Please help with paranoid family member - page 2

by ernurse2244

6,450 Visits | 18 Comments

I need help. I was having alot of trouble with my daughter-in-law and just couldn't figure out what was going on. Our relationship had deteriorated over several years from warm, close to hostile and lots of control issues. ... Read More


  1. 0
    I am not a professional but I am interested someday to try psych nursing as I took care of one of my friend who has schizophrenia for close to a year.

    Have you try your local NAMI (National Alliance for the Mentally ILL) office? They are at www.nami.org

    You might get some down at the trenches kinds of advices from NAMI since most of them are parents with loved one who has a serious MI. If your local chapter has a Family to Family class, you might try to take it (it is a 12 week commitment, unfortunately) dealing with the mental health system, the police, communication with the ill family members, ... etc.

    There is a classic book in which you might know already call "I am not sick - I don't need help!" by Dr Xavier Amador. It is a good book on how to communicate with an illed relative who is suffering from a serious mental illness. If you want to get really technical, there is a hard to get book call "Cognitive Therapy for Delusions, Voices, and Paranoia" by Paul Chadwick, Max Birchwood, and Peter Trower. Some of the principles and techniques you might be able to use. The Brits are a little bit ahead of the US in terms of CBT and serious mental illnesses.

    Hope some of it helps.

    -Dan
  2. 0
    Quote from ernurse2244

    I only want to know what I can do. I can only change my behavior...not her's and not my son's.

    I feel that now I am a target for her paranoia...maybe I should let that keep happening so she won't change to my grand-daugher and/or my son. Just don't know. I have been carrying the burden of this for several years, blaming myself and trying to jump through the hoops that she has created, thinking I could change our relationship if only I did something different. Each hoop I jumped through created two more hoops.

    Please...just some suggestions about how you approach and carry on with paranoid patients.
    Hello, again the following comments are not from a professional. But from someone who does have a love one with sz.

    As for what you can do, here are a few suggestions for you to reflect on:

    • Keep a log of her behavior. That is your documentation which you might need sometimes in the future.
    • In the log, do not make any "diagnosis". Just keep purly description. Let the pdoc do the diagnosing as you are just giving him/her the data.
    • Want to create a short form of the log to hand out to the pdoc or psych nurse if the times comes. The summary should contain behaviors that say either it can be a danger to herself or to other, or that she is "gravly disable" (like won't eat for days). These are the behaviors that they can use legally to hold her and give her some treatments.
    • Do not argue or contradict her paranoia or delusion, which I am sure you know that already.
    • On the other hand, do not go along with it either. Just say your view and leave it. Don't get into a discussion over it.
    • If you are going to address the paranoia (or delusion for that matter), try to address the emotions behind it instead. Lots of time it is some form of fear. Do not address her reason for the paranoia because you will lose 100% of the time since you are not dealing with logic here (it is however perfectly logical to her).
    • One of the hardest thing for families who has someone with a serious MI is the helplessness that one feels. Lots of time, there is NOTHING anyone can do except to watch helplessly their love one slowly get worst and worst. Because the way the laws are set up, all they could hope for is that the illed relative will get bad enough that legally the mental health system will have to take them in, and one just hope it is not too late.
    • Take care of yourself right now. Learn to recognize when you can do something and when you cannot do anything. You are reserving the energy basically for when you can do something. With seriious MI, it affects everyone, not just the illed person. You try not to be part of the "body count" in this battle.
    • Expect your ill relative will say the most customized hurtful things you can imagaine to you. That is part of the illness but recognize that it still hurts like there is no tomorrow in your heart.
    • Create a crisis file. You should be able to do this with the help of your local NAMI chapter or some other organization.
    • Realize that her illness has control over her now and it is probably getting stronger each day until she gets the help she needs. What you can do is to refuse to have the illness control you also (indirectly through guilt or over-worrying... etc).
    • What else, safety for everyone is your number one priority.
    • Do not critisize as lots of people with serious MI have very very "thin skin". They would remember a complement for 5 minutes but they will remember a negative comment for 5 months.
    • Does she has any problem with the term "paranoia"? If so, use something else like "suspicious".
    • Does her paranoia bother her a lot? If so, there might be a small opening in that you can suggest that you know of potential ways to take care of it (going to get medical help). But it will be up to her. It is her choice (she will probably say no, but it is worth a shot). Bascially you are trying to gently push her in the direction where she see there is a price she pays for the paranoia and she does not have to pay the price if she is willing to get help.
    • Does she have a stigma going to a pdoc? If so, do you take any meds at all say for depression. If so, you can share with her that you yourself also go to a pdoc and there is no shame in it, you are doing it through your action.

    Again, these points are not from a professional. It is just from someone who was down in the trenches for a while watching helplessly the one I care for get worst and worst until finally the mental health system is willing to takes over because it fits the legal requirement.

    -Dan
  3. 0
    We have two examples of her behaviour that lead you to think she might be mentally ill: - one seems to me to be a heightened concern about an ex-partner. Perhaps the ex was abusive (her description of him "going postal" suggests this): it is not uncommon for people who have suffered violence to be over-vigilant. The other example seems to me to be the kind of hyper-vigilance and anxiety about the baby's wellbeing and her ability to cope that again is not uncommon in mothers of new babies. I would hesitate before proceeding on the basis that this woman has a mental illness, a conclusion reached after a chat with a counsellor and a look on the Net. If you go looking for personality disorder, you can find it in everyone!
  4. 0
    Quote from CliveUK
    We have two examples of her behaviour that lead you to think she might be mentally ill: - one seems to me to be a heightened concern about an ex-partner. Perhaps the ex was abusive (her description of him "going postal" suggests this): it is not uncommon for people who have suffered violence to be over-vigilant. The other example seems to me to be the kind of hyper-vigilance and anxiety about the baby's wellbeing and her ability to cope that again is not uncommon in mothers of new babies. I would hesitate before proceeding on the basis that this woman has a mental illness, a conclusion reached after a chat with a counsellor and a look on the Net. If you go looking for personality disorder, you can find it in everyone!
    Obviously more pronounced in some.
  5. 0
    Quote from finness
    Obviously more pronounced in some.
    Hardly a very helpfull response to a lady whom is obviously in distress.

    As a UK-based mental health professional with extensive experience of both acute and psychiatric rehabilitation clients, within both in-patient and community-based settings, I absolutley agree with the comments posted by CliveUK.

    CliveUK quite rightly points out that
    Quote from CliveUK
    I would hesitate before proceeding on the basis that this woman has a mental illness, a conclusion reached after a chat with a counsellor and a look on the Net.
    This is an opinion of one who has obviously evaluated the available information within its wholistic, professional, context. To presume clinical diagnosis in the abscence of fact, and then proceed to assume the need for treatment based upon what is effectively hearsay evidence, is helpful to neither ernurse2244 or DIL. This lady needs advice, not speculation.

    If any of the available information were absolute, then clearly DIL's behaviour and mental health needs to be assessed within a professional, clinical framework of reference, and potentially addressed through a psycho-social approach. One which balances her own perception of her beliefs with others perception of problem and need. However, the use of the term "paranoid" should be avoided until explored in greater detail, and clinically evidenced. CliveUK justifiably points out the potential post-natal influence, and this was my initial thought when reading the post. However, such speculation on my part would be tempered by the lack of available information.

    I urge ernurse2244 to seek further advice and guidance upon the matter before accepting a somewhat isolated and detached diagnosis from a counsellor who may not have had the oportunity to assess DIL directly. My unfamiliarity with US-based services does not help you, but here in the UK I would advise those in your position to contact a community-based mental health team for assistance in sourcing professional guidance. Psychiatry is not always preferrable to psychology.
    Last edit by Ishmail on Jul 27, '04
  6. 0
    "Hardly a very helpfull response to a lady whom is obviously in distress. As a UK-based mental health professional with extensive experience of both acute and psychiatric rehabilitation clients, within both in-patient and community-based settings, I absolutley agree with the comments posted by CliveUK."

    Well, SNAP, I guess you told me!!! I tried to be as helpful as possible in my TWO previous replies. How silly of me to have added that off the cuff one-liner in response to CLIVE about personality disorders being present in many, but more pronounced in some. From the sounds of it, I am not NEARLY as polished and professional as you. I didnít realize that we were limiting our responses on this board to those with the appropriate credentials, rather then those with personal experience and empathy.
  7. 0
    Whoa. Let's back off a second, folks.

    This is not ask-a-nurse. I think legitimate thoughts have been offered here with appropriate disclaimers. No one questions the distress the OP is in.
  8. 0
    Quote from ernurse2244
    Thanks for all the answers and questions. I have worked 24 of the last 36 hours so haven't gotten back to you before now.

    I didn't give you alot of details about my DIL to keep my post short. As an ER nurse, I see mental health patients in crisis situations, but don't have much other psych experience. However, I did do alot of research on the 'net about Paranoid Personality Disorder after my counselor suggested that as a possible dx for my DIL. It certainly explained her reaction to many things I did that I did not understand caused such a problem. Just a couple of examples of her behavior...I wanted to put their picture in the paper with an engagement announcement before their wedding. I live in a rural town in Georgia, less than 600 folks...she said no because her ex-boyfriend, who lived in Texas, might see the announcement and "go postal". She won't take the baby to a mall if she can't wear her contact lens because if she has her glasses on she doesn't have good periphereal vision and someone might run up and kidnap the baby.

    All I am asking is for you guys, the professionals, to give me advise on how you approach paranoid patients. I am convienced as I view many of her past behaviors with definitions of paranoia and realize that this explains her behaviors, that she is Paranoid, with a capital P. I can't help her, I doubt that I can get her to seek help. I doubt that I can convience my son to push for her to get help. I only want to know what I can do. I can only change my behavior...not her's and not my son's.

    I feel that now I am a target for her paranoia...maybe I should let that keep happening so she won't change to my grand-daugher and/or my son. Just don't know. I have been carrying the burden of this for several years, blaming myself and trying to jump through the hoops that she has created, thinking I could change our relationship if only I did something different. Each hoop I jumped through created two more hoops.

    Please...just some suggestions about how you approach and carry on with paranoid patients.
    I have two views on this. One is if your daughter in law is as paraniod as you say she is, then probably nothing you do will allow her to bring down those walls. On the other hand, what are the chances of your DIL trusting you? Can you work on that part of the relationship? Usually patients respond to our skill in being very empathic. This does not mean agreeing with them, but rather showing that you understand their situation and how they feel. If you can break some of those walls down, perhaps she may begin to trust you. I always say when in doubt, empathize, empathize, empathize. It does sound like however that these paraniod behaviors are well engrained.

    Good Luck!
  9. 0
    After reading all this, I give my thanks to Nurse Ratched for stepping in. Persons can be fearful or paranoid for many reasons. Without having alot of info but hearing lots of advise, all I can recommend that even if a person has a mental disorder/personality disorder or not, fear is the primary emotion/thought process here. Empathy is good if it is genuine (understanding that person's frame of mind or emotional angst from their own perspective...the DIL). Trust comes with time, never rushed, without an agenda. Come to understand the person's fear in order to understand the rationale of the behavior. Depending how entrenched the fear or paranoia is, provide reality checks as a means to reassure that the environment or others are safe, but never to force the point. Sometimes, empathy can be provided by sharing similar feelings or experiences we have had that have caused similar distress and learning how to cope through it. A person with paranoia, if it is present, feels like everybody's eyeballs are on him/her. Sometimes when interacting with someone of this nature it is helpful to keep the focus on oneself (as you observe the other person), allowing the person to present his/her own concerns when he/she begins to feel more comfortable sharing that info. When it occurs, don't just jump in both feet by digging in deeper. Take a one down position, letting the person be the master of their info. Go slow and at that person's pace. Discuss with an interest to understand how it is like for that person to carry that concern and how tiring/frustrating it might be, especially if he/she has to make major adjustments in his/her life to accomodate this fear/concern in his/her daily life. When the person begins to feel you're trustworthy, he/she may begin asking for "your" point of view. Even here, go slow and be sensitive. The person may be simply testing the waters to see if you are really safe. Do not lie or be dishonest. If you don't know an answer, simply say so. Don't therapize a truely paranoid person...it may distance him/her. Be genuine, honest, empathetic from his/her point of view, matter of fact, and non-confrontational. I don't know if this helps. But, I hope it does.


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