When Your Child Doesn't Believe They're Ill: Understanding Anosognosia and Mental Illness, with Dr. Xavier Amador

ABOUT THE EPISODE:

When your child doesn't believe they need help, finding a path forward can feel nearly impossible and is exhausting in every way. Dr. Xavier Amador offers profound hope through his LEAP method—a neuroscience-backed approach born from both his clinical expertise and the raw reality of loving family members with schizophrenia.

Dr. Amador's journey began with seven transformative days at his brother's side, where traditional confrontation failed spectacularly. His brother, brilliant yet trapped by anosognosia (the neurological inability to perceive one's own illness), couldn't recognize what everyone else could see. It wasn’t denial or stubbornness, but definitely looked like it. What Dr. Amador’s brother was suffering from is brain-based, affecting 50% of people with schizophrenia and 40% with bipolar disorder.

The beauty of LEAP (Listen, Empathize, Agree, Partner) lies in its counterintuitive wisdom: stop trying to convince someone they're ill. Instead, build a relationship where trust flourishes despite fundamental disagreements about reality. Dr. Amador's approach honors the cognitive friction between what you see and what your child experiences, while creating emotional proximity that transcends the diagnosis.

What you'll discover in this conversation: 

• Why arguing about symptoms backfires—and the neurological reasons behind anosognosia 
• How to implement LEAP strategies that preserve relationships when insight seems impossible (you’ll want to copy the actual words Dr. Amador provides!)
• Dr. Amador's personal breakthrough with his brother that changed everything
• Medications available for psychiatric disorders including injectables and ones suitable for adolescents
• Why accepting their reality (without agreeing) opens doors that confrontation slams shut

Even if your loved one never gains recognition of their mental illness, you can still cultivate connection, influence positive choices, and maintain your own emotional equilibrium. 

EPISODE RESOURCES:

• Dr. Amador’s website
• Videos for parents

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Chapters

• 0:00 Welcome to Hopestream Podcast
• 0:37 Introduction to Anosognosia and Treatment Refusal
• 1:37 Why This Episode Matters - Mental Illness and Substance Use
• 2:08 Dr. Amador's Professional Background and Credentials
• 5:21 Dr. Amador's Personal Story - Brother Henry's Schizophrenia
• 9:07 The Cycle of Treatment Non-Compliance
• 12:38 Understanding Anosognosia - When the Brain Can't See Illness
• 16:48 How Anosognosia Differs from Psychological Denial
• 20:24 The Science Behind Anosognosia - Brain Dysfunction Explained
• 24:31 The LEAP Approach - Listen, Empathize, Agree, Partner
• 29:24 Real-World Application of LEAP with Examples
• 33:50 Common Mistakes Parents Make and How to Avoid Them
• 37:43 Treatment Outlook and Recovery Statistics
• 41:00 The Role of Therapy Alongside Medication
• 42:27 Closing Thoughts and New AI Tool Launch
• 43:24 Episode Wrap-Up and Resources for Parents

Transcript

Dr. Amador: To the families and clinicians I work with and police officers say, well, this person just re refuses to admit. And I'm like, no, it's not that they're refusing to admit, it's that they cannot comprehend. Would you ever say somebody's refusing to stop hallucinating? No. Why not? 'cause they can't control it.

[00:00:15] Dr. Amador: It's the same thing with the beliefs that I'm not ill, the anti agnosia, it's not a choice on the part of the person. It's broom dysfunction. They tend not to understand, even when successfully treated, all the other symptoms are treated about 75%. Still have anosognosia. The medications don't seem to help with that,

[00:00:37] Brenda Zane: welcome to Hopestream, the podcast for parents of teens and young adults struggling with substance use and mental health. I'm Brenda Zane. I've walked this path with my own child's addiction and high risk lifestyle. Each week we help you gain clarity, learn new skills, and most importantly. Find real hope in what might feel helpless.

[00:00:58] Brenda Zane: You are not helpless [00:01:00] and you're not alone anymore. Find more resources at hopestreamcommunity.org.

[00:01:09] Brenda Zane: Hi, friend. I'm so glad you're here today because you're going to hear information that I know will be life changing if your child is battling a mental illness like schizophrenia or bipolar disorder. And is misusing substances and also refuses help because they say they don't have a problem. I know this is the case for many of the families we work with in our private community, the stream, and it's beyond frustrating and heartbreaking.

[00:01:36] Brenda Zane: At the same time, you feel confident that with medication your child could have a very functional and fulfilling life, yet they won't take it consistently because they don't think there's anything wrong with them. Well, when I came across Dr. Xavier amateur's work, I immediately fired off an email inviting him to join me for an episode because his work so [00:02:00] directly aligns with the craft approach and I know is gonna provide answers and resources for so many.

[00:02:08] Brenda Zane: Dr. Amador is an internationally renowned clinical psychologist, author, and a pioneer in the field of treating individuals with mental illnesses and anosognosia. He's the CEO of the Henry Amador Center on Ignia and a family caregiver of two close relatives with serious mental illness. Dr. Amador is the author of several popular books, including I Am Right, you Are Wrong.

[00:02:34] Brenda Zane: Now What? I'm Not Sick. I don't need help. And when Someone You Love is Depressed, how to Help without Losing Yourself. He draws on 30 years of experience as a therapist, his personal story, and published scientific research when he gives advice. Dr. Amador is a visiting professor of psychology at the State University of New York, and over the course of [00:03:00] two decades, he was professor of psychiatry and clinical psychology at Columbia University and director of Psychology at the New York State Psychiatric Institute.

[00:03:10] Brenda Zane: He served as co-chair of the schizophrenia and Psychotic Disorder section of the DSM four tr. Dr. Amad avatar's expertise has been called upon by government industry and the broadcast Imprint Media where he's appeared as a frequent expert for C-N-N-A-B. CNBC, the Today Show, Fox News Channel CBS 60 Minutes.

[00:03:34] Brenda Zane: New York Times, the Washington Post, USA today, the Wall Street Journal, and so many other national and international news outlets. So you can see why I was adamant on getting his insights for our community. Please take a listen to a note taking or conversation with internationally renowned clinical psychologist Dr.

[00:03:56] Brenda Zane: Xavier Amador. Enjoy.[00:04:00] 

[00:04:02] Brenda Zane: Dr. Amador, thank you so much for joining me today on Hope Stream. This is such a, a special conversation that we're gonna have, and I just appreciate you giving us some of your time. I came across your work through one of the members in our community who, um, you know, has a son who struggles with substance use, some mental health concerns, and she was just like, you've got to get out the door on the podcast.

[00:04:27] Brenda Zane: So I reached out. You were so generous to, um, reply and give us some time. I was gonna try and quickly like, summarize all everything that you've done and there's no possible way to do that, um, because you've done so much, but you are an expert in schizo. Sorry, what? No, you've just done so much. But the things that really stood out to me in your, in your bio were obviously your expertise in, um, schizophrenia, bipolar, some of those really difficult mental health conditions.

[00:04:55] Brenda Zane: You served on the board of directors at nami. And [00:05:00] also, um, serving as the co-chair of the schizophrenia and psychotic disorders section of the DSM four, right? 

[00:05:10] Dr. Amador: Yeah. The diagnostic manual. Yeah. 

[00:05:12] Brenda Zane: Yeah. And then worked with, I mean, Columbia, everybody. So anyway, if you are not qualified to talk about this, I don't know who is.

[00:05:19] Brenda Zane: I 

[00:05:20] Dr. Amador: think my biggest qualification is having two family members with schizophrenia and one with bipolar. 

[00:05:26] Brenda Zane: Absolutely. And I was just gonna ask if you best credential. Yes. Best credential ever. I know people always ask me, oh, are you a therapist? I'm like, Nope. I have a PhD in real life experience with, with a child.

[00:05:40] Brenda Zane: Um, maybe you could just give us some background on your personal experience. 'cause I do think that that. Mostly qualifies you, um, in addition to all of your other credentials? 

[00:05:51] Dr. Amador: It's interesting. I always had an interest in schizophrenia and this is before my brother Henry became ill. I was, I look back on my [00:06:00] college career and I was always interested in that and I was also also very interested in insight.

[00:06:06] Dr. Amador: People who tend to be kind of repressive and in denial a lot. So my undergraduate thesis was on, but who are repressors? Brain function. So it is really weird. I was already kind of interested in, in these topics when, as a senior in college, I got a phone call from my brother who was living in, in Tucson, Arizona with my mom and stuff, uh, stepfather that was in New York.

[00:06:31] Dr. Amador: Right. And I pick up the phone and he says, uh, come home quick. I killed dad. You know, hung up the phone. 

[00:06:40] Brenda Zane: Not the time you were expecting. 

[00:06:42] Dr. Amador: No, it wasn't. I was shocked. I had a thin expression you just had but of shock. Uh, but I didn't really think Henry would've done anything like that because he had never been violent in any way.

[00:06:54] Dr. Amador: He had been for about four years, withdrawing from the world. [00:07:00] And I know in retrospect now, that was the early sign to the Schizophrenias. But I got him back on the phone. And what became really clear, really quickly. That he was in a full blown psychotic episode. One of his delusions, he had many, was that he had killed our fathers and our stepfather and was hearing voices.

[00:07:21] Dr. Amador: He was hearing a voice of the devil. So I flew him to Arizona. The whole family gathered. Of course my mom and, and, uh, Henry was in his room suicidal 'cause he was convinced he killed dad. And my siblings all said, you go deal with Henry, you're a psychologist, which is a joke. I was 21 and I was studying psychology.

[00:07:42] Dr. Amador: Um, I think the reason that they, they asked me to help Henry was because we were always very close. Even though he was eight years older, older than me. We really was. I called him my, you know, my rock [00:08:00] at his funeral. He is since passed away, but. But it's actually a positive, happy story. I'm not, not gonna focus on he in his passing.

[00:08:09] Dr. Amador: Um, I, you know, I talked to Henry and I said, look, well, you're hearing voices. You think you killed dad or you didn't kill dad? Come on. And um, and he said, not crazy. One point he said, you're the crazy one, not me. I wasn't calling him crazy. I wasn't using that word right. Uh, and for seven days, I cajoled.

[00:08:31] Dr. Amador: Debate and even argued with them, and I couldn't get him to go to the hospital. So I called the police 'cause he was talking about, about dying from suicide. Um, they were really compassionate. It really worked out well. Uh, I prepped them before they came into the house and he got treatment and he did really well.

[00:08:52] Dr. Amador: The voices went away. The delusions disappeared. He was in the hospital for a month. This is back in 1981, a long time ago. [00:09:00] Back then we had hospital beds. We had longer hospitalizations than we have today. 

[00:09:05] Dr. Amador 3: Yeah. 

[00:09:06] Dr. Amador: At the discharge meeting he was, it was explained to him I was there that he had schizophrenia and the medicine he was taking, he'd have to take for the rest of his life.

[00:09:15] Dr. Amador: Do you understand? And then he says, yes, I understand. We get home and he's in his room again by himself. Mom made us there. I'm visiting from New York, so I'm still there, and I was there for a few months. And I'm doing the dishes and I go to throw a napkin. Oh, in the trash bin under the sink. And what do you think I found there?

[00:09:37] Dr. Amador: I'm his medicine. Yeah, I'm pretty sure it'd be his meds. So I fixed the bottle, brandishing the bottle. I knocked on this door. I said, what the heck is going on? You said you'd take this medicine? And he said, I don't need it. I was like, Henry five hours ago in the hospital. He says, well, that was just to get out of the hospital.

[00:09:57] Dr. Amador: I, you know, I, I, maybe I needed it then. [00:10:00] I don't need it now. That was a, there was a seven year period where I argued with my brother, he was homeless for a time. He was hospitalized four times a year, involuntarily. He was the first person that ever said, I'm not sick. I don't need help. To me, that ended up being a bump.

[00:10:17] Dr. Amador: That road call I was gonna say, which 

[00:10:19] Brenda Zane: turned into the title of your book. Ha. 

[00:10:21] Dr. Amador: Yes. 

[00:10:22] Brenda Zane: Yes. 

[00:10:22] Dr. Amador: Yeah, that's Henry it. That's a quote from my brother. Um, and then I was working on an inpatient unit in my last year of training to become a clinical psychologist. I met this woman, this young woman, who was just like my brother.

[00:10:38] Dr. Amador: Nothing's wrong with me. I don't need to be here. It's all a big mistake. My mother, mother shouldn't have called the police on me, and I was really frustrated, frustrated with her like I was with my brother. And now when I talked to my supervisor, 'cause I'm in training, right? I heard a supervisor and as I'm telling him the same story I'm telling you, he tells me to stop talking.

[00:10:58] Dr. Amador: So I stop talking [00:11:00] and he says, no, you don't understand. Stop talking to her. Just ask her a couple of questions, like what do you want and how can I help? So I went back out and did that and she said, I want to get out of the hospital. And she said, I want my mom to stop calling the police. So I told her I would work with her on those two things, but one of them would entail her having to take medication.

[00:11:24] Dr. Amador: Was she up for it? She said yes. So a light bulb went off it, it went really well. I ended up working with her and her mother in an outpatient clinic after she got discharged from the hospital on medication. And, um, it went really, really well. So I had this epiphany. I thought, wow, what I've been doing with my brother, trying to convince him, trying to educate him, you know, trying to demonstrate to him that he had an illness.

[00:11:48] Dr. Amador: Was an backward, it was wrong. And so I called him up and I said a couple of really important things, which I often recommend to families I work with. I said, I'm sorry for all the times I told you you've got [00:12:00] schizophrenia, that you're mentally ill, I'll never do it again, and I'm sorry for all the times I told you you need to take medication.

[00:12:08] Dr. Amador: I'll never do that again. Within six months of this big change in me and how I was with him. Stopped hammering him with You're ill, you need help. And instead started listening or working with his goals. Was able to persuade him to accept antipsychotic medication and not just any antipsychotic medication, but given by injection.

[00:12:29] Dr. Amador 4: Wow. 

[00:12:30] Dr. Amador: For the next 18 years of this life. Until he passed. He passed away being a good Samaritan on the street, and he got hit by a car, sadly, but, oh, but for the, but for 18 years, he was in treatment. He went to a club and it's a replace for people suffering from severe and persistent mental disorders. He had a girlfriend, he had two volunteer jobs.

[00:12:51] Dr. Amador: He was in recovery, he was doing great. And, uh, and we got our relationship back. 

[00:12:56] Dr. Amador 3: Wow. 

[00:12:57] Dr. Amador: So that was the beginning of me kind [00:13:00] of rethinking for myself and for the families I was working with. You know, how should we be talking to, to our loved ones? Don't understand the ill, the other thing it did is it sparked a, a research program that I had at Columbia University in New York City studying this problem.

[00:13:19] Dr. Amador: Like, why do so many people? It turns out 50% of all people with schizophrenia and bipolar disorder and related disorders don't understand the, I turns out it's a, it's an incredible number and it turns out. That's a neurocognitive symptom. It's another symptom, just like a delusion or a hallucination. This lack of awareness, it's not denial.

[00:13:44] Dr. Amador: And, and that, that's a big shift and, and how we approach the person if they really, truly don't understand, stop hammering them over the head with education, because see it as being relevant. 

[00:13:58] Brenda Zane: Yeah, I was gonna [00:14:00] say the, the term denial comes to mind because so many of us, when our kids are either, you know, struggling with a mental illness, or in our case with our families, substance use layered on top of that.

[00:14:15] Brenda Zane: The kids are, you know, I'm fine. I don't need help. We talk about it and I'd be so curious to get your thoughts on, we talk about that a lot as being in the pre-contemplative stage. Right. In the stages of change, 

[00:14:26] Dr. Amador: five stages of change. Yeah. So 

[00:14:28] Brenda Zane: how does that, how do you know, like is there a litmus test for, is this person really in the pre-contemplative stage or is it something different?

[00:14:40] Dr. Amador: Like how do we talk? Well, if something different has a name. It's something different, has a name. It's called Anosognosia. It's a tongue twister. And this comes from neurology. And it's neurological patients who are unaware of things as profound as paralysis. 

[00:14:57] Dr. Amador 4: Okay. 

[00:14:58] Dr. Amador: They just actually don't know they're [00:15:00] paralyzed.

[00:15:00] Dr. Amador: They try to get up outta bed and they fall. And when they're in the hospital and restrained, and I'd done a neurology internship, um, externship rather. And and evaluated patients like that. And it got me thinking maybe this is what's going on with my brother and so many people I'm working with who don't understand they're ill.

[00:15:20] Dr. Amador: And so our group and many other groups around the world have studied this problem. The DSN, when I helped revise it 25 years ago now talks about ignia as the issue. The DSN five, which is our current DSN, goes even further. That this is a neurocognitive deficit. And, uh, it's not a coping strategy. It's not denial.

[00:15:44] Dr. Amador: So there is no pre contemplate precontemplation going on. I mean, if you really have no awareness, but what, what are you gonna contemplate? Right? And, and hitting rock bottom doesn't work trying to help [00:16:00] somebody in front of these illnesses. In fact, it's very dangerous. Yeah. 

[00:16:03] Brenda Zane: People, 

[00:16:03] Dr. Amador: you know, food and shelter.

[00:16:05] Brenda Zane: So you, you said 50%, which is staggering. Have this, so if we, I'm just trying to think of how to help some parents who are like, Hmm, how do I know if they, maybe they haven't been able to get a diagnosis yet, right? They're, they are in that stage where they're like, something's wrong. It could be denial, but it could also be a mental illness.

[00:16:31] Brenda Zane: What would you suggest they do in that in between time? 

[00:16:35] Dr. Amador: I mean, a couple of things. A rough, a rough measure. First of all, to answer your first question is if three to six months the person has had, let's say they've had, they've had a psychotic episode or a manic episode, or a depressive episode, and, and they've gotten, gotten some help, or they've gotten feedback from family after six months, they don't see it.

[00:16:57] Dr. Amador: What everyone around them sees, [00:17:00] they seem to be suffering from a mental health condition. They probably have anno here. And that means stop trying to convince them. Start listening. Listen actively, you know, without judgment, without, without, uh, uh, reacting, without, and listen with respect. So when the person, if your, your son or daughter says to you, you know, you're the crazy one, not me, I'm not mentally Ill reflect that back.

[00:17:28] Dr. Amador: So what you're saying is I'm the one with the problem. Not, not you, you don't have any problem. I did that. Right. That's part of the program we developed called leap. And uh, that's the elder leap is for listening, but actively and in a way that's respectful and nonjudgmental. That, and, and that's when you start to join with the person, right?

[00:17:50] Dr. Amador: The person's abusing substances. I ask them, what, what's it feel like when, when you smoke? Well, I feel happy, I feel at peace, and then we [00:18:00] empathize with that, you know, with our program. You know, if I was smoking and felt happy and at peace, I'd wanna do it too. I think anyone would. 

[00:18:11] Brenda Zane: Makes 

[00:18:11] Dr. Amador: sense. Yeah. 

[00:18:13] Brenda Zane: Is that the e?

[00:18:14] Brenda Zane: Is the E for empathy? 

[00:18:15] Dr. Amador: That's exactly right. Yeah. 

[00:18:17] Brenda Zane: Okay. So listening, empathy, 

[00:18:19] Dr. Amador: uh, which the E is for agreements. Looking for things we can agree on. Okay. Talk about that a little bit. It's things like staying out of the hospital, things like getting a job and having a relationship, having friendships again.

[00:18:33] Dr. Amador: 'cause so many times with these illnesses people lose community, they lose friendships, they lose the ability to have intimate, loving, romantic relationships. Uh, they lose the ability to work. There's so many things we can agree on in the p and lead as partner, and then we partner on those things together.

[00:18:52] Dr. Amador: There's a few other tools, but. These are communication tools and they're designed to do two [00:19:00] things, really validate the person's experience with respect and a lack of judgment and get them interested in our opinion. 

[00:19:11] Dr. Amador 3: Hmm. 

[00:19:12] Dr. Amador: My brother never believed and schizophrenia, I asked him the last year of his life.

[00:19:17] Dr. Amador: I didn't know it was gonna be the last year of his life. Because he, he knew I wrote about him. He, I had his permission and he knew I talked about him. And I said, Henry, some, you recently asked me, do you think you have schizophrenia? And I haven't asked you in 10, 15 years, what? 

[00:19:33] Dr. Amador 3: Mm-hmm. Do 

[00:19:33] Dr. Amador: you think you have schizophrenia?

[00:19:35] Dr. Amador: And he laughed out loud and said, no, I don't have schizophrenia. And I said, so why are you taking these injections every month for the last 18 year? And he said, I do it for you. Yeah.

[00:19:51] Dr. Amador: Was relationships, and that's what the research that we've done and others have done, shows you can build that relationship [00:20:00] where the person feels heard, they feel respected. They will oftentimes do things for us, take medication even though they don't, they'll believe they need it. 

[00:20:11] Brenda Zane: That is so fascinating that he, that he did that.

[00:20:16] Brenda Zane: It's counterintuitive, right? Yeah, yeah, for sure. And, and uh, like side note, I'm very interested in the injection part of it. Is that for compliance? Like Yes. Okay. 

[00:20:28] Dr. Amador: Yeah. I mean, when somebody has pills and capsules and they have anti nausea, they don't understand the real every day, once, twice, three times a day, they have to fight the urge to throw the pills away, right?

[00:20:41] Dr. Amador: With injections once a month or once every three months, there's one formulation that's just twice a year, 

[00:20:47] Dr. Amador 3: you know, 

[00:20:47] Dr. Amador: 12 times a year or three, four times a year, or twice a year, you show up at a clinic or a pharmacy year. 

[00:20:56] Brenda Zane: Hey, I wanna pause for just a sec to talk about something that has been life [00:21:00] changing for so many women who started right where you might be.

[00:21:03] Brenda Zane: By listening to the show, if you're feeling the isolation, the exhaustion, like nobody gets what you're going through, there is a place designed specifically for you. The Stream is our private community for moms and female caregivers who are parenting teens and young adults through substance use and mental health struggles.

[00:21:22] Brenda Zane: And when I say private, I mean completely confidential. It is not connected to Facebook or any other platform, or your business could become everyone's business. What members love about this stream is that you can be as visible or as anonymous as you want. Some moms jump right into conversations and calls.

[00:21:41] Brenda Zane: Others like to read and learn quietly in the background. Both are perfect. It's not social media. It's genuine community focused on learning growth and breaking through the isolation that might be keeping you from moving forward right now. Whether your child is in active use in treatment [00:22:00] or early recovery, you'll find practical strategies and tools that actually help motivate healthier choices.

[00:22:06] Brenda Zane: Because we know you wanna see positive change in your family. Check it out@hopestreamcommunity.org. We would love to welcome you into this village of support and understanding. Okay, back to the show. 

[00:22:21] Dr. Amador: I could get a flu shot and you get a shot. So compliance is way better for these long-acting injectables.

[00:22:29] Dr. Amador: Way better than pills and capsules. 

[00:22:31] Brenda Zane: Yeah. And is that approved for just adults or could an adolescent, like let's say a 16-year-old who's been diagnosed, is that okay? Adolescent 

[00:22:42] Dr. Amador: for children? I had, um, I have, if I didn't had, I have a son, uh, who had early onset schizophrenia, 11 years old. It took me a year to find the psychiatrist to do it because there's no reason not to do it.

[00:22:58] Dr. Amador: But since the age of 12, he was [00:23:00] prescribed, uh, an injectable antipsychotic medication because he, he was pretending to take pills and not taking them right. And he did fantastic. He's in recovery, he's working, uh, he's doing really well. And, uh, and he, you know, once when he was 18, he thought about stopping.

[00:23:21] Dr. Amador: And he wanted to stop. And I talked to him using this approach and I said, well, it's your your choice son. I totally will respect her, but you do. But just so you know, and I could be wrong. I think it helps you. I hope you'll think about it. And he put his arm around my shoulder and said, oh, it's okay, dad. I know you're worried.

[00:23:40] Dr. Amador: I'll take it. You know, because I was worried not as a worried dad. Yeah, I love that. So again, it was not, it was a relationship. That, that led to his acceptance of an injection. The short answer is yes. There's no reason. You can't, you can't use it with kids. 

[00:23:57] Brenda Zane: Okay. That's, that's amazing. Uh, [00:24:00] and that's like a whole separate podcast, but um, I'm just thinking about the parent who is trying to sort out also, what is the impact of the substance use and what is the mental.

[00:24:15] Brenda Zane: Health concern? Like how do you tease those apart? Or can you even, like, where do you even begin if you've got a kid who's been diagnosed bipolar and they're using a high potency THC vape every day. Holy cow. Like that gets really difficult. 

[00:24:32] Dr. Amador: It does. It does. And how do you tease it out? Well, first of all, in terms of understanding the psychiatric disorder, you wanna see them over and still having symptoms.

[00:24:43] Dr. Amador: You don't wanna, you don't wanna see them. If you want clarity, uh, they're still having manic symptoms grandiose or delusional, or hallucinating when they're, when we know they're not. So then, you know, they've got both conditions. Okay? The substance use [00:25:00] disorder and the psychiatric disorder, right? Um, what, what I try to do is, is, um, uh, and, and what I coach families to do is do not judge and not complain.

[00:25:14] Dr. Amador: And not educate and instead use the leap approach. Actively listen to the person, be empathic, normal. And part of the empathy we teach is normalizing. So, son, you told me that when you smoke you can, you can, you can sleep better. You're, you can be chill. I can see why you do it. I'd do it too. This is from normalization.

[00:25:36] Dr. Amador: I'd do it too if I was in your shoes and the kid says, so you're saying it's okay. And you give your opinion with this approach, you say, one comes and there's the three, a's we call them. I'm sorry. We acknowledge our fallibility. We ask the person not to argue. So here's what it sounds like. I, I'm trying to understand how it is and do you feel like I understand what it's like for you when you smoke and you said yes.

[00:25:59] Dr. Amador: [00:26:00] Right? And, and this sort of archetypal conversation. We're, we're right now. Um, and you've asked me do I think you should keep smoking? All right, well I'm sorry and I could be wrong. I think it's a good idea not to smoke for you to stop or, you know, stop vaping. And I hope we don't have to argue about this.

[00:26:21] Dr. Amador: I'm sorry I have this opinion 'cause I might upset you. I could be wrong. I think you should stop. I really think it'd be better for you if you stopped and not, but I don't wanna argue with you. You know, take a very humble approach to giving your opinion. And, and do that after there's a foundation of your kid feeling heard and appreciated and not critic criticized Yeah.

[00:26:44] Dr. Amador: And complained about. 

[00:26:46] Brenda Zane: Yeah. It's definitely a, it, I can just feel how that lowers the defenses, right? Because you're not being combative and you're not being confrontational. You're really coming alongside as kind of a [00:27:00] partner and it, and this, it sounds like it. Aligns beautifully with the craft approach, which is what we teach community reinforcement and family training, where you are really curiously trying to understand what is this doing for you, which is different, like, um, from a substance use standpoint, you know, what is, what is the weed doing for you or what is the alcohol doing for you?

[00:27:22] Brenda Zane: But you can't really say that when it comes to a mental illness. Like what is your bipolar doing for you? Doesn't make sense. So that's. I think so why you're this lie approach is so beautiful is because it, it works with something that's so difficult, especially if you yourself have never experienced a mental illness like that.

[00:27:43] Brenda Zane: It's so hard to relate. 

[00:27:45] Dr. Amador: Yeah, it is. And I mean, people with psychotic disorders, you have ansia. Are some of the loneliest people. I'd never met everyone around in this telling room that reality is false. [00:28:00] Right. So, you know, so I, I'll I, if the person is delusional, I love talking about the delusion. So tell me about the CI conspiracy.

[00:28:08] Dr. Amador: I can see why you're scared. I'd be scared too. Well, do you believe me? I could be wrong. Or I'm sorry. I have this opinion. I don't see the same thing you said. You see I'm doing the opinion tool again. Mm-hmm. Yeah. Are you with you? Yeah, you don't get into, you can't talk somebody out of a delusion, but what you can do, it will join the person emotionally, you know, with how it feels to them what's going on.

[00:28:35] Dr. Amador: Yeah. Uh, and validate their, their feelings around it. Not the same as agreeing. It's true. Right. It's not the same. 

[00:28:43] Brenda Zane: That's a big distinction because I do know a lot of times when we're talking about motivational interviewing or with craft, and we're talking about. You know, curiosity and using reflections, right?

[00:28:55] Brenda Zane: And using, you know, affirmations. Parents are like, yeah, but I don't want 'em to [00:29:00] think that I approve of this. And in the way that you just phrased that. So elegantly does a good job of, you know, um, connecting with them, but not giving your sample of approval. So that's a big, big difference. 

[00:29:16] Dr. Amador: Yeah, it's validation, not verification.

[00:29:19] Dr. Amador: Mm oh, it's not saying I believe you. It's saying I understand you. Yes. 

[00:29:26] Brenda Zane: The other thing that we see a lot of that I'd like to get your thoughts on is young folks who are using these high, high potency marijuana products. 90 to a hundred percent. Daily, multiple times a day, and they are starting to have psychosis and psychotic breaks with no history in the family.

[00:29:47] Brenda Zane: Right. Just it seems to be. And the jury's probably still out. It seems to be very directly related to the THC, and I'm imagining that this approach [00:30:00] obviously still works with someone like that if they're having these, you know, we have moms who are like, oh my gosh, my daughter's in the grocery store thinking that, you know, somebody's trying to kill her in the grocery store.

[00:30:11] Brenda Zane: Never had this problem before. What are you seeing with that? This kind of convergence of, um, psychosis and, and marijuana? I, I 

[00:30:23] Dr. Amador: see it a lot and I don't think the, I actually don't think the jury's thrown out. When I look at the research, and there's a lot of research on this, it appears that the high potency THC is triggering the onset of the illness.

[00:30:37] Dr. Amador 3: Mm-hmm. 

[00:30:38] Dr. Amador: You know, it's, and it, and it could be that somebody had some vulnerability to the illness, maybe not family history. Other things that can make you vulnerable to the illness seems to be triggering, if not causing the onset of schizophrenia and related, related psychotic disorders. So yeah, smoking at a young age and smoking this, these hot potency.[00:31:00] 

[00:31:00] Dr. Amador: Look, when I was younger. When I was much younger, I smoked a little bit. I didn't like it. Luckily my brother smoked a lot. He loved it. I don't know if that's why he got it and I, why he asked it and I didn't, you know, I don't know. We do have a family history in our family, um, but, um, the research is pretty clear that that excessive use of THC and adolescence and early adulthood is associated with a much higher incidence of schizophrenia.

[00:31:33] Brenda Zane: And that could be. Do, do you know, can that be then reversed if they stop or, yes, it can. Okay. Because that, that's a big question that parents are having is like, oh my gosh, what? You know, if I can get 'em into treatment, do we have a chance of reversing this? 

[00:31:52] Dr. Amador: And by reversing, let's make sure you and I are on the same.

[00:31:55] Dr. Amador: Yeah, but I, what I mean by that is if they can get sober. Get [00:32:00] into treatment for the schizophrenia, they can get into recovery. Okay. That's what I meant by reverse. Okay. It's not, it is not as if they stop smoking and then they don't have any more psychosis. Okay. You still have to treat the psychosis because the threshold has been passed and they now do have that psychiatric disorder.

[00:32:18] Dr. Amador: You do have to treat that separately. 

[00:32:21] Brenda Zane: Okay. 

[00:32:21] Dr. Amador: That makes sense. 

[00:32:22] Brenda Zane: I would imagine that you, so I know you do training. Professional training. So you're spreading the word to providers, therapists, law enforcement, like how does this work? Because I know so many of our families, you know, they have to call 9 1 1 because things are just so out of control.

[00:32:41] Brenda Zane: And often that can be not helpful depending on how, you know, well trained the, the police are that are showing up. What does it look like when you look at the law enforcement world and you know, more people having these psychotic breaks and, oh, I just, I can [00:33:00] see that going so wrongly. Um, if they're not trained, how's that going?

[00:33:06] Brenda Zane: Well, 

[00:33:06] Dr. Amador: they've gotten a, a, you know, a bad deal here, the law enforcement, because. Because the failure of our outpatient psychiatric care has, has left them being the first responders. So we train, uh, police officers, sheriffs deputies, and EMTs in using this approach. And, uh, it's, it's, it's very streamlined.

[00:33:29] Dr. Amador: It's, it's a way it know, we teach them ways to use these tools to quickly deescalate the person if they're agitated and to gain their trust and to get them to the hospital. So it's very focused on. On gaining trust and deescalation and getting the person to the hospital, and these officers and these EMTs love the program.

[00:33:49] Dr. Amador: It really makes sense to them. I get a lot of good feedback at for the trainings from people that, that it helped them. 

[00:33:56] Dr. Amador 3: Yeah. So 

[00:33:56] Dr. Amador: we're training not only police officers and, [00:34:00] and EMTs, um, but nine 11 dispatchers when somebody is psychotic and, and calls 9 1 1. How to help that person deescalate and stay polite, wrong.

[00:34:11] Dr. Amador: Police come, or the crisis team comes. Uh, we teach judges. We've taught hundreds of judges because many judges are doing mental health diversion courts, 

[00:34:21] Dr. Amador 4: right? 

[00:34:22] Dr. Amador: And they're trying to convince the person, don't go to trial, go to treatment. We wanna divert you to treatment. And, and they've got people saying, I'd rather go to trial 'cause I'm not, there's something wrong with me.

[00:34:33] Dr. Amador: I'd much rather go to trial. These poor judges are like trying to get the person to accept the diversion that they can offer them. Yeah, so we train, we train judges in this approach as well. And most important, we train families. There's three groups, criminal justice providers, clinicians like myself and family members like myself.

[00:34:56] Brenda Zane: Yeah. So how does that work? Like if stakeholders, yeah, [00:35:00] if one of our families is interested. What is available to them that they could tap into from your, I know you're working on a really cool AI thing, so tell us a little bit about how a family could get some help. 

[00:35:14] Dr. Amador: Well, in November we'll be launching our, our lead AI coach, which is really cool.

[00:35:18] Dr. Amador: Um, we just piloted it and got great responses from, uh, 300 people who tried it. We're just doing some, some fine tuning. Uh, and what it does is it, as one person said, it's like having urometer in my ear. You can ask it any question that sounds kind of, it's amazing. Or in your back pocket or your purse on your I like that better.

[00:35:41] Dr. Amador: Yeah. Um, but, um, well first, the, the easiest thing to do, and it's all this, this is all, it is all free. What you were gonna have to charge a little bit for the coach because we have to pay every time. You Sure. But, um, you can go to leap institute.org. [00:36:00] P institute.org, and there's free videos under resources.

[00:36:05] Dr. Amador: There's about two dozen videos. There's a TEDx talk that I, that people over half a million people have watching. They love it. Learn, say, this really helped me to understand that my loved one has this symptom. They're not in denial of not being difficult, stubborn. And then we have acted out scenarios where, you know, we have actors together with me acting out how to use lead.

[00:36:35] Dr. Amador: So all that's free and available internet. 

[00:36:37] Dr. Amador 4: Okay. 

[00:36:38] Dr. Amador: Leap institute.org. You can also certainly read my book. Um, there are some excerpts free on, uh, like four or five chapters I donated to Noami, so noami.org. Nice. Okay. Or you can buy the book. Buy the book. Buy the book. That's ebook, audio, book and print. It's all three.

[00:36:56] Brenda Zane: Yeah. I, I wanna just go back, those are all amazing [00:37:00] resources and we'll put those in the show notes. So if you're listening, don't feel, feel like you have to write it all down. It'll all be in the show notes. But I think what you said was so important, I don't wanna skip over it. Is that, and I'm gonna try to say it, Anna Sinia, is that right?

[00:37:15] Brenda Zane: Anosognosia. Anosognosia is a symptom. It's a symptom. I think that's so important to understand because we, I think that's flipping it a bit from what people typically think is denial or is this sort of precon, you know, pre-contemplation. So I just wanted to highlight that because it's so important. Yeah.

[00:37:39] Dr. Amador: Well, can I add to that? Yeah, of course. Real quickly. And the, the families and clinicians I work with and police officers say, well, this person just refuses to admit. And I'm like, no, it's not that they're refusing to admit, it's that they cannot comprehend. Would you ever say somebody's refusing to stop hallucinating?[00:38:00] 

[00:38:00] Brenda Zane: Of course not. Yeah. I can control it. Yeah. 

[00:38:06] Dr. Amador: It's the same thing with the, the beliefs that I'm not ill, the ignia, it's not a choice. On the part of the person, it's broom dis dysfunction. 

[00:38:14] Brenda Zane: Yeah. 

[00:38:15] Dr. Amador: Um, 

[00:38:17] Brenda Zane: that's, that's so important. Are they, can they ever, do they ever get to a point where they then do recognize, like you said, your brother, you know, forever said, no, no, I don't have this.

[00:38:28] Brenda Zane: Do they ever, or I guess this is an individual thing, do they get to a point where they can recognize it? 

[00:38:35] Dr. Amador: The, the research shows that most people are like my brother. They tend not to understand even when successfully treated or the other symptoms are treated. About 75% still have anosognosia. The medications don't seem to help with that.

[00:38:52] Dr. Amador: Uh, there might be one exception. Clozapine, it's generic, so I'm not trying to sell anybody's drug here. Clozapine, [00:39:00] uh, is some. Minimal research indicating that it might lead to insight and into awareness to reducing ignia, but most people don't respond. Now, the other side of that number is, yeah, about 25% do gain insight after being in treatment for a couple of years.

[00:39:19] Dr. Amador 3: Mm. 

[00:39:19] Dr. Amador: The anosognosia does remit just like the hallucinations, delusions, and the mania remits with bipolar disorder. We see anosognosia kind of waxes and wings. So during the depressive periods and during recovery, uh, in bipolar disorder, the story's a little bit better. People tend to gain awareness and do see with consistent treatment.

[00:39:43] Brenda Zane: Yeah. And when you see treatment, uh, I understand the medication side of it. Is it also then mandatory to have more, uh, like talk therapy, psychotherapy along with that, or when you say treatment, are you primarily talking about medication? [00:40:00] 

[00:40:00] Dr. Amador: Primarily talking about medication, but by all means, psychotherapy, psychosocial supports, uh, socialization, uh, and you know, there's all kinds of structured, uh, places where you can get socialization, but definitely having a psychotherapist is really important if you've got one of these psychiatric illnesses because you're, you're in recovery, you're trying to get your life back, and there's a lot of challenges.

[00:40:29] Dr. Amador: So having someone to talk to, there's a caveat here is that there's also CBT cognitive behavioral therapy for psychosis. Mm. Because about 20% of people don't respond to medication and many of them do respond to CBTP cognitive behavioral therapy for psychosis. Okay. But this is really an exciting area where talk therapy is actually helping with the hallucinations of delusions of mania.

[00:40:59] Dr. Amador: That's [00:41:00] so 

[00:41:00] Brenda Zane: interesting. 

[00:41:01] Dr. Amador: Yeah. Medication is the cornerstone, but for many people, CBTP can, can really make a difference as well. 

[00:41:08] Brenda Zane: Okay. Yeah, I asked 'cause I thought, so if you're seeing a therapist but you are not aware that you have a mental illness, it could be a little tricky from the therapist standpoint.

[00:41:18] Brenda Zane: And I would imagine that therapist has to be extremely well trained in. Schizophrenia or in bipolar, whatever it is, so that they're not hammering them on the, the exact thing that you don't want to hammer them on. Right. 

[00:41:34] Dr. Amador: Okay. I like that you used the word hammer. 

[00:41:37] Dr. Amador 4: Yeah. Well, I think Wes really good at that.

[00:41:41] Dr. Amador: Yeah. That's what it feels like. Why are you telling me about the schizophrenia thing? I don't have it ran. 

[00:41:46] Dr. Amador 3: Yeah. Yeah. 

[00:41:48] Dr. Amador: One, not me. 

[00:41:49] Dr. Amador 3: Yeah. 

[00:41:50] Dr. Amador: It does feel like the person's being hammered. Yeah, and I did that for seven years, so I don't criticize anybody who does it. I get it. 

[00:41:57] Brenda Zane: You're a pro addict [00:42:00] 

[00:42:00] Dr. Amador: and unfortunately, yeah, but I learned to stop doing it.

[00:42:04] Dr. Amador: I learned to put the hammer away. Yeah. Stop educating. Start validating and joining with the person. 

[00:42:10] Brenda Zane: Incredible. Well, I can't thank you enough for this, so insightful. I know everybody's going to jump to the resources because it's such a difficult and confusing. Thing to experience as a parent when you have zero training and you know, zero insight into what's going on.

[00:42:29] Brenda Zane: So I think this is gonna. Expand a lot of people's understanding and we'll put them in touch with your tools. Good luck on your launch. I'm sure we will. Thank you. We're excited. 

[00:42:39] Dr. Amador 4: Yes. If you need any test users, I'm sure we could, we could gather up a few for you. So all our 

[00:42:44] Dr. Amador: testing period's over, but okay.

[00:42:46] Dr. Amador: So the real deal is coming. Yeah, and you can ask it any question you want. My son just accused me of poisoning. What do I say to him? It'll give you the leap approach for how to start talking to 'em about it. Amazing. I mean, any kind, [00:43:00] you know, how do I convince 'em to take medication? Right. Why give steps?

[00:43:04] Dr. Amador: Incredible. It's really cool. It's kind of, it's, it's giving me a lot of, um, all this, that when I'm gone, this will continue without me. 

[00:43:14] Brenda Zane: Yeah, yeah. 

[00:43:15] Dr. Amador: Divides the book and the rest of it. 

[00:43:16] Brenda Zane: Absolutely. Okay. Well, thank you. Thank you. 

[00:43:19] Dr. Amador: That's amazing. You're very welcome. I appreciate it. Thank you for what you do 

[00:43:23] Brenda Zane: so much.

[00:43:24] Brenda Zane: Thank you. Okay, my friend. If you want the transcript or the show notes and resources from this episode, just go to our website, hope Stream community.org, and click podcast. That'll take you to all things podcast related. We even have a start here playlist that we created, so if you're new here, be sure to check that out.

[00:43:45] Brenda Zane: Also, if you're feeling anxious and confused about how to approach your child's substance use, we have got a free ebook for you. It's called Worried Sick, A Compassionate Guide for Parents of Teens and Young Adults Misusing Drugs and Alcohol. [00:44:00] It'll introduce you to ways that you can build connection and relationship with your child versus distancing and letting them hit rock bottom.

[00:44:10] Brenda Zane: It is a game changer and it's totally free. Just go to Hope Stream community.org/worried to download that. You are amazing my friend. You are such an elite level parent. It is an honor to be here with you and please know you're not doing this alone. You've got this tribe and you will be okay sending all my love and light and I will meet you right back here next week.