Mom is 84, diagnosed with paranoid schizophrenia. Has been hospitalized unwillingly multiple times. Cannot believe she is ill. Will not take any medication whatsoever. She is extremely intelligent, was on the debate team at school, a grant researcher for a university. She has delusions and hallucinations that result her making poor and disastrous financial decisions. I am the only child, besides one cousin, no else in her/our family wants to deal with her. She recently fell, broke her hip and refused surgery, not believing she had broken something. She was forced to have surgery, has been found to be “without capacity” by the hospital physician. Now there is a legal battle to keep her in the hospital and reinstate the Roger’s guardianship. My question, at what point do I stop trying to help her?

You should try everything in your power to help her. Do everything you can think of. At the point at which you’ve tried everything that is humanly possible, then perhaps you can stop trying. If you have not reached that point yet, then you shouldn’t give up.

I once worked with a family in a similar situation. It was a mother, father and their three children. The mother had schizophrenia. She had been involuntarily hospitalized approximately 50 times. Her hospitalizations were precipitated by her stopping her medication. She would subsequently decompensate and invariably have to be hospitalized against her will. It was a vicious cycle.

Over time, in addition to her mental illness, she developed health problems. They significantly complicated her situation because when she would stop taking the psychiatric medicine, she would also stop taking the medications for her health problems. They were life-sustaining and when she would stop taking them, her life would be in danger. It is not an exaggeration to say that her psychiatric decompensation nearly caused her death, on a number of occasions. She was her own worst enemy.

Her husband had become very frustrated with repeatedly trying to convince her to take her medication. She did not listen to him. Nothing he did was working. Eventually, he stopped trying, figuring there was nothing else he could do. But the reality was, it was a mistake to give up. He had not tried everything. The proof of this was that his daughters were able to convince her to take her medication in shot form. After she began taking her medicine as a long-term injection, she never had another illness relapse. The shot worked. She never spent another day in a psychiatric facility. That was a major accomplishment.

I can fully appreciate the frustration that you have. It’s undoubtably very challenging. You’re dealing with someone who does not recognize their illness despite a great deal of evidence indicating otherwise. This is a situation that few people would understand. Even if you want to give up, you might reconsider until you’re certain that you’ve tried everything you can. There still may be an idea that you have yet to try.

One way to generate new ideas is to interact with people who are facing similar problems. You may be able to find these individuals in your local community. Most communities have support groups run by the National Alliance on Mental Illness (NAMI). NAMI is an advocacy organization for people who are caring for loved ones with mental illnesses. Many support group members can relate and empathize. If nothing else, they can be a support system for you during this difficult time.

Your mother’s inability to recognize that she is ill is a symptom of schizophrenia called anosognosia. To varying degrees, it affects about half of the people with the illness. If someone doesn’t think they’re ill, they will typically not accept treatment for an illness they don’t believe they have. The result is often the refusal of all treatments.

In extreme cases, the solution is guardianship. In a guardianship scenario, someone is appointed to make decisions on behalf of the incapacitated individual. It seems as if your mother is not capable of making decisions for herself at this time. If she lacks the capacity to make decisions that are in her best interest, and is in fact making harmful decisions, then something must be done. Even if it’s difficult, you should try to protect your mother. Guardianship may be necessary.

I’m not certain if I’ve properly answered your question but the bottom line is that if your mother cannot care for herself, due to her disability, and there’s no one else who can help her, then it may be up to you to help her. Hopefully, there will be a peaceful and satisfactory resolution to this problem. Reach out to your local support group for further assistance and see a counselor if you need more assistance. If you have additional questions, please don’t hesitate to write again.

Dr. Kristina Randle