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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
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Experience:  Dr. Mark is a PhD in psychology in private practice
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Will letting a paranoid schizophrenic "hit rock bottom" help or hinder in their

Resolved Question:

Will letting a paranoid schizophrenic "hit rock bottom" help or hinder in their recovery?
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Mark replied 1 year ago.

Hi! I'll be glad to be of help with this issue.

I truly wish that schizophrenia, with or without paranoid features, was the type of disorder that does go away with time on its own. Depression, for instance, has been shown to "even out" after a certain for many people regardless of treatment. Schizophrenia is a mental illness, however, that does not improve on its own typically.


We don't have research evidence to really say authoritatively that the illness progresses along certain lines if treatment is withheld. People suffering from schizophrenia who refuse treatment do not volunteer for research studies either, so we don't have the ability to do that research.


But there is clinical evidence that the brain is impaired with each psychotic episode. And further, that the brain is impaired with each successive psychotic episode more severely. Meaning, that recovery is less successful with each succeeding episode. Paranoid features are considered a further degree of severity in the thought disorder.


So, while we can't give the same precise answer we could with disorders where people typically agree to be part of research studies as in medical studies or studies on depression, etc., we do have accumulated evidence to offer you.

Okay, I wish you the very best!

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

Customer: replied 1 year ago.

He has been under mental health care for seven years or more. Many medications have been tried but he refuses, mostly, to take his meds.


The mental health facility will not commit him unless he endangers


himself or others, as rightly so. What I want to know is if we refuse care


for him ( shelter, food etc.) will he then get to a point to ask for help and be more likely to


take his meds?

Expert:  Dr. Mark replied 1 year ago.

Thank you for the added information. It helps a lot in helping you with this issue.



First, let me say I can imagine how frustrating and worrisome this situation must be for you. On the one hand he is an adult and because of the patients rights climate we have today he legally has responsibility to care for himself if he does not want treatment unless he is presenting a clear, stated danger to himself or others. But on the other hand he is not really able to care for himself in a healthy way. I wish this was a rare situation, but it is estimated to be a significant portion of the homeless population and those who are chronically in shelters.


And this is actually the key to my answer to you that you need to consider and think about. Your concerns seem correct. Many are homeless because family members came to the conclusion that continuing to prop up the patient only let him stay untreated and barely functional with little incentive to change. This is because of a condition called anosognosia that is unfortunately common in schizophrenia. More on this in a minute. But it is important for you to not become adversarial about this. To have him feel that you are on his side even if and when you cut off material help to him. Why?

Because taking his meds, staying true to the treatment, and staying stable, is his lesson to be learned and he will not learn it from being lectured to about it or have his errors pointed out. He will become defensive. So it is vital for you not to take his situation personally and to always make him feel as if he is in charge of himself.


One of the problems here is that with many schizophrenia disorders sufferers, manipulating the situation to avoid medication or treatment in general is part of the disorder, the anosognosia I mentioned above. It is very pernicious and very difficult to treat. I would like to recommend to you the work of Dr. Xavier Amador. I think that in this area of treatment resistance he has been invaluable to all of us working with schizophrenia. I know some people don't go for his style, but I have found it very valuable and I think you will see its value as well. Dr. Amador's whole approach is to find the way to make treatment a win-win situation. Because for him, treatment is only for others' sakes: family, doctors, etc. Not for himself. The meds probably cause whole sorts of side effects he doesn't like. And this is going to be true of any meds the doctors come up with. Because resistance is often part of the illness and all meds have side effects.

So this approach can help you very much. But not only you personally, but the whole family. Here are his two most known books:



I am Not Sick, I Don't Need Help. This is the book that made Dr. Amador famous. It details a bit the story of his brother, who will remind of you of Leo probably in some aspects. Amazon page for it:



http://www.amazon.com/someone-mental-illness-treatment-Anniversary/dp/0967718953/ref=sr_1_3?s=books&ie=UTF8&qid=1289946492&sr=1-3

The other book is I'm Right You're Wrong, Now what? Break the Impasse and Get What You Need. Amazon page:



http://www.amazon.com/Right-Youre-Wrong-Now-What/dp/B001Q9E9OC/ref=sr_1_1?s=books&ie=UTF8&qid=1289946492&sr=1-1

Here is his organization's website that has wonderful resources available:



http://www.leapinstitute.org/index.html

Okay, I wish you the very best!

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5170
Experience: Dr. Mark is a PhD in psychology in private practice
Dr. Mark and other Mental Health Specialists are ready to help you
Expert:  Dr. Mark replied 1 year ago.
Hi! I'm very glad that I was able to help you with this and thank you for your positive rating. If I can help you in the future in any way, please don't hesitate to let me know.


All the best,
Dr. Mark

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Dr. Mark is a PhD in psychology in private practice