The simple answer to this complex question is that you do not confront an individual with schizophrenia. Nothing good or productive can come from such a confrontation.
With at least half of the people who suffer with schizophrenia, they actually do not know they are ill. They are not denying they are ill to be difficult or cause problems in the family. There have been over 100 scientific studies that show that at least half of people with schizophrenia do not know they are ill. Scientists think that these 50 percent of individuals with schizophrenia who do not know they are ill suffer with anosignosia (lack of insight), a brain defect related to the frontal lobes that makes it impossible for them to recognize their illness. While it can be frustrating to deal with an individual who lacks insight into their illness, know that his is not something that is done deliberately by the individual with schizophrenia. Lack of insight into their illness is thought to be a symptom of the disorder, like delusions are symptoms, or paranoia. Also, their denial is NOT analogous those suffering from addiction, in which it is thought that those suffering with addictions are in denial of that addiction.
To be perfectly honest, you will be wasting your time and energy putting together strategies to prove there is nothing crawling all over your house. No amount of evidence you could compile would be enough to prove that you are right and he is wrong. I also believe that you will also be wasting your time if you try to convince him that medications will be of help to him and that they will help him lead the life he wants to live. Using logic to help an individual who is psychotic, and by definition, not able to be logical, and who is unable to recognize their illness, is a tactic that will be unsuccessful in this situation. The best strategy you can employ is to find some way to leverage him into taking his medications and not focus on getting him to admit or recognize that he is ill. Let me explain further.
I worked with a family who had a mother who suffered from schizophrenia and could not recognize her illness, just like your brother-in-law. For years, she would go in and out of hospitals simply because no one could convince her that she was ill and that medications could help her. The family, because they did not know any better, let her decide if she wanted to the take the medications. Of course, she never did. This went on for years-getting ill, being hospitalized, being released and her not taking her medications. To be fair, they tried over the years all sorts of tactics to try and get her to take her medications. They pled with her, they begged, and even on desperate occasions, tried to put the medication in her food. They spent many years trying to make the logical connection for her between her many hospitalizations and her medication noncompliance. It seemed obvious to them that when she did not take medications, she would be right back in the hospital, the place she feared and despised the most. Unfortunately, none of their efforts worked and the mother could never seem to understand that she was ill and that when she stopped taking her medication, this led to her subsequent hospitalization. Overtime, they grew exhausted at trying to get her to see the connection. Her refusal to admit she was sick, as they saw it at the time, frustrated the family tremendously and they would often become angry at her for not seeing that the medications could be helpful.
What the family did not realize until many years later is that she was not able to recognize that she had schizophrenia. It was not done deliberately by her, but it was part of the disease. Once they realized this fact, they were able to take a different approach to trying to keep her well. Until then, they had essentially blamed her for her many hospitalizations.
Finally, one day the family took a stand with her. On her 23rd time coming out of hospital, they told her that they would be in charge of her medication and that they would ensure that she took it every night. They informed her that she could only come back to live with them if she agreed to follow their plan (i.e. they controlled the medications and she took them every night) or she would have to go live in a group home. At harsh at this threat sounds, and as guilty as they felt in giving her this ultimatum, they had to do it. It was the only way they could get her to take the medication. The family assigned each other specific days. On each person’s specific day, he or she would take responsibility for ensuring that the medications were consumed. The family did mouth checks and they were even able to get medications from the psychiatrist that dissolved in the mouth within five seconds so there could be no “cheeking” the drugs. At first, she resisted the new plan. After a few weeks of her resistance, the mother finally was okay with the situation. Her resistance wore down and it no longer was an issue.
It has been over two years since this family plan was enacted. Prior to this plan, the mother relapsed with seemingly never-ending frequency. To this day, the mother still does not acknowledge that she has schizophrenia but to the family, this hardly matters. The only thing that matters is that she takes the medication and no longer relapses.
Let me point out that the only way this plan has worked was because each member of the family was committed to making it work. This meant for some of them, they had to drive out of their way to make it over to the mother to give her medication. Sometimes they had to cancel plans because their plans conflicted with the time the medications needed to be given. They made sacrifices. But these scarifies were necessary and frankly, the only reason their plan worked so brilliantly.
I tell you this to illustrate some key points. First, confronting the person with schizophrenia will never work. There is truly no amount of evidence or proof that you could produce that would help convince a psychotic individual that you are correct and that they are wrong. This is a waste of your time or energy. Second, persons with schizophrenia who deny they are ill are not doing it on purpose. Realizing this may help ease the frustration that comes along with many of these issues. Third, if you truly want to help your brother-in-law take his medications that he believes he does not need then you and the family will have to come up with a similar plan that was mentioned above. This usually means a serious commitment and sacrifice on the part of the family. I am not saying the plan I wrote above will work for everyone in every situation. But I believe that a variation of this plan can work and I say this after working with family who truly turned what appeared to be a hopeless situation into a plan that likely saved the mother from years of psychotic episodes and hospitalizations.
I hope this helps shed light on this very complex situation. If you have any questions or need clarification about something I wrote, please write again.
This article has been updated from the original version, which was originally published here on Apr 30, 2007.