My impression is you and your psychiatrist are treating the situation similarly to interrogating a suspect or informant who will provide you information and break down and “confess” to help you “crack the case”. You may disagree with this assessment, but for the sake of argument, let’s explore this.
First, I think the premise is flawed. In one breath you say he isn’t thinking clearly, and then you are expecting him to articulate what’s going on with him and “accept” his illness. But how’s he supposed to develop this insight and change in behavior when he isn’t thinking clearly? Don’t you see this is a version of the classic Catch 22? In the book/movie, airmen were crazy to fly dangerous missions, but could request to get out of flying by admitting they were crazy to fly the missions. But it was rational to think that flying dangerous missions was crazy, so they were declared sane and forced to fly even more missions. In your case, you want your son to start thinking more clearly, if only he’d think more clearly, open up to you and “accept” his illness. Presumably you and your psychiatrist are hoping that drugs will do that work for you, but it seems they aren’t. Now what? New drugs? Wait a bit longer? Blame your son? Blame yourself? (that’s you talking, not his psychiatrist-- they, like military leadership, are all perfect or at least won’t admit fault)
Second, your psychiatrist is correct. Some people with SZ recover and find a spectrum of improvement to their lives. These may be: independent living, marriage, scholastic achievement, employment etc. I’m one of them. In my case three-out-of-four wasn’t bad. I’ve had an upper middle class professional science and technology career and own my own home. However, did this success come from opening up and expressing my thoughts and feelings about my illness to my father? [excuse my emphatic swearing] HELL NO! Quite frankly, that’s why your son has a therapist and occupational therapist (that’s what you call someone who helps manage daily life). Why take on this job when your son doesn’t respond well to you and you lack training on how to do it properly?
There could be a myriad of reasons why he doesn’t respond to you. He could be embarrassed that’s he’s not living up to your expectations, and to admit or display weakness would cause him to further “lose face”. He may be afraid of consequences of opening up to you that you may use that information against him in some way emotionally or to abridge his agency. Or you may express too much emotion in you interactions with him, normally, or out of frustration driven by his reticence. Studies link excessive expressed emotion at home to a poor prognosis-- your son may sense this and is shutting down to protect himself. Or his behavior could be tied-into some false delusion and he may be shutting down to protect himself, others, or even you from “the conspiracy”. Sometimes you just feel uncomfortable with certain people in certain roles and they feed into your delusional system or their “vibes” just aren’t right. I’ve had this happen in work situations, and once I got out that headspace or situation I’m fine with the person, but while “in it” I avoided them at all costs.
Third, I think good caregiving boils down to people filling or stepping into roles-- each according to their abilities. And a family member’s perception or preference of fitness for the role is important too. In my case, my mother settled into the primary caregiver role. I spoke to her the most about my day-to-day life and frustrations the most, yet she was also the emotional “heavy” and demanded I find a job and start paying rent. She helped me find a therapist and help navigate healthcare. My father helped me find a job, helped me with school work and navigating interpersonal and technical aspects of my work environment. He also served as the “bank”, helped me fix up an old car to drive, supported me continued therapy and later psychiatric treatment, and staying in school and employed.
These roles largely mirrored and expanded on roles established while they were raising me, and fell into stereotypical gender roles. Conflict ensued when my parents or I fell out of our lanes (established roles). For example, I particularly resented paying rent to my mother, since she didn’t have the role of “the bank”. She wasn’t working at the time, and had contributed little to the mortgage and utilities that I could see, and over the years had developed a notion of “her money” when she started working. But it did fit the role of her being “the heavy”, or to use a less kind and gender-loaded term-- the bitch.
So, if you aren’t seeing results or respect for your efforts from your son, consider your family history: are you swimming outside of your lane? When I hear terms like “mama’s boy” and “molly coddling” from you and @Sando, I question whether the male gender might be at a distinct societal disadvantage for primary caregiving of the SMI. As a male who has SZA and has never been a parent, I’ll be a traitor to my gender and say this is one disease you can’t boot-camp your way out of, and a directed, action-oriented, search-and-destroy, take-no-prisoners approach is doomed to failure. Even if you “aren’t that guy”, be aware you may be perceived as such regardless. I’ve exclusively had male psychiatrists and female therapists for a reason: I take prescriptive medical advice better from males; and share my thoughts and feelings better with females. I’ve worked within consulting and support in technical areas, and invariably team members report you can give the exact same advice to a client and the help will be received differently depending on who gives it. Bedside manner matters, and you soon learn it’s nothing personal-- people are quirky and the SMI are even more so.
Finally, let’s look at LEAP through the lens of gender norms. LEAP, if you don’t know by now, is an acronym for Listen Empathise Agree Plan. It’s an approach used by an increasing number of caregivers to improve their relationship with the SMI in their care, and guide them toward treatment in the face of anasognosia (lack of insight into disease). Let’s break this down from a gender normative perspective. Listening? There are probably dozens and dozens of stand-up routines by women about men being bad listeners when they express thoughts and feelings. So men appear to be at a disadvantage. Empathizing? another weak spot stereotypically of males. Agreeing? Getting warmer, but women are viewed more as negotiators and men more as fighters for their point of view within a consensus. Planning? Here’s where men may have a perceived upper hand or equality, although I submit planning is more of an individual skill than a gender norm. We often say “the man with the plan”, yet coming up with a plan can either be a collaborative female-oriented skill, or visionary male-oriented skill. The male approach is often associated with executing plans, rather than collaborating and negotiating what those plans are, however. All this said, gender norms are changing, no one strictly adheres to a norm, and there are hybrid males, and I think I might be in that category, whose strengths bridge stereotypical norms. LEAP is an inherently talky approach, that relies on establishing trust and acceptance, and there are gender differences in numbers of words spoken in certain contexts that are less than widely believed stereotypes, but my experience with my father is I can count on one hand times we spoke of our feelings, many more about how I thought, and maybe a couple dozen times we spoke about delusional content or symptoms.
A pitfall for people practicing LEAP is they often mistake projecting their own desired outcomes or reality onto subjects for “putting themselves in their place”. This may or may not be gender specific, but I see it in this quote:
Well… yes. He’s likely not concerned and doesn’t know the severity of his mental health status, because in his mind he’s perfectly fine. You are the one who is concerned about his mental health-- not him. Even more telling is you are the one wanting him to communicate, not him. He’s not going to be motivated to talk to you for many reasons: he doesn’t believe he’s sick, he doesn’t believe communicating will help the situation or “cure” a sickness he doesn’t even believe he has, he doesn’t feel comfortable talking to you regardless and various other hypothetical reasons I gave you above.
Still I think LEAP is your best bet for your son, and I think you’ve done a good job of assembling a recovery team and getting and keeping him compliant on medication. You may need to adjust his medication, trust the process and your other team members more, have patience and see if you and the rest of the team can work to their strengths. I’ll end this “talky” post with a link to the one video I think is the best introduction to LEAP. My apologies if you’ve seen it, but I think it’s definitive for the subject. It can be difficult to change your mindset and understand the method, especially when you have a doctor who talks about nonexistent denial phases and other contrarian notions. An important realization is most people who go through this process never gain insight into their illnesses, but the method can still improve their lives regardless.
and a dad with bipolar. I was disappointed when it turned out that bipolar, scz and autism are genetically related. I have noticed amongst family members and people on the forum that a sibling with a mental illness causes a lot of belief that behaviors are chosen deliberately.