Understanding Schizophrenia Denial: Why It Happens and How Caregivers Can Help

Some people with schizophrenia don’t believe they have the condition, even after they’ve been diagnosed. Denial of schizophrenia can potentially harm the person with the diagnosis by decreasing quality of life and worsening symptoms. It can also challenge caregivers who want to help.

In this article, we’ll discuss common behaviors linked to schizophrenia denial, so you can better understand what the person may be going through. We’ll also share practical strategies to help you guide the conversation and support recovery.

Why Does Schizophrenia Denial Happen?

Schizophrenia denial isn’t always resistance. It can be a sign of a condition called anosognosia, a neurological condition in which someone doesn’t recognize that they have a health disorder. People with this condition have damage to the part of their brain that senses their body’s status or “image.” This part of the brain tells you whether there’s a problem with your body. When it’s damaged, a person’s perception of themself is that their body is working as it should.

Anosognosia (“lack of insight” or “lack of awareness,” as some clinicians say) is common with certain neurological and mental health conditions, including dementia and stroke. It also affects most people — between 50 percent and 98 percent — with schizophrenia, but it doesn’t look the same for everyone. Some people are entirely unaware of their illness or symptoms, while others may recognize them but don’t link them to their diagnosis or its severity.

Anosognosia can also come and go. Someone may notice their symptoms for a short time, but that awareness may fade. This can be confusing for caregivers and may look like denial, but it can be part of the condition.

Someone may be aware of symptoms for a short while, then insight fades over time. This change can be confusing for caregivers and may appear to be an intentional denial of symptoms, but it’s actually part of the condition.

Behaviors of Schizophrenia Linked to Anosognosia

Some behaviors might suggest that someone with schizophrenia may be experiencing anosognosia. You may notice the following:

• Rejecting their diagnosis — Some people don’t believe they have schizophrenia because they don’t perceive anything abnormal about their own behaviors.
• Resisting treatment and medication — They may not think they need treatment or need to take medication because they don’t see a reason to do it, which could make the condition worse.
• Generating explanations for their experience — They might try to explain away their symptoms with a plausible external scenario. For instance, they may say their auditory hallucinations (voices) are coming from a radio in the next-door apartment, to make it feel more real.
• Increasing conflict with others — In some cases, a person may fill in gaps in their memory or understanding with false details without realizing it, which can sound like lying and may hurt relationships.
• Showing risky behaviors — Misunderstanding or explaining away symptoms can lead individuals to act in ways that feel safe to them but are actually risky. This can increase stress, create conflicts with others, and sometimes result in legal or housing difficulties.

In some cases, a person may fill in gaps in their memory or understanding with false details, without realizing it, which can sound like lying and may hurt relationships.

Caring for someone with anosognosia can be challenging and take an emotional toll. One MySchizophreniaTeam member wrote, “Need more information about anosognosia because my son refuses to get help or let anyone help him because there is nothing wrong with him.”

Another wrote, “I feel bad, but I am not sure how to help my daughter. … I know she has a mental illness. She believes she is not sick. How can I help her?”

Conversation Strategies for Caregivers

While insight may never come for some people with schizophrenia, some strategies can help guide conversations and try to make progress toward recovery. Here are a few ways to approach the person you care for when discussing their mental illness.

Stay Calm

Moments of denial can be confusing for the person with schizophrenia. Confronting someone during these moments can cause more anxiety and frustration for you and them, which could lead to a breakdown of communication — or the person pushing you away.

Instead, choose calm moments to discuss your concerns about their mental health. Listen carefully to what they say and the emotion behind their words. Even if they say hurtful words, try to acknowledge the emotion and express understanding to avoid an argument and find common ground. If the conversation starts to escalate, pivot toward more collaborative and constructive subjects to plan next steps together.

Modify How You Communicate

One common strategy during emotionally sensitive discussions is to use “I” statements rather than “you” statements. By focusing on how “I” feel, you’re speaking toward your own feelings rather than pointing a finger at the other person. It’s a gentle way to express concern without sparking defensiveness.

For example, if your family member is willing to talk, avoid saying, “You’re not going to appointments and taking your medications, which is making you worse.” Instead, acknowledge their emotion from your perspective and tell them how you feel. You can try saying, “I understand that you feel anxious about treatment, but I think professional support can make a difference. I care for you and want to see you happy. What can I do to help?”

Maintain Trust

Build and maintain trust by continuing normal routines rather than only focusing on the condition. A strong connection can create natural opportunities to discuss difficult subjects. It also teaches you and the person you care for that you can live with schizophrenia instead of fighting it.

One member found that driving her daughter to work has improved their relationship. “We get to talk with no distractions, and I can show up for her on a regular basis,” they wrote.

One member found that driving her daughter to work has improved their relationship. “We get to talk with no distractions, and I can show up for her on a regular basis,” they wrote.

Share Goals

Think of ways to work together toward shared goals that complement their treatment plan and encourage recovery. Try framing your support as team collaboration, working together to improve overall well-being.

Shared goals might involve practicing self-care. For example, you can both attend exercise classes, organize a monthly calendar with appointments and medication schedules, or find healthy recipes to try a few nights per week.

Support Treatments

Find ways to support treatment adherence without confrontation. You and the other person can discuss ways you can help, like taking them to appointments or providing medication reminders. To avoid annoying them with reminders, you can ask how they’d prefer to receive them (and how often).

Not only can support help people with schizophrenia stay consistent with their treatment plan, but it also gives you peace of mind that they’re receiving the help they need.

Seek Help

You don’t need to support the person you care for alone. Find professional and community resources by joining a support group, seeing a therapist, or going to an educational session about schizophrenia. You may discover problem-solving strategies that could make a difference by talking with others who understand.

It’s also OK to ask for family support. Ask loved ones to help share in the caregiving responsibilities. Be clear about what you need and what would be most effective.

Prioritize Your Self-Care

When focusing on the health of others, it can be easy to overlook your own needs. Give yourself permission to make space for self-care to help you cope and avoid burnout.

• Recharge with your favorite activities — Take breaks from caregiving when possible. Stay connected with your friends and family to keep your own support system, engage in hobbies, or unwind with some alone time.
• Take care of your mind and body — Keep up with your own physical and mental health by keeping up with your hygiene, sticking to an exercise plan, or journaling at night. If necessary, find a mental healthcare provider to manage feelings of grief and guilt.
• Set your boundaries — State your limits clearly and enforce them consistently. Don’t allow yourself to be in unsafe or abusive situations, and call 911 if you experience violence.

Join the Conversation

On MySchizophreniaTeam, people share their experiences with schizophrenia, get advice, and find support from others who understand.

As a caregiver for someone with schizophrenia anosognosia, have you found effective ways to discuss recovery? Let others know in the comments below.