I Am Not Sick - I Don't Need Help --- Book Review

Psychiatr Serv 52:397, March 2001
© 2001 American Psychiatric Association

I Am Not Sick, I Don't Need Help! Helping the Seriously Mentally Ill Accept Treatment: A Practical Guide for Families and Therapists by Xavier Amador, Ph.D., with Anna-Lisa Johanson; Peconic, New York, Vida Press, 2000, 239 pages, $17.95 softcover by Jane E. Moser
George had been hospitalized 4 times in the past year, each time because he had stopped taking his prescribed antipsychotic medication and symptoms of his mental illness returned.

After each hospitalization, he was released with a plan for outpatient treatment, including medication. Each time, his family and therapist hoped that George would finally realize that he had a mental illness and be aware that he needed to continue taking medication.

But instead George continued to insist that he was not really mentally ill, had been hospitalized for some other reason, and certainly did not need to continue taking medication. The cycle repeated itself.
George's story is painfully familiar to many thousands of us.

How could a person who is otherwise intelligent fail to be aware that he has a brain disorder? How could he not understand that medication is needed to relieve symptoms of his illness?

For years, families and professionals have blamed persons like George for "being in denial," for being "stubborn," or for being "too proud" to admit that they are sick. But research in recent years is pointing toward another explanation.
In his newly published book, I Am Not Sick, I Don't Need Help! Dr. Xavier Amador reviews studies that have explored areas of the brain, in particular the frontal lobe, that affect a person's lack of awareness or insight about his or her own mental illness.

Those studies and Dr. Amador's own research have concluded that "poor insight into having an illness and into the benefits of treatment is clearly another symptom of the disorder, and has nothing to do with being defensive or stubborn." In other words, George's anosognosia or poor insight about his illness is itself another symptom—one that does not necessarily improve with medication.
Dr. Amador not only explores a scientific basis for answering that vexing question of why the obviously sick person will not take his or her medication, but he also provides families and professionals with a step-by-step plan to work with the mentally ill person to improve awarenss of illness. He also tackles the sometimes thorny issues of involuntary commitment, suicide, and patient confidentiality.
Throughout the book Dr. Amador emphasizes an approach of respect and validation for everyone involved—the person who is ill, the family, and the professionals—which is especially welcome in an arena where sharp differences of opinion can be divisive.

Both the format and style—bordering on breezy—of this book are geared for easy reading by busy people, while the content remains substantive. Reference lists for relevant organizations, publications, research studies, summaries of state commitment laws, and Web sites for updated information are included.
Dr. Amador knows whereof he speaks.
In addition to his professional credentials as director of psychology at the New York State Psychiatric Institute and professor of psychology in the department of psychiatry at Columbia University, Dr. Amador also has a brother with schizophrenia who for years insisted, "I am not sick, I don't need help."

As the mother of a son who repeats that very phrase, I urge families and professionals to put Dr. Amador's book on their must-read list.

Footnotes

Ms. Moser is president of National Alliance for the Mentally Ill of Western Massachusetts in Springfield.