Medication nonadherence in schizophrenia is often framed as defiance — but that narrative misses the truth and harms the very people it claims to help. Guest host Rachel Star Withers (who lives with schizophrenia) unpacks why up to 70% of people with schizophrenia have trouble taking medication as prescribed — and why the reasons are far more complex than “noncompliance.” From severe side effects and cognitive symptoms to stigma, trauma, access issues, and being dismissed by providers, this conversation exposes the real barriers standing in the way of effective treatment. Rachel shares deeply personal experiences of both intentional and unintentional nonadherence, including how side effects like extreme fatigue and tardive dyskinesia shaped her decisions — and how lack of education nearly cost her years of quality of life. The episode also explores how medication refusal can be weaponized, stripping people with schizophrenia of autonomy under the guise of “lack of insight.” Later, Rachel sits down with board certified toxicologist and psychopharmacologist Dr. Alberto Augsten, who brings clarity, hope, and science to the discussion. Together, they explore long-acting injectable antipsychotics (LAIs), new treatment advances, realistic expectations, and how education — not force — improves outcomes. If you’ve ever wondered why medication adherence is so difficult in schizophrenia — and what actually helps — this episode delivers answers rooted in empathy, evidence, and lived experience. Our guest, Dr. Alberto Augsten, is a board certified toxicologist and psychopharmacologist. He is a consultant and expert witness specializing in psychopharmacology and clinical toxicology. Offering professional, impactful, and strategic consulting services, Dr. Augsten caters to legal, healthcare, and clinical practice development. His expertise encompasses many areas, ensuring clients receive top-notch guidance and insights. Dr. Augsten specializes in providing tailored consulting services to assist in the development and optimization of clinical practice standards. His expertise covers many areas crucial for clinic development, allowing for standard of care reviews concerning those matters. Dr. Augsten's influence extends beyond his clinical practice. He offers consultation and education services to pharmaceutical companies, contributing to the advancement of pharmaceutical knowledge and practices. Through his contributions, he is helping to improve patient outcomes and ensure the highest quality of care. Our guest host, Rachel Star Withers, creates videos documenting her schizophrenia, ways to manage, and let others like her know they’re not alone and can still live an amazing life. She has written “Lil Broken Star: Understanding Schizophrenia for Kids” and a tool for schizophrenics, “To See in the Dark: Hallucination and Delusion Journal.” Learn more at RachelStarLive.com. Fun Fact: She has wrestled alligators. Our host, Gabe Howard, is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, "Mental Illness is an Asshole and other Observations," available from Amazon; signed copies are also available directly from the author. Gabe is also the host of the "Inside Bipolar" podcast with Dr. Nicole Washington. Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without. To book Gabe for your next event or learn more about him, please visit gabehoward.com. Learn more about your ad choices. Visit megaphone.fm/adchoices

Ask this episode

“What did the council decide on item 42?” — answered with the speaker and the moment.

Transcript

Related