People with schizophrenia may have the misperception that they are OK and do not need help. (Photo courtesy Pixabay)

“I’m not sick. Stop telling me that I am.”

The medical community calls it anosognosia, one of those tongue-twisting ancient Greek words, in this case meaning “without disease knowledge.” For many families, friends and co-workers, it is often a key sign of serious mental illness for someone they love or care about and a huge roadblock to getting needed care.

In some instances, people with conditions such as schizophrenia or bipolar disorder will refuse to take antipsychotic medicine, or stop taking it as prescribed, because they don’t believe they are ill. This is a symptom of their illness.

Damage to the brain in schizophrenia, which can lead to an inward state of altered thoughts and perceptions, even severe delusions about reality or vivid hallucinations, can also disturb the updating of one’s self-image.

Often, the more we try to convince someone of this issue, the greater the resentment and push back. Remember, the affected person is not in denial, as much as that they simply cannot detect that they are changed; they suffer from a lack of insight or awareness.

Many of us are perhaps familiar with this issue after strokes, or in Alzheimer’s disease or other forms of dementia. Think of a parent or grandparent who insists that “I am fine,” even when they clearly are not.

Denial in schizophrenia

Schizophrenia is a complex, long-term mental illness that can be difficult to diagnose or understand in its earliest stages, as it interferes with a person’s ability to think clearly, manage emotions, make decisions and relate to others. Overall, schizophrenia is one of the top 15 leading causes of disability worldwide and individuals with schizophrenia have an increased risk for shortened life spans, by as much as 30 years.

One stark statistic highlights the critical need to for early detection: The lifetime risk of suicide is about 1 in 20 for those with schizophrenia, with the highest risk in the early stages of illness. Genetics also clearly plays some still incompletely understood role — if an individual has a close relative with schizophrenia, he or she is more than six times likely to also develop it.

Common symptoms of schizophrenia include nonspecific ones such as sleep issues, withdrawal from others and difficulty organizing thoughts or completing tasks, in addition to the lack of insight. As noted, more dramatic symptoms include delusions and hallucinations. These hallucinations can involve hearing voices, seeing things or smelling things that others don’t. While symptoms can lead to dangerous acts that harm the individual or others, people with schizophrenia are more likely to be the victims of violence than to perpetrate violence.

Fortunately, the medical community is becoming increasingly alert to the role or impact of anosognosia in serious mental illnesses like schizophrenia. In fact, half of the individuals with schizophrenia have anosognosia and it often becomes a long-term, hard to overcome issue. One of the main concerns we hear from families is that a loved one with schizophrenia does not believe they are ill. We must “solve” anosognosia to make progress in caring for schizophrenia.

Breaking through the denial

How do we break through this cloak of unintended self-deception? For starters, we must remember that anosognosia is not a character deficit or defense mechanism, as much as a mistaken perception.

Becoming upset and angry or having heated arguments with our loved ones is no help. Instead, we must build relationships based on trust and respect with the affected individual. When they trust us, they will be more open to our conclusions about their condition and our suggested remedies.

Today, clinical psychologists such as Dr. Xavier Amador, author of “I am Not Sick, I Don’t Need Help!,” are formalizing these insights into helpful programs. Amador, who has conducted numerous training sessions here in Michigan for NAMI Metro, also is the founder of the LEAP Institute, which emphasizes a process of listening, emphasizing, agreeing and partnering with individuals who have serious mental illness.

Through approaches like these, we are making significant progress in communicating with our loved ones who have schizophrenia or other serious mental illnesses, helping them access the multifaceted care they require. If we are both alert and compassionate, communicating in constructive ways, we can restore for individuals with this illness an integrated, healthy life filled with purpose and meaning.

Laura Mueller, LMSW, ACSW, is director of admissions and clinical programs at Rose Hill Center, a Holly, Mich.-based residential psychiatric treatment and rehabilitation facility offering services for adults with serious mental illness. For more info, visit rosehillcenter.org.