turning your son into his dad would break his heart? Effectively what your doctor is asking you to do here to empathize with him and put yourself in his place, and the second step of the LEAP process used to work with people with anosognosia. I’m assuming you know about the LEAP process and Dr. Amador’s book if you know about anosognosia. If not, search this forum for LEAP.

Second, have you tried using an alternate nickname for your son to see what happens? I say this because some of my misperceptions when I was symptomatic were mishearing things that sometimes had similar sounds or rhythms. This could be a temporary thing until he either gains insight or is less symptomatic. I would suggest a unique monicker that sounds very different. You could try a middle name or something else that fits. This isn’t without precedent in my family. My nephew had trouble pronouncing his stepfathers name which began with D, and he couldn’t call him dad, because that was his biological father, so he started calling him ‘Da’ and it was so successful the rest of the family started calling him that until my nephew said it wasn’t necessary anymore.

Third, in my recovery I started singing in a choir and taking voice lessons. My mother is convinced the extra focus on learning sound processing and sound generation helped me do a better job filtering sound and augmented my medication. I believe drug-only therapies only take recovery so far, so I’d look to holistic approaches with talk and psychosocial therapies.

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Hi Sara,

Check out CBT, cognitive behavioral therapy for schizophrenia. Check out this link and read the ABC model, this is how a therapist would challenge delusions in a neutral setting. https://www.psychiatrictimes.com/schizophrenia/abcs-cognitive-behavioral-therapy-schizophrenia

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He thinks we are trying to turn my son into MY father. That we are taking my son away from him in some way. Additionally, my father’s name is similar to the word Man, so my husband is triggered when anyone refers to my son as “little man,” even though that’s a common phrase said to a toddler.

I’ll look into LEAP, thanks for the recommendation. I actually had a very frank discussion with my husband and for the first time he seemed to accept that he may be hearing things that I am not actually saying, which is a breakthrough on its on.

I appreciate the input!

I see, sorry I missed that. Could point to separation issues, or feelings of insecurity in his role within the family. When you start to get ill, you get feelings of your life slipping away from you, for whatever reason the tendency is to think it’s caused by outside elements, especially when you are mishearing or hallucinating things. The sad part is you try to prop up your own ego by blaming other people, and that has a tendency to alienate you from the people you have the most contact with-- the ones who can actually help you.

It’s good that he’s beginning to question things. It may be a good time to talk about next steps without making decisions for him. These are the Agree and Plan parts of LEAP. Listen and Empathise are the others. Here’s a video that explains LEAP and how and why it may help.

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Thank you so much for this!

That really is a HUGE breakthrough indeed!