Two of the biggest problems in schizophrenia are insight and compliance by the individual diagnosed with schizophrenia. Insight is an awareness that schizophrenia exists and that the individual has some form of it. Compliance is the willingness to take medication daily and implies a faith and trust in the psychiatrist recommending medication.
Dr. E. Fuller Torrey has found that about half of the people on any given day, diagnosed with schizophrenia, have no insight that they have schizophrenia. Without that awareness they are often unwilling to take medication or to even see a psychiatrist. To such people the problem is not with them but with everybody else.
Dr. Torrey has become such a strong advocate for people with schizophrenia partly because his sister has it. When he asks her if she has schizophrenia she replies "I know you think I have schizophrenia...," and doesn't really understand why she has been hospitalized.
No one really knows why the person with schizophrenia has so much trouble understanding they have an illness. Researchers have postulated that since schizophrenia is interfering with brain function, the area of the brain which would be capable of insight is affected by the illness. One has to also remember that delusions and hallucinations are very real sensory experiences for the individual. I still believe that World War 2 was caused by a neurovirus, and even though nobody else believes that, I am firmly convinced and await the day when scientists catch up with me. I can't unbelieve it. To believe you have schizophrenia often involves unbelieving the reality of your delusions and hallucinations.
When a psychotic person is brought by family, friends or police to the emergency ward of a hospital for assessment that person is already living a very different reality, involving powerful outside forces with much more authority than a lowly human psychiatrist. And so in becoming psychotic people often lose respect for human authority. I remember when I was sentenced to see a psychiatrist for three years as a condition of my probation, and I was at the time in more or less constant telepathic communication with aliens from outer space, aliens who had actually created the planet and planned the evolution of humans. I didn't bother to tell the psychiatrists anything about my alien friends. They couldn't have understood. And so it took the full three years to convince me to take medication. Even then I thought I had been misdiagnosed. I knew I didn't
