Today, Xavier Amador, the author of I’m Not Sick, I Don’t Need Your Help, and founder of the L.E.A.P. Institute, offers his suggestions to A Concerned Parent.
Dear Pete,
We have tried to get our son professional help. I think he has bipolar disorder, although he possibly could have schizophrenia. We know he has an alcohol addiction. He has not cooperated with hardly anything, and we’ve been unable to get him to go to our local mental health center, although officials there said he is eligible for treatment.
We feel like our hands our tied. The few times that we’ve gotten him to a psychiatrist, our son denies that he is sick, won’t take his medicine, and is extremely hostile to doctors for the short time he’s being seen by them. We’ve had him in our house for several months with his erratic moods and high level of anger. Yesterday he asked to go to a homeless shelter and he is now on the streets. If we try to visit him, he runs away.
His dad and I are at the point where we feel resigned that there is no hope nor help for our son. The system has worked against us at every turn … and he needs help. People have recommended “he needs to hit rock bottom” and that we need to wait for him to *want* help. We simply don’t know what to do. Do we wait for him to hit rock bottom on the streets where we know he is not safe?
In our view, the mental health network has been ineffective at best, and is rolling the dice with people’s lives. Now we can see how barriers in the mental illness system keep people from receiving basic services. This has been hell for his dad and me, and I’m sure worse for our son.
If you have any advice please let us know.
A concerned parent.
As a brother of someone with the same type of disorder (who I almost decided to let hit “rock bottom” after hearing the same advice 30 years ago), and as a mental health professional and researcher, I couldn’t agree with you more–letting him out of sight to fall further through the cracks of our mental health system would be a big mistake. Monitoring how he’s doing and assisting in the ways you can (while staying safe) is what I recommend because the mortality rate by suicide alone for the disorders you suspect your son has is over 10%. That’s 1 out of 10 that die from the disorder, especially when left alone and untreated. And there are other dangers including ending up in the criminal justice system.
Dr. Xavier Amador
An involuntary admission to a hospital may be needed, but this will be a short term solution. For some suggestions and specific information on how to do this feel free to write to me at www.LEAPinstitute.org and I will send you two E-chapters from my book “I am Not Sick, I Don’t Need Help!” How to help someone with mental illness accept treatment (Vida Press, 2012). In the meantime I have two suggestions:
1) Consider that he may not be in denial. A common symptom of schizophrenia and bipolar disorder, made worse by alcohol abuse, is “anosognosia”. It is a symptom just like a paranoid delusion or a hallucination. And if you’ve ever tried to talk someone out of a delusions you know this is futile and time poorly spent. It also usually stresses or destroys the trust and relationship. So promise your son you will not ever again tell him he is ill and instead focus on healing your relationship with him (the cover of my book is a picture of a mentally ill person walking out the door and running away–that’s how common your circumstance is). Your common sense effort to educate him may be driving him further from you and from the help he desperately needs. If you balk at my advice consider this: have you succeeded in convincing him he’s mentally ill and has an alcohol problem? How long have you tried? If the answer is months or years and you’ve failed, you have nothing to lose by making the promise (and keeping it) that I suggest above. You have much to gain if you then take my 2nd bit of advice.
2) Apologize for arguing (I know this can sound hard–why should you apologize!) with him and tell him you want to listen to his point of view. If we take his point of view–he’s very likely in a very lonely and desperate place. No one understands he’s not ill and the people closest to him are telling him he’s “crazy”!). Apologizing and promising not to tell him he’s sick does not mean you will change your point of view or lie and say you agree there’s nothing wrong. It means you will stop arguing. You will stop the I’m right, you’re wrong cycle that has resulted in his anger worsening and his running from you. Focus on listening and respecting his point of view and from there you can talk about his getting help. Please consider visiting our website (www.LEAPinstitute.org) and registering to get free book chapters and videos that show you how to do this–how to use the LEAP method which is focused on your winning on the strength of your relationship (healing the riff and building trust), not on the strength of your argument (which if your experience is anything like mine, never works because he cannot see he is mentally ill).
There is hope and specific tools you can use to shift your focus to lowering the anger, the tension and building trust so you can lead him to the help he desperately needs. But if and when he goes for that help, it won’t be because he has come to see he is mentally ill. It will be because he does it for you or for some other reason the two of you have uncovered together (to feel less angry and scared, to sleep better, or some other common ground). I hope this is helpful and feel free to reach out to me and our faculty directly if you think we can be of help.
— Xavier Amador, PhD.
Dr. Amador is an internationally sought after speaker, clinical psychologist, professor at Columbia University Teachers College in New York City, the founder and director of the LEAP™” Institute, which helps families and mental health professionals develop lasting relationships with patients to get the help they need. He is the author of eight books including the best seller, “I’m Not Sick, I Don’t Need Your Help. ™”
Previously, Dr. Amador was a professor in the Department of Psychiatry at Columbia University, College of Physicians & Surgeons; on the Board of Directors of the National Alliance for the Mentally Ill (NAMI); Director of Research at NAMI; and the Director of Psychology at the New York State Psychiatric Institute.
He is a regular contributor to the Today Show and a featured guest on ABC Good Morning America, Prime Time Live, CBS This Morning, NBC Nightly News, 60 Minutes, CNN, Dateline, ABC’s World News Tonight, Fox News, New York Times, Wall Street Journal, USA Today and many others. He has been a consultant to the National Institute on Mental Health and an expert witness in numerous cases. His forensic cases include the Unabomber, PFC Lynndie England, Elizabeth Smart Kidnapping, and Zacarias Moussaoui trials. Dr. Amador has over 25 years experience working with adults, families, and couples. He lives in New York.
In addition to his books Dr. Amador has published over 100 peer-reviewed scientific papers, and many other publications that have been translated into more than 20 languages. Dr. Amador was co-chair of the last text revision of the Schizophrenia and related disorders section of the DSM IV-TR (often referred to as the “Psychiatrists’ Bible”).
Tomorrow: A parent and popular mental health blogger, Chrisa Hickey, responds to A Concerned Parent
About the author:
We used Dr. Amador’s book to help us help our son, who had undiagnosed bipoloar disorder and addiction also. We were also ready to give up and wait for the call from the police. But then I was told about this book, “I Am Not Sick, I Don’t Need Help” and it saved us all. It is the best $10 investment you will ever make in your life and your son’s. Our son has been sober for 16 months and stays on his medication at all times. He is actively involved in AA and his recovery community. I urge you to get Dr. Amador’s book. It may hold the key you are searching for.
Concerned parent, you are not alone – the fight is exhausing and painful but don’t lose hope. Late one night, in tears and desparately clinging to hope I too found Dr. Amador’s book among a list of suggested reading – I used it in crisis mode as per the book and my adult son agreed to substance abuse treatment. We too have experienced our son on the streets and in the midst of psychotic episodes. We have been sorely tested by a system whose job sometimes seems to be to make it as difficult as possible for us to help our son. Insurance companies have their own agenda and throw more stumbling blocks in your way. My son has severly impaired insight due to a developmental disorder and more recent symptoms which could indicate psychiatric illness, drug abuse or inappropriate meds. Because he had been seeing a psych he agreed a ‘dual diagnosis’ program was best. For almost a month now he has been in a sober living environment and is safe, supported and going to AA meetings. He has been turned away from some programs because of his developmental disorder and told he has none by others.The effort to enroll him into an appropriate treatment program continues after a gruelling three months! Dr Amador’s book continues to help me understand better and guide my interaction with my son. Dr. Amador’s LEAP method, NAMI support groups and a sober living home have offered us the best hope for our son’s future we’ve had so far.
To all family members dealing with your loved one suffering from Mental Illness. These stories are all too familiar. Yes, my son was diagnosed over 10 years ago with schizoaffective disorder. It took me almost 2 years to get a diagnosis. THe odd behavior beliefs and manic behavior was killing me. My son is and was an A student. He was a junior in HS when the onset started. I finally found a doctor to help him understand he needed medicine. He went on to graduate HS and received a AA in Psycology
When he was getting his BA all hell broke loose. He went off his meds ran away, cleared out his bank account, sold his car, etc. and ended up in Mental State Prison. When he was first diagnosed I went to NAMI Classes. When he was hospitialized the first time I had no idea about “Conservatorship”, Locked facilities, SSI or anything related to this disease. I begged the hospitial not to let him out. He was released and ended up in State Mental Hospital. He was released and ran away again. I had to fly to San Fran to find him. Thank God I did find him. At this point I educated myself on State Mental Health Laws. I found out I could get conservatorship of my son and dicate where he can live, doctors, etc. I also became the payee of his SSI. I also reached out to Dr. Amador. I follow his principles and emailed him. He gave me hope. About 18 months ago the cycle started. He was hospitalized 5 times in 6 months. Then about 4 months ago he started having severe symptoms. He was living in an independent living home. Thank god I communicated with the manager of the home and kept a close eye on my son. I had to call “PERT” . In California its called Psychiatric Emergency Response Team to do a 5150 on him. This is where they hold him for 72 hours. I did this THREE Times over 3 months. Three different hospitals. THe doctors kept releasing him. I would argue with the Social Workers in the hospital constantly and was on the doctors cases daily. I finally reached the CEO of the last hopstial he was in and he helped me get my son on 30 day conservatorship. He is know in a locked facility and on county conservatorship. I urge anyone dealing with this disease to keep records of when your family member is in the hospital or any other incidents in chronillogical order. I have 10 years of records I keep on a word document so I can immediately give to the hospital doctor, social worker, etc. Surround yourself with a team. SOcial worker, doctor, Psychiatrist
, ssi workers, etc. I have my son sign a letter letting me have access to his recovery. The first thing you need to do is take care of yourself. If you are not healthy you are no help to your family member. If your family member also has a drug/alcohol issue I woud advoate going to alanon. I have 2 kids addicted to heroine and it has helped me understand its about taking care of myself. Ironic I have one son I want to take drugs and he won’t and the other two are addicts. I should say recovering addicts. Without Dr. Amador, Nami and alanon I would be a basket case. I am going to write a book to help family members understand their resources. Each state has different programs. I would start with your local mental health department to find out what your options are. Experience Strength and HOPE. Remember you did not cause this disease you cannot control it and you cannot cure it. Stay strong. Thank you Chris F.
Have not Found this approach helpful.
We tried Dr. Armador’s approach after reading his books, watching his videos and attending his talk. We are well educated people in general and are open to anything that might help the situation.We sadly have had absolutely no luck using his approach.
We have a young adult daughter who is in her first highly Manic state and it is lasting over 1 year. We love her very much and are at a loss as to what to do. She is not talking to us even though we were a very close family before this manic episode came on.
I felt the need to let other people know that in spite of their best attempts you may not be able to get through using a certain” method” like the one Dr. Armador’s suggests. I feel so awful that his method did not work for us.. We tried for several months and continue to try but all his method seems to accomplish is making us feel awful and inept. ( which we are not… we are educated and open to learning but this method just isn’t working)
So please don’t beat yourself up if this method does not work for you. There is enough pressure and worry associated with dealing with mental illness without beating yourself up because a method doesn’t work. After trying to use this method for several months all it has done is make me feel like everything I do is not good enough and that I am more inept then capable. And it seemingly has given our daughter more power to stay manic then to talk with us.
I’m sorry to hear about your daughter’s heart-breaking journey. Have you spoken to any specially trained community out-reach social workers/doctors about your daughter? Sometimes community-based services and highly trained mental health social workers can accomplish alot more than psychiatrists in offices or doctors in hospitals. Not all communities have these services, but I can tell you from experience that my brother benefited greatly from connecting to these types of services rather than a hospital setting or out-patient clinic. Sometimes hospitals or out-patient clinics are the best answers; sometimes outreach programs are. As parents it will take patience, fortitude and the tenacity of a pit bull to not let go and lose hope. Having a family member with severe mental illness can be best described as being stranded in a lifeboat in the middle of the ocean with your mentally ill loved one. And you know there’s no coast guard coming to the rescue. Then, you’re loved one jumps into the ocean and you jump in after him or her. You get them back into the boat somehow, and then they jump overboard again. And you jump in after them again, and again. You feel helpless. Alone. Frustrated. Exhausted. Hopeless. But I’ve lived through 18 years of my loved one’s paranoid schizophrenia and I can tell you that miracles do happen. And I will keep “jumping overboard” to save him as much as I can because I can’t help but believe “There but for the grace of god, go I….” Good luck.
My husband and I have read Dr. Amador’s book. Our son is 43 and was diagnosed bipolar about 8 years ago. He refuses to accept his illness and will not take medication. As a result he has been in and out of jail. We can’t bring ourselves to give up on him because you know the son we raised before this illness. He was an excellent student, always worked all through school. Graduated with honors and is highly intelligent and earned a high income. At age 35 he became very paranoid and delusional. He lost his family, home, and job. We attended NAMI classes and they have helped us to try and understand his behavior and not blame ourselves for his illness. We don’t know what trauma caused this. We want our son back. We are now seeking guardianship of his person because we don’t know what else to do. If anyone else has tried this route, we would appreciate your comments.
I agree with just about
everything Xavier Amador writes, save for point 1, which I’ll get to later. In
response to the comment from Lisa, about trying Amador’s approach and it didn’t
work, my response is that people expecting a quick fix with regard to the kinds
of issues described in this post, are like stock analysts who only focus on
quarterly results and then urge “sell.” Amador’s suggestion, which is
also part of practicing low expressed emotion, works because it is focuses on the human being and how we would want ourselves to be treated. We are all human and this strategy doesn’t work perfectly. We make mistakes, we vow to do better next time, but we
don’t abandon the strategy (this empathy) because it has failed to deliver in the short term. If Lisa is as educated and open to learning as she says she is, then she should be willing to learn some more outside of just what Dr. Amador recommends, but not abandoning the strategy he proposes.
Re point 1, actually it is Dr. Amador, a psychiatrist, who lifted the term
“agnosognosia” from neurology. Neurologists use the term to describe
the behavior of patients who show damage to the parietal lobe of the brain,
often because of stroke. Psychiatry quickly realized the market potential
of equating so-called “lack of insight” with neurological brain damage,
even though even Dr. Thomas Insel, Director of NIMH says re the science behind brain scans that “there is simply
too much individual variation in brain structure and function for an
individual’s scan to be diagnostic or predictive, given the current state of
the science.”
It is good to know that we are not alone but also very sad that so many people suffer from mental illness and how extremely challenging it is for their families who want so desperately to help. My wife and I have 2 children with Bipolar disorder. My daughter is 24 and has a milder case that my son who is 20. My son was diagnosed at 16 and my daughter at 21. This morning I was at the county jail trying to get him released. He was arrested at 2AM for smoking marijuana. I know many of you can empathize.
I read Dr. Amador’s book, “I’m not sick…” 2X so far and plan to read it a 3rd time. Although the methods taught in the book have not delivered any real breakthroughs yet, it has made a world of difference in our relationship with our kids and I strongly believe it will prove to be one of the only strategies that will eventually help our son. My daughter is functional for the most part, she is able to work and go to school but my son is not. Unfortunately he has a very strong belief that all medications are useless and are pushed by greedy pharmaceutical companies for the sole purpose of profit. However, he seems to have no problem experimenting with illegal drugs at times. He smokes pot as his way of self medicating and to be honest, it seems to help him mitigate his bipolar rage and stay out of the hospital. It helps him relax and stay calm. We know it is not the right solution but there are worse things he could be doing. I hope more states consider legalizing marijuana. I believe it is better than alcohol and may actually benefit people going through chemotherapy in addition to mental illness. I expect I will get a very negative response from most of you on my comments, especially the medical community.
We will continue to use Dr. Amador’s methods to hopefully someday have our son realize there are significant benefits to being medicated. I will never, ever give up on him.
My wife is very close to earning her master’s degree in child psychology and her studies have helped us in our research and understanding. Her family has quite a bit of mental illness so it is no surprise now that our children have been diagnosed. He hope our 13yr son is spared but we will be keeping a close eye on him to make sure we can get him in treatment early if he does.