The question I am asked most frequently in the classes that I teach is, “How can I get my loved one into treatment when he/she denies the reality of the illness?” A close second to that dilemma is, “How can I convince my son, daughter, mother, dad or spouse to continue taking their medication after they’ve been diagnosed and treated?”
As with all complex medical, psychological and interpersonal relationships, there are no hard and fast answers. Each case is different and carries with it its own set of communication problems, usually complicated by a long family history of frustration, enabling behavior, fear, guilt, anger and blame on both sides. And then there’s the A word: Anosognosia = a hard to pronounce, and difficult to understand, medical term that describes the lack of insight persons experience towards their own condition when the frontal lobe of the brain is neurologically impaired. This deficit, first observed in stroke patients, is accurately described by Xavier Amador, Ph.D., in his book I’m Not Sick and I Don’t Need Help. Amador’s work helps us understand that we may be pressing futility in our efforts to communicate with a person who is not just stubborn, not just in denial, but who has a “broken brain!”

But in spite of that grim possibility, Dr. Amador has developed a communication model that he has used successfully with many of his patients who have a serious mental illness and with his own brother, who has schizophrenia. The Psychologist recommends a collaborative, rather than a confrontational approach.; a model that he calls L.E.A.P. This strategy employs four communication tools: Listen, Empathize, Agree and Partner. To begin, we non-professionals need to remember that no one can talk a person out of their delusions or false beliefs, no matter how bizarre or irrational, if they have a psychosis. And this is a frequent presentation with schizophrenia and some forms of bipolar disorder. But the good news is that it is possible for us to learn to by-pass our loved one’s broken brain and touch their heart with the L.E.A.P model.

I used this strategy with my adult son who experienced many episodes of psychosis and delusions due to untreated schizoaffective disorder and substance abuse over the years. When he was not symptomatic, he was productive, self-employed, and sociable. He lived in Los Angeles. Unfortunately he died by his own hand in 2007 but I am very glad that I was able to become his friend during his last two years of depression, paranoia, and four previous suicide attempts. His choice to live life on his own terms, his inability to stay committed to his multiple treatment plans and multiple professional’s guidance forced me to take a different kind of action! I stopped rushing out to California to try and help get him “fixed.” I changed the way I talked to him. Using L.E.A.P. methods, sometimes more successfully than others, by telephone he slowly began to trust me as his ally, not treat me as his opponent. When he began talking about the “enemy” that was going to kill him and take him down, I agreed with his conclusion. It was indeed his reality. I did not affront him with my reality: that “his thoughts were caused by the disease talking to him.” He began to feel that I was in his corner. I let him do the talking. I listened closely. I empathized with his fear, his desire to be relieved from the pain. I remembered that I cannot talk someone out of a psychotic delusion. No one could talk me out of mine, when I was sick.

Now that I wasn’t part of the conspiracy against him, he started calling me. He was keeping the line of communication open for a change. He talked; I listened. He agreed to keep calling. Maybe the L.E.A.P. strategy gave him back his Mother. In the very end I knew there was nothing more I could do to save his life. That allowed me to be free to simply listen. When I made that disciplined sacrifice I sincerely believe that he finally felt that I loved him unconditionally.

Jacqueline Castine is the community education specialist at the Oakland County Community Mental Health Authority . Her fall class schedule is posted at www.jacquelinecastine.com. She is the author of I Wish I Could Fix It, But. . . She can be reached at castinej@occmha.org and 248-975-9684.

For the CNS Anti-Stigma Team the month of July took off like a firecracker! While we did not have an overwhelming amount of presentations to do, those that were scheduled required a lot of preparation.
The month began with our monthly New Hires Training, sponsored by the Oakland County Community Mental Health Authority. The participants were employees from the various core provider agencies in Oakland County. Many of them were surprised and appreciative of the insight and openness that was shown by the presenters during the session.

Then CNS Anti-Stigma Program was invited to share mental health resources and the celebrated “Stomp Out Stigma” workshop at the Community Breakfast sponsored by Families and Community Enrichment of Michigan, Inc. (F.A.C.E.) a community outreach program of the Immanuel House of Prayer located in Detroit, MI. Remarks by the pastor, Bishop Thomas L. Johnson, staff, other ministers in attendance and members of the community were exciting and very encouraging. At the request of another pastor the Team has been asked to come back to Detroit in August for another presentation.

Lastly the month of July went out with a bang as the Team was privileged to present “Recovery, A Journey and Not a Destination” at the first annual Consumer Conference. This conference was sponsored by the Michigan Department of Community Health and was located at the Kellogg Convention Center located on the campus of Michigan State University. Our new program is a “slam poetry” duet using PowerPoint slides to illustrate the various components of recovery referred to in the poem. A lively in-depth discussion on recovery was held at the conclusion of the presentation. There was no shortage of active participants who freely shared their own ideas on recovery, including an original poem which is featured as the success story in the August edition of the “Stomp”. Many of the workshop attendees were people who’ve had experience with mental health challenges, were in different stages of their own recovery journeys, and didn’t mind sharing their joys, struggles, and victories with the rest of us. Remarks by the audience and comments written on program evaluations about the new program were very positive.

My boss called me this morning on the way to work, telling me to tune into a Detroit area radio station. Their morning show raised a discussion about “crazy” neighbors. Attached to the listener’s descriptions of their neighbor’s behavior were phrases like “they must be schizophrenic” or “he has gotta have obsessive compulsive disorder.” When I began listening, someone had called in talking about the “strange” rituals that their neighbor does each day. Supposedly, this neighbor taps on his mailbox each day, in the same way. This listener said, “he has got to be obsessive compulsive,” and continued to joke and laugh about his behavior. Then, the radio announcer posed a question asking if it would surprise this particular listener if the media or the police came around saying he had done something wrong. The listener replied that it would absolutely not surprise her if that were the case, and continued to talk about the crazy man living next door.

The media has been a major contributor to society’s tendency to equate mental illness with violence. That one question the announcer asked the listener was an example of this. As if the conversation wasn’t already headed in a stigmatic direction, this question, “Would it surprise you if the media or the police came around saying he had done something wrong?”, moved the conversation to yet another level.
An interesting article was published by Patrick W. Corrigan, Psy.D and a team of other doctors and researchers in the Psychiatric Services journal in May 2005. This article reported a study that was done in six week-long periods in 2002, looking at large newspapers throughout the United States. During this period of time, there were 3,353 newspaper stories that reported on some aspect of mental illness. 1,291 stories reported on dangerousness. Only 139 stories talked about recovery as an outcome.

What is wrong with this picture? Recovery is the victory story, yet it is under-reported. It’s true that the media has an influence on our mindset. This morning’s radio show just emphasized the blatant stigma that is out there today.

So, what can we do? The media seems to have free reign over our outlook. If we see, hear, or read stigmatizing material, we need to do something about it. In an effort to do just this, I went to NAMI’s website (www.nami.org) where there is a FIGHT STIGMA tab. It leads you to their StigmaBusters page and tells you how to contact the media and combat stigma at both the local and national level. Because this was a local radio show, StigmaBusters advised me to contact the radio station directly. So, I located the website and the radio show host’s email address and started writing. I didn’t write to them to put them down or be negative. I wrote to them in an effort to educate.

I wrote that I usually like what they do on their show, but that today I heard something that fed into the stigma of mental illness. I explained how their conversation was stigmatizing, and then I fought that stigma with some facts; that one out of four people in the United States live with a mental illness, and that recovery is possible. You see, we CAN combat stigma! We CAN be advocates!

Dialectical Behavioral Therapy (DBT) is an evidenced-based practice that was developed by Dr. Marsha Linehan, Ph.D in the early 1990s. Although DBT has been used and studied as a treatment for consumers with various diagnoses, including substance abuse and anxiety, it is primarily a treatment for Borderline Personality Disorder (BPD).

BPD is a disorder in which a person has a very difficult time regulating their emotions. This affects virtually all parts of the person’s life, including: emotions, sense of self, thoughts, behaviors, and relationships with other people.

Because the research on DBT has been so strong and positive, Oakland County began offering the program through the County’s Core Provider Agencies in 2004. The value of DBT has been recognized at the state-level, as well, and the State of Michigan is very supportive of training and setting standards for the various DBT programs across the state.

Consumers in the DBT program at CNS attend a weekly skills group in which they learn specific behavioral skills, such as mindfulness, distress tolerance, and emotional regulations. Along with skills group, consumers attend a weekly individually therapy session. In these meetings, a DBT therapist assists the consumer in applying the skills learned in group to the specific circumstances in the consumer’s life.

Any consumer wanting more information about DBT can contact their case manager. It is the case manager who makes the referral to the DBT program. Once the referral is received, the consumer can then meet with a DBT therapists for an assessment to determine eligibility for the DBT program.