Xavier Amador

About twenty-five years ago I learned first hand how my natural instinct to confront denial head-on led to disaster. My brother had just come home after his first psychiatric hospitalization for a serious mental illness. The medicine he had been given brought him back to reality, but within a day of his getting home, I found the medicine in the garbage can. Naturally, I asked him why he’d thrown it out

“I’m okay now. I don’t need it anymore,” he explained.
Since this ran counter to everything he was told in the hospital, I made a point of reminding him. “But the doctor said you’re probably going to have to take this medicine for a rest of your life. You can’t stop taking it!”
“He didn’t say that.”
“Sure he did! I was at the family meeting, remember?” I countered.
“No. He said I had to take it while I was in the hospital.”
“Then why did he give you a supply of medicine to take home?” I argued, trying to prove him wrong.
“That was just in case I got sick again. I’m fine now.”
“No. That’s not what he said.”
“Yes, it is.”
“Why are you being so stubborn? You know I’m right!” I said.
“It’s my business. Leave me alone.”
“When you got sick it became everyone’s business. And besides, I’m worried”
“You don’t have to worry about me. I’m fine.”
“You’re fine now, but you won’t be if you don’t stay on the medicine.”
“That’s not what the doctor said!”
“Then let’s call him and I’ll prove it!”
“I don’t want to talk about it! Just leave me alone,” he said as he walked away.

With every dose of “reality” I tried to give him, Henry countered with more denials. And with every go-round we both became angrier and angrier.

I thought he was being stubborn and immature. My accusations and threats to prove him wrong made him angry and defensive. My natural instinct to confront his denial was completely ineffective and made things worse. We got caught in a cycle of more confrontation and denials (what I call the denial dance), which pushed us farther apart. The end result was always that he walked away. And within two months he relapsed and ended up back in the hospital

In 1989, when I first started doing research on the problem of poor insight into having a mental illness there were fewer than ten studies in the research literature. When the first edition of this book was published, there were more than one hundred. Today, there are more than two hundred! There has literally been an explosion of new research on the problem of poor insight into mental illness, and we have learned a great deal.

It has been six years since the first edition of I am Not Sick, I Don’t Need Help! was written, and the fast pace of research continues. The new edition includes an update on that research but also, as importantly, an account of the important lessons I have learned over these past six years. In that time I have given several hundred talks and workshops on the problem of denial and the solutions offered in this book (i.e., LEAP). I have learned a lot about what works and what doesn’t. My experience with thousands of patients, families and therapists over the past six years, and the new research, are the reasons I felt a new edition was needed. Indeed, many workshop participants, who had read the book, have complained that a new edition was long overdue. I am excited about this update and feel it is a much better and more immediately useful book. I hope that you will feel the same.