A family needing help dealing with psychosis

gwenith, BSN, RN · Dec 8, 2003

Norm - rather than confrontation and using words like "mentally ill" which carry thier own stigma s- why don't you try the "softly softly" approach - after all you cannot diagnose mental illness from a book. If you can get your parents and even your sister to acknowledge that she needs professional help i.e. a counsellor then you have got her a giant step forward toward getting the help she needs. Sit down with them and have a quiet talk - about how things used to be and how you wish you coud heal the rift in the family and then little by little bring them to the realisation that she needs some assistance.

Gently, kindly and indirectly bring them around it may take several conversations before you get there but beleive me it is a surer path than confrontation. Get them to accept she needs a little "help" - they, especially your parents will be equating mental illness and treatment with locked wards and straight jackets - counselling will sound the better option - often the counsellors can refer someone on and they are in a better position to do so than you are.

Will Benson · Dec 10, 2003

Norm

I'm very sorry to hear about your sister. 4 years is a long time to go without help. I'm also sorry that your family fails to recognize the need for counseling and assistance. I'm guessing they are "running interference" for her when her behavior becomes erratic. However, at some point, she may cause a public disturbance and your family may be put in the position of mandating admission. This is occasionally the case when everyone involved ignores the problem, as though it will go away. Eventually, the problem becomes too large to handle.

Maybe if your family understood this, they might be more objective in their view on your sister and seeking professional help. I don't want this to be taken the wrong way, but perhaps, the sooner the crisis "comes to a head", the sooner she can get help. Please keep us posted on how she is doing.

Will Benson

norm · Dec 11, 2003

Will Bensen

I would like to thank you for your reply to my letter about my sister. You hit the nail on the head every thing that you said is exactly what is going on. Thank you for getting it . This is what i have been up against for a very long time and i am starting to feel helpless and don't know what else to do. I have been trying to protect so many members of my family from being hurt by this illness but the hurt is already gone to far. Thanks again Norm

sanakruz, ADN · Dec 11, 2003

Say to your sister"it must be very frustrating and even scary to think people are tampering in your personal life;you should talk to a counselor, No one should feel as badly as you do. Maybe a doctor can recommend something to give you some relief in the shotterm. I can see you are under alot of stress"

Try validating her experience emotionally, rather than confronting her with reality. To her the delusions are real. You will never convince a delusional person otherwise. it's an exercise in futility.

I dont know what state you live in. Each state deals somewhat differently with involuntary treatment. If you can get her to seek treatment on a vol so much the better. My suggestion is leave your parents out of this if you can

Will Benson · Dec 11, 2003

Norm -

If I may, I'd like to suggest a few things.

First, allow the family to experience some of the problems you have been having with being the "buffer" in these situations. If they have to be put in that position, maybe they will be less reluctant to seek help.

Second, be aware that the paranoid person rarely sees themselves as the problem. Getting them to voluntarily see a counselor is often futile because they will say "I'm not the problem, it's everybody else" thus creating a situation where they rarely follow up with medication or appointments. This then creates a situation where an involuntary admission may occur if the person is a danger to themselves or anyone else or represents a risk to the public welfare because of flawed judgment. Right now it is still just a "family affair". If her judgment is erroneous and her insight is non-existant, it might not be a bad idea to consider guardianship. This could eliminate involuntary admissions. Someone could "sign in" voluntarily for her if she were to need admission. Paranoid persons are at a greater risk for harm to self or others in the community because of greater access to weapons, drugs, etc. Those risks decrease significantly when they are hospitalized.

I appreciate how hard these decisions are to make, but you sound like a great person who is trying to break a vicious cycle and start a tradition of getting help within the family. I wish you well. Keep us posted on how this is going.

Will Benson

Finally, it is good that

sanakruz, ADN · Dec 11, 2003

Please realize that whatever the cause of your sister obvious distress, she is still reacting to it.

ALL OF US need to have our experiences validated. Just because one believes strangers are draining one's checking account, however erroneous this may be, does not change the emotional reaction one experiences behind such a belief.

To assume that an individual has no insight, and thus needs to be conserved or placed on a guardianship coming out of the gate,

is wrong. For many reasons. My experience with mentally ill people has shown me time and again that the greatest fear of all, after the FBI, aliens, Satan, etc. is LOSS OF SELF.

Please try, Norm, to get your sister to seek help voluntarily by showing her you care about her well being. Without treatment she will get sicker. Share this with her. Tell her stress causes physical illness(which indeed it does). A person may be more open to seeking physical based healthcare because there is less stigma there.

Whistleblower · Sep 7, 2004

my family has a history of psychosis and we r now dealing with the 3rd sister who is displaying psychotic behaviour. because of her personality which is a very sweet loving woman it is hard for some members of my family to recognize that she could possibly be mentally ill. she has been displaying paranoid and accussatory delusions of everyone around her for the last 4 years . my parents and her twin sister seem to be the ones that r the most in denial and don't discourage this nasty vindictive behaviour. her marriage has broken up and now my surrounding and extended family are all fighting and don't want to be around each other and we use be very very close to one another. i have spent the last 4 years trying to tell my parents that my sister is mentally ill but because she looks so normal on the outside they refuse to listen to what i have to say. my words fall upon deaf ears. this has driven a wedge between my family to the point that we don't spend holidays and special occassions together anymore because no-one wants to be her next victim of abuse or accusations . she is not a nice person to be around anymore.. . some of my sisters delusions are people stealing from her, people manipulating her bank account , her husband cheating, people stealing her mail, she sees all people and every situation in a negative way which is the opposite of her when she is well. what i need is some literature on psychosis signs and symptoms and effects on people families and how families can cope and deal and recognize these behaviours so that i can show my parents that what i have been saying is really happening to us and that something can be done. could u direct me to a web site on these issues or give me some advice on a different approach with my parents. i thank you very much for your time and appreciate any advice or help u can give me thx again

will this help convince your family?

regards,

tom

what is mental illness?

mental illness is a term used for a group of disorders causing severe disturbances in thinking, feeling, and relating. they result insubstantially diminished capacity for coping with the ordinary demands of life. mental illnesses can affect persons of any age-children, adolescents, adults, and the elderly-and they can occur in any family. several million people in the country suffer from a serious long term mental illness. the cost to society is high due to lost productivity and treatment expense. patients with mental illness occupy more hospital beds than do persons with any other illness. those with mental illnesses are usually of normal intelligence although they may have difficulty performing at a normal level due to their illness.

schizophrenia

schizophrenia is one of the most serious and disabling of the mental illnesses. it affects approximately one person in one hundred. the disease affects men and women about equally. its onset is usually in the late teens or early twenties. people with schizophrenia usually have several of the following symptoms:

disconnected and confused language
poor reasoning, memory and judgment
high levels of anxiety
eating and sleeping disorders
hallucinations-hearing and seeing things that exist only in the mind of the patient
delusions - persistent false beliefs about something, e.g. others are controlling their thoughts
deterioration of appearance and personal hygiene
loss of motivation and poor concentration
tendencies to withdraw from others

unfortunately there are many myths about schizophrenia. people with schizophrenia do not have a "split personality" and are not prone to criminal violence. their illness is not caused by bad parenting and it is not evidence of weakness of character. their illness is due to biochemical disturbance of the brain.

depressive illnesses

depressive illnesses are the most common of psychiatric disorders. they are generally less persistently disabling than schizophrenia. the primary disturbance in these disorders is that of affect or mood. these mood disorders may be manic depression (bipolar) in which the person swings between extreme high and low moods, or they may be unipolar in which the person suffers from persistent severe depression. about six percent of the population suffers from an affective disorder -a major cause of suicide. persons diagnosed as having bipolar illness usually have several of the following characteristics during a period of mania:

boundless energy, enthusiasm, and need for activity
decreased need for sleep
grandiose ideas and poor judgment
rapid, loud, disorganized speech
short temper and argumentativeness
impulsive and erratic behavior
possible delusional thinking
rapid switch to severe depression

persons having depression (or depressive phase of a bipolar disorder) may have four or five of the following characteristics for two weeks or longer:

difficulty in sleeping
loss of interest in daily activities
loss of appetite
feelings of worthlessness, guilt and hopelessness
feelings of despondence or sadness
inability to concentrate
possible psychotic symptoms
suicidal thoughts and even actions

other disabling mental illnesses include severe anxiety and panic disorders, personality disorders, and obsessive compulsive disorder.

causes of mental illness

the causes of biologically based brain diseases are not well understood, although it is believed that the functioning of the brain's neurotransmitters is involved. many factors may contribute to this disturbed functioning. heredity may be a factor in mental illness as it is in diabetes and cancer. stress may contribute to the onset of mental illness in a vulnerable person. recreational drugs may also contribute to onset but are unlikely to be the single cause. family interaction and early child training were once thought to cause mental illness; however, research does not support that theory any longer.

can mental illness be prevented? cured?

since the causes of long term mental illnesses are not known, there is no effective prevention at this time. more research is needed to determine causes and strategies of prevention. likewise, there are no cures for mental illnesses. however, treatments can substantially improve the functioning of persons with these disorders.

what are the treatments for mental illness?

an expanding ranges of medications markedly reduce symptoms for many people. supportive counseling, self-help support groups and community rehabilitation programs promote recovery and build self-confidence. housing and employment services enable some people to develop independent living skills, hold a job, and achieve a fulfilling life. others may need support for most or all of their lives. helping them achieve a sense of dignity with the highest degree of independence, productivity, and satisfaction with life is the goal.

the above write-up was provided by nami, the national alliance for the mentally ill, of arlington, va.

see our bibliography of brain and neurological diseases

Thunderwolf, MSN, RN · Oct 6, 2004

Norm, you got a lot of good info here. The degree of insight the identified patient has is a key factor. It sounds like your sis has been sick for a long time, probably longer than 4 years before symptoms became evident. You are sort of stuck in a situation which many folks were stuck in a long time ago when caring for a person with Alzheimer's... which left the identified care giver burned out, unheard, and unappreciated. How old are your parents and your sis? Stigma and fear of stigma or "airing ones dirty laundry" sort of speak, which entails acknowledging a problem, even a severe problem, exists can be difficult for older folks. Generational factors may be a reason. I commend you for sticking up for your sis, being there. One of the most importnat things you can provide your sis is being that piece of structure in her life that doesn't change...even when others pull away. In paranoia, the key element is fear. That is why folks with paranoia often become afraid and angry. Being a reality check for her when she questions safety of her environment and others can reduce her anxiety and lessen her fear. Never lie to a person with paranoia. He/she can pick that up quite readily. Being honest, straight forward, matter of fact is usually the best approach while being supportive. Is she a harm to herself or others? That is the key question you need to ask which needs to determine if involuntary hospitalization is warranted. If she is at risk to self (neglect/harm) or others, you can seek legal guardianship to make her medical choices for her in obtaining treatment. If you might overwhelmed with this, you can seek an attorney to be her guardian which lets you off the hook for awhile from "being the heavy"...which sounds like you have been for a long time already. Patient insight and safety are the two key issues when paranoia is present. Norm, I hope all goes well. Make sure to take care of your needs too.