Book review: Lay My Burden Down

REVIEW: '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

Reviewed by Jim Reiser

Immediately after reading this short but important book, I knew that I should recommend it specifically to family members who, like myself, have loved ones who have refused treatment for many years because they deny that they are ill. Only by reading this book would family members not suffer further anguish, but would understand that the lack of insight in their loved ones was merely another symptom of their illness, and not open to reasoning or discussion.

Just as we must avoid direct reference to the unreality of their delusions, we must also avoid confronting them with their obvious lack of insight. Only those of us who have had many years of failure, I assumed, could understand that Dr. Amador's thesis of the neural-biological basis for lack of insight was true.

But after more sober reflection it became obvious that this book should be read by all family members and professionals who are involved with the severely mentally ill who lack insight and refuse treatment. This practical guide will provide immediate consolation and help to countless families, regardless of how long their loved one has been sick.

Dr. Amador, Director of Psychology at the New York State Psychiatric Institute and a Professor of Psychology in the Department of Psychiatry at Columbia University College of Physicians and Surgeons, has a brother who suffers from schizophrenia. He speaks as one of us, but as one with substantial scientific training.

Dr. Amador demonstrates that this insight deficit is not related to personality type (e.g. stubbornness), nor to illness strength, but functions independently as another symptom or trait. As with hearing voices or having delusions, some individuals have this symptom while others do not.Replicated research indicates that this lack of insight is present in about 50% of all people with schizophrenia and manic-depression, yet it is perhaps the most difficult symptom to deal with.

Dr. Amador has provided a useful strategy in showing how to work in partnership with our loved ones in gaining their agreement to go ahead with treatment. His is a most humane and caring approach. If you are a family member or caregiver, this book could change your outlook and approach entirely. I Am Not Sick, I DonÕt Need Help was written with Anna-Lisa Johanson, a student at Georgetown University Law School, who works part-time for the Treatment Advocacy Center. She is the daughter of Margaret Mary Ray, the woman most people know as "David LettermanÕs stalker." Her mother, diagnosed with schizophrenia and schizoaffective disorder, took her own life in the fall of 1998.

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