Undoubtedly, you are faced with a difficult situation. There are no easy answers. Schizophrenia is a lifelong illness. Many people with schizophrenia stop taking their medications when they feel better. They figure, as your sister did, “why is medicine needed when I feel quite fine?” Discontinuation of medication is one of the most common problems among people with schizophrenia.
Another difficult aspect of schizophrenia is a lack of insight, also known as anosognosia. About 50 percent of people with schizophrenia don’t think they are ill and subsequently refuse to participate in treatment. Studies consistently show that people who recognize their illness and are willing to participate in treatment have better outcomes than individuals who don’t recognize that they’re ill and are unwilling to participate in treatment.
The best way to prevent ongoing psychotic episodes is to consistently take medication. It’s the most effective proactive method for the prevention of psychosis. Currently, your sister is taking medicine and it will in all likelihood keep her stable; however, she is unaware of the fact that she is being medicated. At some point, she may realize what is happening and stop taking her medication.
Specifically, in your case, I would recommend reading the book I Am Not Sick I Don’t Need Help by Xavier Amador. This book is highly recommended for family members who struggle to convince their loved one to participate in treatment when they don’t think they have an illness. It explains the concept of anosognosia and offers helpful advice and strategies that may assist you in convincing your sister to voluntarily participate in treatment.
I’m not familiar with the mental health laws and services in your country. I would urge you to speak to your sister’s treatment team about your options. They may have good ideas.
In many ways, I consider schizophrenia a family disorder because it tremendously affects all members of the family. Typically, family members serve as primary caregivers for their loved ones with schizophrenia. It can be quite a challenge to convince someone to participate in treatment when their brain tricks them into believing that they are better off without it.
Learn all you can about schizophrenia, meet with her treatment team and do everything in your power to help her but recognize that there is a limit as to how much you can help her. It may ultimately be in her best interest to live in a rehabilitation center, at least for a period of time, where mental health professionals can care for her around the clock. The rehabilitation center can keep her safe. She will have direct and immediate access to mental health treatments. It may be her best option. Please take care.
Dr. Kristina Randle