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Contrary Mary & Denial of Mental Illness

937739_78746384Mary D., an incredibly intelligent, former high-school teacher, is in her early 50s and has been variously diagnosed with schizophrenia, bi-polar disorder, and anti-social personality disorder.

My evaluation showed that she indeed had a significant number of symptoms of schizophrenia, enough to warrant two previous diagnoses.

But Mary denies that she is mentally ill. And, she can, at times, convince others, even doctors, that she is fine, especially on what she will admit to are “good days.”

Several years ago Mary stopped seeing her therapist and found another therapist who was willing to agree with her self-assessment that she didn’t need medication or a higher level of care than once a week therapy. She allowed Mary to treat herself with vitamin C and vegetable juices. Unfortunately, within a few days she decompensated, but somehow stayed in therapy on and off for four years.

Eventually, she ended up living on the streets of New York, camping out in front of her former apartment, but refusing to go inside. She had malnutrition, parasitic infections, and infected cuts and bad bruises.

A short while later her former doorman, a very kind, special individual, arranged for Mary to go into a nursing home, albeit one that is not adequately staffed for the treatment of mental illness. Mary, who can be quite charming and charismatic, convinced the staff that they had gotten hold of the wrong medical records, and actually had those of someone with the same name as her, but who was mentally ill. They believed her for a couple of days.

Fortunately for Mary, one of the nurses called her sister who was listed as next of kin on an old report and found out that they did have the correct information. Mary has terrible relationships with most living family members, and was both an abuser and a victim of abuse, both emotional and physical violence.

Mary has been in denial about her schizophrenia diagnosis for about 20 years (she was first diagnosed in her 30s, but when she feels like it, she’ll tell you she had depression in her teens and twenties.) She survived a brutal childhood and has a history of mental illness and personality disorders in her family. The fact that she was able to get her master’s in education is a testament to Mary’s determination, a determination that sometimes doesn’t serve her well when it amplifies her resistance to treatment. Mary had some high-functioning days, but these were not necessarily the norm.

The nursing home arranged for Mary to receive therapy and see a psychiatrist and now Mary is back on medication, this time one with fewer side effects. She is less agitated, lucid, and no longer plagued by hallucinations. Because of her physical disabilities brought on by exposure and malnutrition, she qualifies for long-term residential care, which is a blessing because she loves the nursing home. The fact that it is not a mental-health care facility has lessened her resistance to treatment, as Mary is okay with admitting she has physical health problems.

Although the relationship with her sisters and brothers is still on the outs, her father has begun visiting her and has even come to therapy with her a few times.

Part of what I gained from being a consultant on this case is an even deeper appreciation for how sensitively therapists must treat patients who are in denial about their mental illness. The fact that Mary can say she is being treated for physical problems has preserved her dignity and she is far less resistant to mental health therapy and the medication that is preventing her from painful, debilitating symptoms of schizophrenia.

And of utmost importance, Mary’s safety is also being preserved.

 

Contrary Mary & Denial of Mental Illness


Richard Zwolinski, LMHC, CASAC & C.R. Zwolinski

Richard Zwolinski, LMHC, CASAC is the author of Therapy Revolution: Find Help, Get Better, and Move On Without Wasting Time or Money and is licensed in addiction and psychotherapy with over 25 years experience as well as a consultant to organizations and companies in the fields of mental health and addiction. He is the executive director of an outpatient behavioral health program. Learn more about Richard here.


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APA Reference
& C.R. Zwolinski, R. (2014). Contrary Mary & Denial of Mental Illness. Psych Central. Retrieved on November 14, 2019, from https://blogs.psychcentral.com/therapy-soup/2014/08/contrary-mary-denial-of-mental-illness/

 

Last updated: 10 Aug 2014
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