Wednesday, December 9, 2009

Should the mentally ill be allowed to refuse to take their medicine?

It's really the same question all over again, explained very well in an editorial in the Boston Globe back in 2002, as follows: “Research shows that almost half of those with schizophrenia have an impaired awareness of their illness. This impairment, called anosognosia by neurologists, is caused by damage to areas of the brain that mediate self-awareness. The impaired awareness is thus biological in origin, similar to that seen in Alzheimers's disease, and may vary in degree from individual to individual and even in the same individual over time. It is not the same as denial, a psychological mechanism that we all use at times. This lack of awareness may explain why a number of the mentally ill are inconsistent in taking their medications, antipsychotic drugs that can help stabilize moods or eliminate delusions.

Dr. E. Fuller Torrey is one of the authors who supply us with the evidence about anosognosia.“Impaired awareness of illness is a major problem because it is the single largest reason why individuals with schizophrenia and bipolar disorder do not take their medications," trumpets a page from the Treatment Advocacy Center in Virginia, where Dr. Torrey is the principal writer. "It is caused by damage to specific parts of the brain, especially the right hemisphere.”

Evidently that's the part that mediates self awareness. But do you mean that people with schizophrenia aren't self aware? The same people get around town every day, get up in the morning, take breakfast, go off to work or program, meet counselors, take pills, talk to friends, enjoy a read in the library? Do they do it all in a trance?

Now for the failure to take medicine. That's mainly because they hate what it does to their mind and body. It stretches them out, knocks them out, makes them listless and foggy minded. They lose any energy, any appetite, any sex drive. And they still have the hallucinations and delusions that are hallmarks of the disease. In Fuller Torrey's “Surviving Schizophrenia” he describes the knockout punch of schizophrenia: “Those of us who have not had this disease should ask ourselves, for example how we would feel if our brain began playing tricks on us, if unseen voices shouted at us, if we lost the capacity to feel emotions, and if we lost the ability to reason logically.This would certainly be burden enough for any human being to have to bear, but what if in addition to this, those closest to us began to avoid us or ignore us,to pretend that they didn't hear our comments, to pretend that they didn't notice what we did? How would we feel if those we most cared about were embarrassed by our behavior each day?”

So there are a lot of reasons, to my mind, for the person who realizes he or she is not thinking clearly or feeling right to act contrary or belligerent. And several reasons why they'll defy others, like parents and doctors, to take medicine when it's urged on them. Sometimes we've found it takes a friend or trusted medical professional to step in and make the visit with them to the clinic or doctor's office. It's always worth trying to get them there, whether it's their lack of self-awareness or just contrariness that keeps them aloof, arbitrary and unwilling to go along with what we want.(Roy Neville)

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