I Am Not Sick, I Don’t Need Help

Have you ever been in denial?

Recently I have been pinching myself in disbelief. Am I really graduated from medical school? Are people actually going to start calling me “doctor?” Wow! It is terrifying, yet exciting. As a fresh graduate, I know that I still have a long road ahead of me before becoming a board-certified physician, but right now I have been feeling so incredibly blessed.

This period of time between graduation and the beginning of residency has been incredibly relaxing. I spent most of it vacationing. In April, I traveled throughout Japan for three blissful weeks. Then, I went on a scenic car trip from Texas and all the way up through New Mexico, Nevada, and Idaho to Washington State. Beautiful, isn’t it?

Driving by the Sierra Nevada © Jennifer Hsu

During these trips, I also read several books. One of these is “I Am Not Sick, I Don’t Need Help” by Xavier Amador, Ph.D., a clinical psychologist. I found it to be a quick, pleasurable read, because of the author’s concise and clear writing style. He also does a spectacular job of evoking empathy and understanding through clinical vignettes and personal stories.

If you know somebody with serious mental illness who is in “denial” and refuses to seek treatment or take medication, then this book is for you.

Dr. Amador divides this book into five parts. The first part provides information about mental illness, particularly schizophrenia. The second part describes the LEAP (listen, empathize, agree, partner) methodology that Dr. Amador developed, which has shown positive results in his work with patients and their families. The third part focuses on the feelings of betrayal and guilt that a patient and their family may feel when the patient is taken against their will to the hospital, and how to re-build trust. The fourth part discusses the value of assessing a person’s awareness of their illness and its purpose in formulating a cooperative treatment plan.

The fifth section is the most memorable of all. In it, Dr. Amador tells us about his brother Henry, who was diagnosed with schizophrenia. I could feel the love and care between the brothers, nearly palpable from the page, and I admired that he shared his brother’s story with us. It is a poignant reminder that every patient, no matter how “crazy” or psychotic, is loved by somebody. I admit that I shed some tears reading Henry’s story.

I highly recommend this book for anyone with a family member with mental illness. It is also a wonderful read for any health professionals.

Key Takeaways
  • “Denial” is the wrong term for poor insight in a person with mental illness. In patients with schizophrenia, the executive (frontal) part of the brain is often dysfunctional, resulting in a symptom called anosognosia, which is the condition in which a person with a disability seems unaware of its existence.
  • Reflective listening is listening with only one goal: to understand. It is not commenting, disagreeing, judging, or reacting in any way.
  • It is not necessary for the patient to believe that they have a mental illness. But, it is necessary for the patient and their support network (family, health provider) to work together for success. Prioritize finding common ground and collaboration, not arguing over who is “right.”
Quotes

“I can’t guarantee that LEAP will definitely eliminate medication and service refusal in the person you’re trying to help, but I can promise that if you faithfully follow the guidelines I give, they will help lower tension, increase trust, and greatly increase the likelihood that the person you are trying to help will follow your advice.” – Amador, X. Page 3.

“I have never talked anyone out of a delusion and, to my knowledge, I have never talked anyone into one either. The point is, when you’re facing someone who rigidly holds irrational beliefs, you gain nothing by disagreeing.” – Amador, X. Page 84.

“I loved Henry, and when someone you love is in pain, it is hard not to empathize. Learning to listen lead to empathy. And my empathy ultimately resulted in my brother showing a real interest in my thoughts about the illness he felt he did not have and the medications he was sure he did not need.” – Amador, X. Page 113.

More Information

Amador, X. I Am Not Sick I Don’t Need Help! How to Help Someone with Mental Illness Accept Treatment. Vida Press. Kindle Edition. 2012.

“LEAP®”; “L.E.A.P.®“;“Listen-Empathize-Agree-Partner®”; “Listen, Empathize, Agree, Partner®” and all similarly punctuated versions are registered trademarks of the LEAP Institute, are protected under the laws of the United States Patent and Trademark Office (USPTO), and may not be used without express license of the LEAP Institute.

Learn more at https://leapinstitute.org

The Right Things

Everything must be used until it falls apart. Clothing should be worn and handed down until it became threadbare. No grain of rice should be wasted.

The man walks up to the volunteer table where we are performing free blood pressure and glucose checks. He is Asian, in his fifties or sixties, with greying hair and a smiling, weather-worn face.

As I prep his finger for the glucose stick, he tells me, “Do you want to know a secret?”

“What is it?” I ask, politely.

“I have a bad liver. My doctor gives me medication to take every day. But here’s the secret. I can make the medication last longer if I only take it when my skin is yellow. See?” He presses on his skin so that it turns pale. “That’s how I check.”

He tells me this with the confidence of a man who does not expect to be challenged. After all, I am a young Asian woman, fresh out of college. In most traditional Asian cultures, the young do not correct the elderly. I probe delicately, with deference and respect.

“Why do you want to make the medication last longer?” I ask.

“To save money, of course!” the man exclaims.

He looks at me incredulously. However, after some more questions, I find out that he is financially secure. Why then, is he concerned about money? I don’t need to ask to understand. My parents and grandparents are similar. After World War II, conflict continued in East Asia for decades. The people became frugal by necessity. When my grandfather was eighteen, he fled to Taiwan with nothing but the clothes on his back. He instilled in my father the mindset of thrift, bordering on cheapness, that everything must be used until it falls apart. Clothing should be worn and handed down until it became threadbare. No grain of rice should be wasted.

I can see that same frugality in this gentleman.

“Maybe there is a reason that the doctor wants you to take the medication every day,” I suggest as I wrap a bandaid around his finger.

“Ayy, they just want my money,” he says with a smile. Then he becomes doubtful. “And I feel fine.”

I attempt to nudge him along.

“It wouldn’t hurt to ask your doctor.”

Then I tell him that his blood glucose is normal. He smiles and shrugs and raises his eyebrows as if to say, See? Everything is fine. He thanks me. I watch him leave and hope that I had said the right things.

Today’s Daily Post Writing Prompt: Yellow