I am Not Sick I Don't Need Help! - Xavier Amador, PhD

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I am Not Sick I Don't Need Help!
By Xavier Amador, PhD




Book Description

Xavier Amador's [book] gives practical advice and hope to those of us with a loved one who is battling a mental illness. It provides readers with a blueprint to affect change.  Amador has translating his research on insight into mental illness into a easily readable and practical book. Family members and therapists who read this will find their frustration with a family member o be replaced with empathy and compassion, qualities that will enable them to begin laying the groundwork for a cooperative relationship with their loved one.  Step-by-step methods for developing that relationship are clearly laid out, making this a helpful and hopeful book for those who live with a mentally ill person.


About the Author

Xavier Amador, PhD.,  is an adjunct professor in Clinical Psychology at Teacher’s College, Columbia University in New York City and is on the Board of Directors of the National Alliance for the Mentally Ill (NAMI). He is a clinical psychologist who treats adults, children, and adolescents in individual, couples and family therapy.  Previously, he was a professor in the Department of Psychiatry at Columbia University, College of Physicians & Surgeons; Director of Research at NAMI; and the Director of Psychology at the New York State Psychiatric Institute.

Amador's expert opinon is frequently sought by the news media. He has worked as an “NBC News Consultant” and “Today Show Contributor” and has also appeared regularly on numerous other programs: e.g., NBC's Today Show, Good Morning America, CBS This Morning, NBC Nightly News, CBS 60 Minutes, ABC Prime Time Live, CNN, NBC Dateline, Fox News Channel, Court TV, A&E Network, Discovery Channel, BBC, and PBS. He has been interviewed by the New York Times, USA Today, Reader’s Digest, the New Yorker.

He has published 100 peer-reviewed scientific papers, and five books; including: ‘I am Not Sick, I Don’t Need Help!’; When Someone You Love is Depressed: How to Help Without Losing Yourself; and Insight and Psychosis. His books and other publications have been translated into 18 languages.


# Paperback: 240 pages
# Publisher: Vida Publishers (June 2000)
# Language: English
# ISBN-10: 0967718902
# ISBN-13: 978-0967718903
~$18 US





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[JoannaK]

Has anybody read this book?

[Auspicious]

Yes; I found it very good.

It goes a lot into what can motivate somebody to seek help, and what won't work.  The big theme seems to be listening and validation of feelings, so we can understand and focus on what is distressing to the person in question, not to us, so we might be able to gently help them decide to seek help for what they perceive the problems to be.

One example I remember from the book is (I think; going by memory here) was a woman who refused to really face her mental illness, but thought that her problem was that she couldn't keep a job.  By working with that motivation, she was persuaded to stay in treatment.  Another was a person who refused to believe that he was mentally ill, but was sick of people always putting him (unjustly, in his mind) in the hospital. He was finally able to see that staying on his medications could help him stay out of the hospital.

Great book - deals with how hard it is for us to set aside our reasons for wanting the person to get help and to really listen and empathize with the sick person's problems.

[Skip]

I think it is a must read for anyone trying to help someone with BPD traits...

One of the points I got out of it:

People seek help for problems that they perceive - not the problems we perceive.  They seek solutions that make them feel better - not to make us feel better.

Meaningful therapy as a goal (not a given)... and it is totally dependent on the person with the illness.  We can help motivate them, but that is a process.

Its not a great analogy, but think of someone who is overweight - can't you change that?  Dieting is tough and it takes willpower and inner strength.  Altering your mind / mental health is much harder.

What can we do?

Anything we say should be how "help" would address a problem the person sees and is concerned about - not the problems you see and are concerned about.   And the outcome should be described in terms of how they will feel better - not us.

If you are very credible, very trustworthy, and they believe you have their interests first - they might listen and start therapy.  If they slip, you might be able to help them up and start again.  If your not that credible - teach someone that is.

It is very tricky - you can support, but you don't want to assume responsibility for their recovery - they have to have the heart to do it.

Skippy

[jason519]

Randi, Xavier, ANybody

Are there any strategies to convince someone who is diagnosed, and admits at times, that she has BPD, to commit to long term therapy starting with in-patient treatment?

Michael

[doubleAries]

This books focus is schizophrenia, which was a big help for me as my husband is schizophrenic, and through him and a support group he attended some time ago, I seem to be surrounded by schizophrenics! But I can see trying to use these same applications with other forms of mental illness. In this case, the issue--which applies more often in strokes, Alzheimers, Bi-polar, and schizophrenia--is anasognosia. A brain issue which causes the effected person to lose insight into their own condition. While BPD's also "deny" they have a problem, it just doesn't seem like anasognosia to me. My T also doesn't think anasognosia is the issue with BPD. However, I suppose its worth a try to attempt the same approach with BPD's...

Michael999, the commitment to therapy and in-patient treatment must be made by the person with the mental illness. I suppose you could try the method outlined in this book... Ask her what SHE thinks the problem is instead of TELLING her what the problem is. Maybe, down the line, point out (after the inevitable response that everyone else is the problem) that even though she doesn't need therapy (wink) it does help keep those other people off her back. And that's a plus, right?

[Auspicious]

This books focus is schizophrenia, which was a big help for me as my husband is schizophrenic, and through him and a support group he attended some time ago, I seem to be surrounded by schizophrenics! But I can see trying to use these same applications with other forms of mental illness. In this case, the issue--which applies more often in strokes, Alzheimers, Bi-polar, and schizophrenia--is anasognosia. A brain issue which causes the effected person to lose insight into their own condition. While BPD's also "deny" they have a problem, it just doesn't seem like anasognosia to me. My T also doesn't think anasognosia is the issue with BPD. However, I suppose its worth a try to attempt the same approach with BPD's...

It helped me a LOT with emotional validation. I mean, if you can emotionally validate someone who thinks that the neighbors are communicating (by flushing their toilets in certain patterns) their secret plans to kill you, then emotionally validating in the face of mere BPD distortions should be a breeze, right? 


Schizophrenia is the main mental illness in the book (Amador's brother is schizophrenic, and it is a focus of his) but the main concepts of the book are how to cope with a mentally ill loved one.

[Auspicious]

Randi, Xavier, ANybody

Are there any strategies to convince someone who is diagnosed, and admits at times, that she has BPD, to commit to long term therapy starting with in-patient treatment?

Michael

I would just read the book, really. It's very hard to summarize it.

You may be able to get it at your library, or via inter-library loan, if you can't afford to buy it.

[doubleAries]

used copies are available very reasonably online as well.

One of the really big  moments for me in the book was the concept of thinking about the persons emotional reaction to their delusion. Instead of pounding them over and over that they are delusional (as my husband pointed out "it wouldn't be a delusion if you didn't believe it")

No, of course I don't believe the neighbor was up to some complicated plot when he flushed the toilet (wouldn't be a delusion if you didn't believe it--it would be an unwanted thought), but how would I feel if I DID believe that and it was happening to me? I'd feel pretty much exactly how they feel.

Same with BPD. If I actually believed everyone was looking for ways to use and abandon me (big time), I guess I'd be pretty angry.

It's not the emotional reaction that's out of whack. It's the thought/belief basis behind it.

I'm glad this book was reviewed here--I was going to suggest it, but was hesitant because it is so schizophrenia oriented. My T had me read it, and it didn't just change how I interacted with the schizophrenic people I know, it changed how I empathise, period.

[mamachelle]

I think it is a must read for anyone trying to help someone with BPD traits...  

One of the points I got out of it:

People seek help for problems that they perceive - not the problems we perceive.  They seek solutions that make them feel better - not to make us feel better.

Meaningful therapy as a goal (not a given)...   and it is totally dependent on the person with the illness.  We can help motivate them, but that is a process.

I just wanted to say I have this book downloaded and have been reading it on and off since last year when it looked like my SS15 might be pre-schizophrenic. I am happy to find it here, though it's rarely referenced.

It really is a great read and has informed and changed the way I talk with people and especially about people who are mentally ill and can not recognize it.

It also offers an excellent way of dealing with psychotic behavior and delusions that pwBPD and others sometimes manifest.

Just wanted to put in a good word as it is definitely worth reading for many here. 

[traddad]

One of the questions I wanted to ask was, in your experience, how do you find these sort of 'handling' strategies affect your feelings towards the person in question?

I'm certainly no expert on this sort of thing, but I've tried different strategies at different times with my wife, and naturally, some methods have worked better than others in calming things down.

However, these sort of methods have also had an effect on me, in that the relationship starts to feel more like a carer/cared relationship to me, than one of equals.

I guess I'm saying that to me a marriage should be somewhere where you can be yourself, where your partner appreciates you just for being you, and vice versa.   If you need to adopt special strategies with the other person to make it work, then to me it somehow feels less authentic. More like you're playing a character in a drama, or something.

I suppose in the end it depends on how much handling you need to do to make living conditions between the two of you acceptable.  But the more handling is necessary, the more attractive it must seem to leave the relationship, and potentially find someone that needs a lot less handling, surely?

[mamachelle]

Hi traddad,

I just suggested a couple books for you over on parenting which I think are better ones for you to start out with   ... So this is a great book for strategies for dealing with anagosia and schizophrenia and psychosis and people that are not following treatment plans. It's a great book but the title alone doesn't sum up all the parts inside.

I think where you are at in your relationship with your wife is in flux and its going to take some time to determine what level of care you are willing to provide.

It's a process.

This is a great book if you want to read it.. I just would wait on it given all the other things going on with your life right now...

[Auspicious]

I guess I'm saying that to me a marriage should be somewhere where you can be yourself, where your partner appreciates you just for being you, and vice versa.   If you need to adopt special strategies with the other person to make it work, then to me it somehow feels less authentic. More like you're playing a character in a drama, or something.

Well ... maybe

I think that we all develop strategies for dealing with various people in our lives ... whether we consciously realize that we are doing so or not. "Don't talk to him before he has his coffee". "She's very sensitive about her height."

In other words, I don't know that there is anybody in my life where I can really just let it all hang out, 100%, without ever having to think about or make choices in my communication.

[traddad]

I guess I'm saying that to me a marriage should be somewhere where you can be yourself, where your partner appreciates you just for being you, and vice versa.   If you need to adopt special strategies with the other person to make it work, then to me it somehow feels less authentic. More like you're playing a character in a drama, or something.

Well ... maybe

I think that we all develop strategies for dealing with various people in our lives ... whether we consciously realize that we are doing so or not. "Don't talk to him before he has his coffee". "She's very sensitive about her height."

In other words, I don't know that there is anybody in my life where I can really just let it all hang out, 100%, without ever having to think about or make choices in my communication.

Hi Auspicious.  Yeah, I was probably a little simplistic in my earlier statement.


I guess what I wanted to say was there feels to me to be some sort of  correlation between how much 'processing' I need to do when I communicate with someone else, and how close emotionally I feel to them.  If I have to do an awful lot of work, 'self-editing' you might call it, in every interaction with someone, to fit in with some sort of behavioural pattern that is necessary to make the relationship between us work, then I find it's harder to feel emotionally close to the other person.

Obviously most people have some sort of processed response to questions like 'Does my bum look big in this?', but for example, if you're having to be careful about how you phrase a question like 'Would you like an ice-cream?', then for me it's harder to feel this constitutes a 'natural' relationship.

In the context of BPD, if I could find some magic self-editing methodology that would render every statement I made innocuous to the BPD person, and thereby avoid a lot of the tension in the relationship, it would certainly improve the quality of the relationship, but if the amount of 'self-editing' was very large, I would find it much harder to regard this as an intimate relationship, and it would seem much more as I imagine a carer/cared relationship.

I suppose it comes into what you mean by a cure, if you talk about 'curing' BPD.  If it were possible to 'cure' BPD by modifying the behaviour of everyone around the BPD individual, causing them all to have to do a lot of work on their behaviour, is that really a cure, or is it a management strategy?  Wouldn't the definition of a cure be that the BPD individual can cope better on their own, without needing the people around them to behave in a special way?  I guess it is possible that one can lead to the other, but that's what I'm not clear on. What if it doesn't result in the BPD individual learning to cope on their own, and the people around them are left with having to treat them in this artificial way in order to maintain the stability.

[Auspicious]

I guess what I wanted to say was there feels to me to be some sort of  correlation between how much 'processing' I need to do when I communicate with someone else, and how close emotionally I feel to them.  If I have to do an awful lot of work, 'self-editing' you might call it, in every interaction with someone, to fit in with some sort of behavioural pattern that is necessary to make the relationship between us work, then I find it's harder to feel emotionally close to the other person.

Obviously most people have some sort of processed response to questions like 'Does my bum look big in this?', but for example, if you're having to be careful about how you phrase a question like 'Would you like an ice-cream?', then for me it's harder to feel this constitutes a 'natural' relationship.

Totally get where you are coming from.

In the context of this discussion, I would suggest: read the book. Let it sink in. Take some time, trying some of the things suggested. By the way, personally I found that shifting my thinking and perspective was way more important than any individual technique (though those were helpful as well).

I think giving it time is important - as well as some humility, accepting that there is much to learn, and positive changes to be made. Emotional validation is difficult to "get" at first - it sounds so simple, but it's easy to get it "wrong." You might think that you "have to" do things that you don't actually have to do. You may be picturing something different from what actually happens in practice, when it goes well.

It's kind of like just reading about all that goes into a golf club swing - you'd be thinking "I have to think about all that every time I swing the club?" But it's not like that, when you actually get some experience.

[traddad]

It's kind of like just reading about all that goes into a golf club swing - you'd be thinking "I have to think about all that every time I swing the club?" But it's not like that, when you actually get some experience.

That's a really nice analogy. I'm not really sure why that's true in golf (and other sports). I've heard people talk about 'muscle memory' and things like that, but I don't know what that really means.  I doubt it's much to do with muscles per se. I think it's probably something seems to happen in the brain that internalises what you need to do, and stores it, somehow like a computer 'macro', so it requires less processing effort each time. And then it all seems easy.  So it's a really interesting observation if it works like that with these 'managing' behaviours.


I can see that if you manage to become slick with the technique, like a golf pro, it can make your experience with the other person much more streamlined.  But are the benefits confined to just the relationship between you and the other person, or do all relationships with other person benefit? Given that others haven't practiced like you have with the validation techniques?

[Auspicious]

But are the benefits confined to just the relationship between you and the other person, or do all relationships with other person benefit? Given that others haven't practiced like you have with the validation techniques?

Hmm ... not quite sure I understand the question.

Nothing that we do is intended to cure or even change the other person. It's to help us and the relationship.

(That said, it can't hurt the other person to be having a better relationship with their significant other, ya know?)

[traddad]

But are the benefits confined to just the relationship between you and the other person, or do all relationships with other person benefit? Given that others haven't practiced like you have with the validation techniques?

Hmm ... not quite sure I understand the question.

Nothing that we do is intended to cure or even change the other person. It's to help us and the relationship.

(That said, it can't hurt the other person to be having a better relationship with their significant other, ya know?)

Sorry, I'll try and be clearer.

There are two people A, and B.  A and B have a partnership together, that isn't working very well.   A and B both agree that the partnership isn't working well. They just don't agree on what is causing the partnership not to work well.

A thinks that B is unwell, and that this is causing the relationship not to work well. B thinks that A is unwell, and that this is actually what is causing the relationship to fail.

Based on their own view of things, and a lack of improvement over time, A decides to change their strategy of dealing with B.  They unilaterally adopt a new set of techniques for dealing with B.  These techniques improve the relationship significantly.

B notices that A has changed their behaviour. B concludes that A has seen the error of their ways, has changed their beliefs, has come around to B's way of thinking, or has simply just got better from their illness, which is why there is much less conflict.  A thinks that the new strategy has worked, and their new way of dealing with things means they are coping much better with B's anomalous behaviour, even though they still think B is unwell.

How do we decide whether A, B (or both) are unwell? Whether A or B's worldview is more accurate? Isn't the only way to determine this by looking at relationships with C, D, E etc.?  If A gets on well with C D & E, and B also has troubled relationships with C, D, & E, isn't it more likely (although not conclusive) that B is unwell, and that A has just found a good way of coping with it?  You could teach the coping mechanism to  C, D & E as well, and it would probably improve their relationship with B too.  However, if you could teach B some sort of mechanism to cope with A, C, D, & E, then this would potentially be a lot less effort, because it involved teaching 1 person, instead of 4 (or in real life, potentially many more).

So what I was asking was, would A adopting this technique to help the relationship with B have any knock-on benefits for C, D, & E, or would B think ' I've sorted A out now, only C, D & E left to go....'.

[Auspicious]

I see what you are asking, but the answer is (I think ) "we can't know".

And more to the point - our motivation should not be to change the other person, fix them, get them to see things our way. Because if that is our motivation, we are very, very, very likely to fail.

The farthest I would go is that maybe, if our relationship gets better, the other person might become more interested in our opinion or ideas. Might. Eventually. But they might not.

[traddad]

And more to the point - our motivation should not be to change the other person, fix them, get them to see things our way. Because if that is our motivation, we are very, very, very likely to fail.

Hi again Auspicious. Thanks again for the response. I don't have any decent answers to these questions myself, but I'm interested in understanding the questions better.

I still find it difficult to understand how this principle applies, for example, to people being sectioned under the mental health act (in the UK) and being treated for a serious mental illness, sometimes against their will.  Isn't that exactly a case of A, C, D & E deciding that B is ill, and trying to fix them?