Psychosis and Resistance to Taking Meds

It is known that psychotropic medication can be quite efficacious in treating the mentally ill. It’s also known that psychotic individuals may discontinue taking their medication. This is a serious treatment consideration. The tendency in some schizophrenics to stop taking their meds bears scrutiny.

The scientific bases for treatment with antipsychotics may be compelling to scientists, and cognitive understanding behind the use of this type of medication is convincing. While it is obvious that antipsychotic medication, to a great extent, alleviates psychopathology, this fact may be less obvious to the schizophrenic.
Medication for treatment of psychotic disorders is not entirely effective. It does not completely resolve mental illness. The complete diminishment of symptoms of psychosis has not been entirely forthcoming, in spite of rigorous research and significant advances in the science of psychiatry. As stated clearly, the “cure” for schizophrenia has not been established, and this reality allows psychotic individuals to speculate about the remaining ineffectiveness of psychotropic medication.

This ineffectiveness of antipsychotic meds allows psychotic thought to compound psychotic thought. Essentially, psychotic symptoms reinforce psychotic symptoms. It is the nature of delusions to provide a basis for further delusions, and one of these delusions in psychotic individuals may be the idea that medication causes mental illness. This is an idea represents a reality to schizophrenics, perhaps reinforced by chance alone.

Another aspect of psychotic thought is that it is quite simplistic, such as the idea that medication causes psychotic symptoms. This delusion may be actualized by psychotic individuals’ perception regarding the correspondence between taking medication and having psychotic symptoms. While correlation does not imply causation, this concept may be difficult for schizophrenics to grasp.

Schizophrenics may believe that, if they do not take their meds, they will cease to be psychotic. The rebound of psychotic symptoms that accompany discontinuation of antipsychotic meds proves that this discontinuation will not entail the lessening of psychotic symptoms. The implacability of delusional material allows for logical thought to be compromised in a manner that confirms delusional material. Clearly, delusion strengthens delusion in a cyclic way, and the psychotic symptoms that remain event in the wake of taking meds will continue to manifest themselves, in spite of taking meds.

Although behaviorism applies to behavior, the “covert” behavior of cognition is reinforced by the schizophrenic’s palatable belief that their symptoms can be explained in a way that is understandable to themselves and others, in a congruent way. This leads to simplistic affirmation of delusional material by the schizophrenic, and it is perhaps the seeming remote quality of the scientific method that will not convince the schizophrenic to relinquish delusion. Relinquishing delusional material may not be possible, as delusion compounds delusion, and the basis for psychotic ideation appears to be psychosis.  Delusional material relies on interval-ratio reinforcement even though it is related to the covert behavior of cognition that is reinforced by chance alone.

What is seen as rewarding to the schizophrenic is the cultivation of comprehensible beliefs that will not be viewed as stigmatizing by others.

While the situation of delusion compounding delusion in the schizophrenic is dire, comprehension of how the schizophrenic views her situation may allow for a deeper understanding of the emotions of the schizophrenic, and these emotions may be asserted to be valid given the subjective, albeit delusional, perspective that the schizophrenic painfully embraces.

Image via Jeng Niamwhan / Shutterstock.

Ann Reitan, PsyD

Ann Reitan, PsyD, is a clinical psychologist and well published essayist of fiction and creative nonfiction. She holds a Bachelor of Arts in Psychology from University of Washington, Master of Arts in Psychology from Pepperdine University, and Doctorate of Clinical Psychology from Alliant International University. Her post-doctoral research at Washington University in St. Louis, MO, involved personality theory, idiodynamics and creativity in literature. She recently published Illuminating Schizophrenia: Insights into the Uncommon Mind.
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