I’m Not Sick, I Don’t Need Help! | Dr. Xavier Amador | TEDxOrientHarbor

I am a clinical psychologist who has been working with people with bipolar schizophrenia and related psychotic disorders for thirty years. Now some people still think that schizophrenia is a split personality. I think it's worth taking a moment when we talk about these psychotic illnesses that we're talking about. about neurodevelopmental disorders like Parkinson's disease, where the person does not have Parkinson's disease all their life, they develop it later. The same thing happens with these disorders that I am going to talk about. The other thing is I think a word about psychosis, what is it? really a couple of symptoms that we see most often false perceptions hallucinations hearing things hearing voices seeing things that don't exist and having delusions I'm not talking about political opinions I'm talking about fixed false beliefs sometimes they are strange there is an alien implant in my brain or sometimes They are not that strange my wife is having an affair with me for many years I worked as a doctor trying to

help

people with bipolar schizophrenia and related disorders and I heard over and over again that I'm not

sick

, I don't

need

your

help

, you're the crazy one, not me, and it turns out that about half of all people with these diseases do not take medications that, from the point of view of other people, help them, so what is this problem? the lessons we learned when I say I'm talking now about my colleagues at Columbia University, where I worked for two decades doing research, what we discovered were two main lessons that I want to share with you today first, you don't normally deny it when someone says no.

I have been

sick

for months, years and even decades and the way we spoke to our patients made things much worse, so let me start at the beginning, the beginning really begins with my brother Henry, who developed schizophrenia when I was 21 years old this This is a photo of Henry and I after we had emigrated from Cuba. This was immediately after the Cuban Revolution. It is me driving the car and Henry looking out the window. Henry was much more than a brother, he was a father. It was as I said in his eulogy, Henry. He was my support, he really was a mature and responsible person now, why am I telling you this?

Because the story of this investigation is about relationships and what happens between family members and the health professionals who are trying to help. people with these serious mental illnesses 20 years after this photo was taken my brother developed schizophrenia he heard voices the voice of the devil out loud just like you can hear my voice now he didn't think he had a problem I'm going to go see a doctor he thought it was double he was delusional our mother was in cahoots with the devil his eyes were laser beams this is where it got a little strange and she was actually cutting him, lacerating him he tried to show me the wounds of course there were no wounds during a week I argued with my brother I begged him to go to the hospital at first I explained gently Henry, you're not thinking clearly something is clearly wrong for a while I thought he might be taking drugs, that was That's not the problem after a week of mild persuasion, it turned into a harsh confrontation accusing him of being immature irresponsible without caring about our poor mother, she hasn't been through enough trying to make him feel guilty.

I took him to the hospital like many others. million families at least three and a half million four million families in the United States have gone through this experience. I had to call the police and he was involuntarily admitted to the hospital over the course of a month and you know, don't pass out, but back then in the 1980s people could stay in the hospital for so long he got better antipsychotic medication eliminated the hallucinations eliminated the delusions and promised he would take his medication I returned home where I found it in the trash and what followed was seven years of my life? my brother and I confronted him telling him that you are sick that you

need

help please get help he says no, no, nothing is wrong with me and what was our relationship like like this him running away from me and running away from all the people who were trying to help him no I was very involved he was homeless for a while he was stopped by the police many times he never broke the laws fortunately during that same time I was training as a clinical psychologist and I picked up some gems and probably The most important tool I learned was not from a psychiatrist or psychologist , was by Albert Einstein, was the definition of madness.

I was doing the same thing over and over again for seven years while he ran away from me. being involuntarily admitted almost 30 hospitalizations while arguing with him Henry you are sick you need help please seek help again and again expecting a different result I called my brother we had a conversation we had together I promised him I would never tell him again he was mentally ill, This is after seven years of trying to convince him and I also did some other things that I am going to tell you that are based on the research that my colleagues and I have done, our relationship changed dramatically and with that he accepted. treatment and in fact over the next 18 years our relationship looked like this this is a photo taken here that is my brother on the right that is me with Jerry Seinfeld's haircut what it looked like then that is not an illusion, I think That was just cool.

That was just Henry style, look at the way he hugs me. I actually can't look at this photo anymore without getting really emotional, but if you can look at the way he hugs me and smiles at me, you know that sometimes a photo really is worth it. a thousand words, love returned, trust and respect returned and, most importantly, he was reliably taking medication for 18 years, a truly voluntary hospitalization, he registered himself, called me and said: "I'm going to the hospital" , so this is the basis of a Many of my own ideas led me to a lot of research that our group did at Columbia University and people around the world followed up on it.

It is now in our diagnostic manual for mental disorders. I was asked to submit the text in the last edition of this that came out in 2013, so I'm going to summarize some research in just a minute. What do we know? We know that the lack of awareness of the disease. We notice that we do not use the word negation. It is generally a symptom of the disorder like a hallucination and it is very very similar to what we see in neurological disorders, if you have ever worked with neurological patients like me, sometimes you see people who are paralyzed and they don't know it, that symptom is called Ana cig nausea, it's a tongue twister.

I did not come. It was a French neurologist in 1919 AB Insky, so if it is Ana sign sia who is already starting to suggest that we should talk to people differently about their illness, without trying to educate them, I wouldn't tell anyone to stop hallucinating, she He just stopped doing it. be delusional stop hallucinating because it is not under your control, but that is what I have been doing for many years not only with my brother but with many patients, this symptom and again this is in our psychiatric manual for mental disorders, although not yet It is widely known in our country.

Field is the most common predictor of who will not take medication. 50 to 75 percent of people with these disorders do not take medications that reduce these symptoms. I have been talking to you about psychotic symptoms, it predicts all kinds of problems, worse course of the illness. involuntary hospitalizations like my brother had and even violent assaults and, of course, we know some of the stories that have made headlines in some of the cases I have worked on, such as Theodore Kaczynski, who was diagnosed with paranoid schizophrenia, He never understood that he was sick, so I'm talking about this, but what does it feel like to have an Ignazio ass for this?

I need a volunteer someone who is married does not have to be happily married just married could you raise your hand if you are married sir can I ask you to help me right there with the yellow shirt. What is his name? Sir Richard Richard. I actually feel uncomfortable doing this. It's something strange. His family has asked me to do it. How long have you been married? are you with your wife 46 years old 46 years old what is her name Eleanor Eleanor and where is she in New York City I have been asked to do an intervention with you you are not actually married to Eleanor I have restraining orders backstage I can, I can bring you from I'll come back here and show them to you.

Eleanor, her husband, and her family have been harassed by you for at least 20 years. I know if I showed you those restraining orders, that would help you understand. I don't believe it. don't believe it laughter please they would convince you it's not okay when you leave here when you go home where you will go to my house her house is that the house Eleanor lives in when she is here in the east yes yes well the neighbors see you they call to the police and you end up in front of a judge, it's called diversion court and the judge says Richard.

I actually have almost 10 years of paperwork here on you in your record. I understand that you have a mental illness. Do you think you have? married to this woman Eleanor, you violated the restraining order again by going to her house now I'm the judge I'm going to give you a choice Richard you can go to the hospital and we'll postpone your trespass case and by the way Let me ask you something Richard, when you went to the house and the police showed up and told you that you were not married to Eleanor, this was not your house, do you think you would resist going with them in all probability and in all probability, so I?

I'm the judge again, so Richard, I also have a problem with resisting arrest here, so I give you an option: you can go to the hospital, we have arranged something nearby and get psychiatric help and in six months we will review it and maybe dismiss these charges or you can go back to jail and we will have an arraignment on Monday morning you will spend the weekend in jail what would you like to do what do you think you will do Hospital hospital wonderful choice so go to the hospital they will take your clothes off they put your personal belongings in a plastic bag then they give you back your clothes they take your vital signs they offer you medication this one here is for the delusions you have this one here brings you anxiety and this one here is for the side effects the nurse gives you the cup, what do you do with it?

I would take the medication, okay, how long would you take that medication? If you were there for two weeks, you take it every day. I would love to, so then you can write a great report to the judge. This patient is complying with treatment. Let's move on now because they won't let you go home. They want to send you to a group home to be with other mentally ill people. Will you probably go? Probably not, where are you going? Probably not, probably, if I don't have a house to go to, I probably live in my car.

Ten years and five years pass. You will never see Ellenor again. You will never see your house again. Do you think that? You would come to understand that you are not married to her that you have a mental illness. I think she would do it in five years. That's all it would take. If you proposed marriage. Yeah, that didn't happen. You really believe that in five years you could come to believe. that the memory you have now of that proposal never happened or of the wedding, do you think you could really be convinced that all of that was just a dream? probably not thanks for your help can we thank Richard for helping me so quickly? any emotions you had while we were doing this I know it's a role play fleeting emotions just name a resistance resistance how about any anger or fear?

Yeah, yeah, okay, thanks again for your help, thank you again, and call Eleanor when this is over. Well, that's what a firm, fixed belief is, it's concrete, it's solid, it's in Richards' bones, he knows he's married to Eleanor and that's what it is for millions of Americans with these serious mental illnesses, so that when it comes to someone who has the sign of Ana, seeif. o mental illness no denial of mental illness the doctor knows best o the father or the mother knows best o the little brother in my case it doesn't work there is no collaboration I can expect Richard to be grateful if you were grateful for my advice now it is insightful no He learned to go underground like my brother did and accept treatment for a month and maybe more just to regain his freedom.

This is what is happening again to millions of Americans with these diseases. Adherence refers to adherence to medication. Medication compliance like again 50% of the patients you see. I'm very unlikely to take medication when what I can expect is that what the research shows us is that we will have someone who is fearful, angry, suspicious, demoralized, lonely and won't take the medication, so how can I treat them well? The focus is, believe it or not. I told you before that it's about relationships, we have to create respectful and non-judgmental relationships. According to research, these result in acceptance of treatment for a disease that the person does not believe they have, so if Richard came to see me in five years and told me his story, I would listen to it with respect and without judging that Ellen LEEP means listen reflectively again withrespect and without judging so after he tells me his story I would say then you went to that TEDx talk and they took your wife away from you At home, I understood everything correctly, which would be very different from what I had been hearing, since You know, Richard, we want you to calm down, we have to keep you away from Eleanor and what we've learned through a lot of research. is that people with these illnesses feel relief now this is not dishonest I'm not faking I think I'm simply reflecting their experience I would strategically empathize with Richard especially with the emotions around delusions it must be terrible for this to happen, what was it like for you?

Well, I resisted if you were angry, yes, I was angry, you know what, Richard? I would be angry too, we work on those things we could agree on. It's never going to be that Richard isn't married to Eleanor. That is an illusion. We've known for 60 years that we don't try to dissuade people from her delusions. Well, we don't try to dissuade people from the sign of it either. Xia, we are not aware of mental illness, we partner where we can work together, there are three other tools that we use, but again the approach is respectful and non-judgmental communication, so with my brother, mom is the devil in her eyes or laser beams, that's what you do.

You're saying yes, well no wonder you're so terrified of her. I would be Henry too if this happened to me. That's the kind of conversations I had with him. If he asked me. Do you really believe this? If Richard asked me. Do you really believe? I'm sick, I might be late, we call it the three A's. I apologize for my opinion. I recognize my phal ability. I agree to disagree. How does that sound? Richard. I'll answer the question if you want, but I want to apologize. Maybe. I upset you and I could be wrong. I hope you don't have to argue when we give our opinion, we are using those three tools and then we are not afraid to apologize for things like previous confrontations like I did with my brother. things like an involuntary hospitalization that we were a part of sometimes people say why do you repeat everything I say, research shows, you can apologize for that.

Sorry, I'm repeating everything. I just want to understand you. It was not. listening before I kept telling you that you were sick I would like to listen to you so it is a very different approach it is not the medical model approach it is the motivational interviewing approach it is a completely different field of study and I will end with a closing of my brother's story I lost sight of who my brother was in those seven years we fought he was a mature, kind and selfless person he died being Henry was safe on a city bus he heard a woman behind him struggling with groceries he got off the bus he got in a sidewalk and was delivering her groceries when someone who had lost control of his car ran over him.

He saved that woman's life. It was an act of kindness that he did when his life ended. He had a very good life during those 18 years. He had a girlfriend. , had a job and got his relationships back, as I think the picture I showed you demonstrates the best, so the way we approach people who have these illnesses and who say I'm not sick is vitally important and the relationships that we build are the key. thank you