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

[Music] I'm a clinical psychologist who for thirty years has been working with people with schizophrenia bipolar and related psychotic disorders now some people still think schizophrenia is split personality I think it's worth taking a moment when we talk about these these psychotic illnesses we're talking about neurodevelopmental disorders like Parkinson's disease where the person doesn't have Parkinson's disease all their life they develop it later same thing with these disorders that I'm going to be talking about the other thing is I think a word about psychosis what is it it's really a couple of symptoms that we see most often false perceptions hallucinations hearing things hearing voices seeing things that aren't there and having delusions I'm not talking about political opinions I'm talking about fixed false beliefs sometimes they're bizarre there's an alien implant in my brain or sometimes they're not so bizarre my wife is having an affair on me for many years I worked as a clinician trying to help people with schizophrenia bipolar and related disorders and I heard over and over again I'm not sick I don't need your help you're the crazy one not me and as it turns out about half of all people with these illnesses do not take medications that have from the view of other people help them so what is this problem what are the lessons that we learned when I say we I'm talking now about my colleagues at at Columbia University where I worked for two decades doing research what we uncovered were two main lessons I want to share with you today first it's typically not denial when someone says I'm not sick for months years and even decades and to the the way we were speaking to our patients was making things worse far worse so let me start at the beginning the beginning really starts with my brother Henry who develop schizophrenia back when I was 21 years old this is a picture of Henry and myself after we had emigrated from Cuba this was on the heels of the Cuban Revolution that's me driving the car and Henry looking through the window Henry was much more than a brother he was a father he was as I said at his eulogy Henry was my rock he really was a mature responsible person now why am I telling you this because the story of this research is all about relationships and what happens between family members and health care professionals who are trying to help people with these serious mental illnesses 20 years after this picture 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 I have a problem I'm gonna go see a doctor he thought it was the double he had delusions our mother was in cahoots with the devil her eyes were laser beams this is where it got a little bit bizarre and she was actually cutting him lacerating him he tried to show me the wounds of course there were no wounds for a week I argued with my brother I begged him to go to the hospital at first I gently explained to him Henry you're not thinking straight something is clearly wrong for a while I thought he might be on drugs that wasn't the issue after a week of gentle persuasion it turned into harsh confrontation accusing him of being immature irresponsible not caring about our poor mother she hasn't she been through enough trying to make him feel guilty I got him into the hospital like many many families millions at least three and a half four million families in America have been through this experience I had to call the police and he was involuntarily admitted to the hospital over the course of a month and and and you know don't faint but back then in the 1980s people could stay in the hospital for that long he got better antipsychotic medications eliminated the hallucinations eliminated the delusions and he promised he would take his medication I came home where did I find it in the trash and what followed was seven years of my brother and I butting heads me telling him you're ill you need help please get help him saying no I'm not nothing's wrong with me and what did our relationship look like like this him running away from me and running away from all the people who were trying to help him not much of a relationship he was homeless for a while he was picked up by the police a lot never broke laws thankfully during that same time I was being trained as a clinical psychologist and I picked up some gems and probably the the most important tool I picked up was not from a psychiatrist or psychologist it was from Albert Einstein it was the definition of insanity I was doing the same thing over and over and over again for seven years while he was running away from me he was being involuntarily admitted almost 30 hospitalizations while I argued with him Henry you're sick you need help please get help over and over again expecting a different result I called my brother we had a conversation we got together I promised him I would never again tell him he was mentally ill this is after seven years of trying to convince him and I also did some other things I'm going to tell you about that are based in the research my colleagues and I have done our relationship changed dramatically and with that he accepted treatment and in fact in the next 18 years our relationship looked like this this is a picture taken out here that's my brother on the right that's me with the Jerry Seinfeld haircut the way it looked back then now that's not a delusion me thinking that was cool that was just style [Laughter] Henry look at the way he's holding me I actually can't look at this picture myself anymore without getting very emotional but if you can look at the way he's holding me and smiling at me you know sometimes a picture truly is worth a thousand words the love was back the trust and respect were back and importantly he was taking medication reliably for 18 years one hospitalization truly voluntary he checked himself in he called me and said I'm going to the hospital so this is the foundation of a lot of insights of my own it led to a lot of research that our group did at Columbia University and people around the world followed up on it's now in our diagnostic manual for mental disorders I was asked to submit the text on the latest edition of this which came out in 2013 so I'm going to summarize some research in just one minute what do we know we know that unawareness of illness notice we don't use the word denial is typically a symptom of the disorder like a hallucination and it's very much like what we see in neurological disorders if you've ever worked with neurological patients as I have you sometimes see people who are paralyzed and they don't know it that symptom is called Ana cig nausea it's a tongue twister I didn't come up with it it was a French neurologist in 1919 AB insky so if it's Ana signo sia that already starts to suggest we should be talking to people differently about their illness not trying to educate them I wouldn't tell someone to stop hallucinating she's just stopped being delusional stop hallucinating because it's not under their control but that's what I had been doing for many years with not only my brother but many patients this symptom and again this is in our psychiatric manual for mental disorders even though it's still not widely known in our field is the most common predictor of who will not take medication 50 to 75 percent of people with these disorders do not take the medications that reduce those symptoms I've been telling you about the psychotic symptoms it predicts all kinds of problems poorer course of illness involuntary hospitalizations like my brother had and even aggression in violence and of course we know some of the stories that have hit the headlines in some of the cases I've worked on like Theodore Kaczynski who was diagnosed with paranoid schizophrenia never understood he was ill so I'm talking about this but what does it feel like to have an ass Ignazio for this I need a volunteer someone who is married you don't have to be happily married just married could you raise your hand if you're married sir can I ask you to help me right there in the yellow shirt what is your first name Sir Richard Richard I'm actually uncomfortable doing this this is a strange thing I've been asked to do by your family how long you've been married to your to your wife 46 years 46 years what's her first name Eleanor Eleanor and where is she in New York City I've been asked to do an intervention with you you're not actually married to Eleanor I have restraining orders backstage I can I can bring you back here and show them to you Eleanor and her husband and family had been stalked by you for at least 20 years I'm aware of if I showed you those restraining orders would that help you to understand I don't think so you don't think so laughter please would they convince you no okay when you leave here when you go home where will you go to my house to his house is that the house Eleanor lives in when she's here in orient yes yeah well the neighbors see you they call the police and you end up in front of a judge it's called a diversion Court and the judge says Richard I have really almost 10 years of paperwork here on you on your rap sheet I understand you have a mental illness you believe you're married to this woman Eleanor you violated the restraining order again by going to her home now I'm the judge I'm gonna give you a choice Richard you can go to the hospital and we'll adjourn your case of trespassing and by the way let me ask you something Richard when you went to the house and the police showed up and told you you weren't married to Eleanor this was not your house do you think you would resist going with them in all likelihood and all likelihood so I'm the judge again so Richard I have also a of resisting arrest here so I'm giving you a choice you can go to the hospital we've arranged something here close by and get some psychiatric help and in six months we'll review and maybe dismiss these charges or you can go back to jail and we'll have an arraignment on Monday morning you'll spend the weekend in jail what would you like to do what do you think you'll do Hospital hospital wonderful choice so you go to the hospital they relieve you of your clothing they put your personals in a plastic bag then they give you a clothing back they take your vital signs they offer you medication this one here is for the delusions that you have this one here is bring xiety and this one here is for 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 wonderful so then they can write a great report to the judge this patient is adhering to treatment let's fast forward now because they don't let you go back to your home they want to send you to a group home to be with other mentally ill people do you go probably not probably not where do you go instead probably not probably if I don't have a home to go to I probably live in my car ten years five years go by you never see Ellenor again you never see your home again do you think you'd come to understand you are not married to her that you have a mental illness I believe I would in five years really that's all it would take did you propose marriage yes that didn't happen you really think in five years you could come to believe that the memory that you're having right now of that proposal never happened or the wedding do you think you could be really convinced that all of that was just a dream probably not thank you for your help can we thank Richard for helping me real quickly any emotions that you had as we were doing this I know it's a roleplay fleeting emotions just name one resistance resistance how about any anger or fear yes yes okay thank you for again for your help let's thank him again and please call Eleanor when this is over okay that's what it's like this is a fixed firm belief it's it's concrete it's solid it's in Richards bones he knows he's married to Eleanor and that's what it's like for millions of Americans with these serious mental illnesses so when dealing with somebody who has Ana's signo seeif or mental illness not denial of mental illness the doctor knows best or the father or mother knows best or the little brother in my case doesn't work there's no collaboration can I expect Richard to be grateful were you grateful for my advice now perceptive no he learned how to go underground like my brother did and accept treatment for a month and maybe longer just to get his freedom back this is what happens again to millions of Americans with these illnesses adherence refers to medication adherence medication compliance like again 50% of patients he's very unlikely to take medication when I can expect what the research shows us is that we will get somebody who is fearful angry suspicious demoralized lonely and who will not take the medication so how do I deal with them well the approach is believe it or not I told you earlier that this is about relationships we have to create respectful non-judgmental relationships these the research shows result in acceptance of treatment for an illness the person doesn't believe they have so if Richard comes to me five years from now and he tells me his story I would listen to it with respect and without judgment that Ellen LEEP stands for listening reflectively again with respect and without judgment so after he tells me his story I would say so you went to that TEDx talk and they took away your wife your home everything did I understand you correctly which would be very different than what had been hearing which is you know Richard we want you to calm down we've got to keep you away from Eleanor and what we've learned through doing a lot of research is that people with these illnesses feel relief now this is not dishonest I'm not pretending I believe I'm simply reflecting back his experience I would empathize with Richard strategically especially with the emotions around the delusions it must be terrible to have this happen how was it for you well I was resistant were you angry yes I was angry you know what Richard I'd be angry too we work on those things we could agree on it's never going to be that Richard is not married to Eleanor that's a delusion we've known that for 60 years we don't try to talk people out of their delusions well we also don't try to talk people out of their ana signo Xia there unawareness of mental illness we partner on what we can work on together there's three other tools we use but again the focus is respectful non-judgmental communication so with my brother so mom's the devil in her eyes or laser beams is that what you're saying yes well no wonder you're so terrified of her I would be too Henry if this happened to me those are 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 delay we call it the three A's I apologize for my opinion I acknowledge my phal ability agree to disagree what does that sound like Richard I'll answer the question if you want me to but I want to apologize I might upset you and I could be wrong I hope you don't have to argue when we give our opinion we're using those three tools and then we're not afraid to apologize for things like previous confrontations like I did with my brother apologize for things like an involuntary hospitalization that we were a part of sometimes people will say why are you repeating everything I say the research shows is you can apologize for that I'm sorry I'm repeating everything I just want to understand you I wasn't listening before I kept telling you you were ill I'd like to listen so it's a very different approach it's not the medical model approach it's the motivational interviewing approach it's a whole other field of study and I'll end with some closure on the story of my brother I lost sight of who my brother was in those seven years that we fought he was a mature kind selfless person he died being Henry he was safely on a city bus heard a woman behind him struggling with groceries he got off the bus got on a sidewalk and was handing her groceries when someone who had lost control of their car ran him down he saved that woman's life it was an act of kindness that he was engaged in when his life ended he had a very good life for those 18 years he had a girlfriend he had work and he had his relationships back as that picture I showed you I think demonstrates best so how we approach people who have these illnesses who say I'm not sick is vitally important and the relationships we build are the key thank you [Applause]

Channel: TEDx Talks

Views: 221,552

Rating: 4.8865471 out of 5

Keywords: TEDxTalks, English, Health, Behavior, Mental health, Psychology

Id: NXxytf6kfPM

Length: 18min 2sec (1082 seconds)

Published: Thu Oct 19 2017

Reddit Comments

[u/[deleted]]

This would be wonderful if used by psychiatrists and staff, but from a family's point of view, what point do you approach medication or getting help in this approach, and how?... And what happens when they do become a danger to themselves and others, do you involuntary commit - how does that fit within this model?

Great video though, explained psychosis/delusions so well.

[u/becksfakk]

I wish I would have known this 8 months ago, when I was dealing with my BP SO. I resisted saying "I think there's something wrong, you're having delusions" for months... but as things were falling apart, this would have been immensely helpful for me.

[u/isabela1031]

Can someone send or post the link please. It keeps starting and stopping and with the link I can at least go to YouTube and find it

[u/PurpleGanon]

Thanks for sharing this. He makes a lot of good points. I'm still confused on how to get them to accept treatment though. Like, being understanding and non-judgmental is all well and good, I don't get how you go from that to getting them help. Anyone?

[u/[deleted]]

That was great to watch - thankyou so much for sharing