"1) Schizophrenics tend to be ambivalent about medication--because for most, albeit not all, their illness feels like a part of them, of their identity. Give them another reason to vacillate, and some will choose to discontinue, or may not comply with the prescription (a probably inaccurate cognition: 'if I take less, I'll have less chance of getting a brain tumor').
2) Frontal lobe dysfunction is seen in schizophrenia, one cannot assume that they will objectively weigh risks and benefits, or the rarity of the event. I have had this conversation with schizophrenic patients:
'I'm afraid of getting tardive dyskinesia'....
(A) but that's very rare with this class of antipsychotics, unlike the older drugs....
'But what if I'm the one who gets it?'
When one has a worldview which is to some degree egocentric..."
I interviewed the head of the Harvard Brain Bank, who has specialized in schizophrenia, and she said they all, down to the last one, said they felt they had NO real self. Not that the illness felt like part of self. There was a gaping hole at the center I guess.
Drugs could give them a sense of self.
Secondly, a more compassionate view is not that they are egocentric in fearing t.d., but that they are already ill--already 'singled out' for a malady, so why, having to live with that, shouldn't they reasonably fear that they indeed will get the side effects? Life probably already feels like it stacked the cards so it might do so again. That's actually a reasonable assumption in the circumstances.
Just a thot. |
