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Does My Mother Have a Mental Illness Problem?

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

From Australia: I am losing hope and no one I contacted can give me help because no one knows what I’m going through which brings me here.

I have no idea if my mother is ill or not, I feel very sorry for her because of this. She is a single and very lonely 55 year old. I still live with her, but planning to move out as soon as possible because of her condition. My brother moved out because he couldn’t deal with her.

We both have a very bad relationship with her because she constantly accuses us and everyone else for stealing her things. She says ‘stop taking my toothpaste’ or ‘toilet paper’, just everyday objects around the house. Even when we deny it she still believes herself and goes ‘well the locals must have taken them.’ She says these types of things only when they have ran out. Every time my boyfriend is over, when he leaves she accuses him of taking things.

She is unemployed and hasn’t had a job for over 10 years because of this and being home 24/7 and being bored isn’t helping it. She has lost all of her friends because she accuses them of taking her things like the front door for example. Even with serious matters like paying the rent, she says she pays it but she obviously hasn’t seeing as we are getting evicted and she still is saying it’s all a lie and ignoring it.

My father is trying to help her, but he says it’s too difficult because she never listens to anyone. She is just believing her lies. I want to move out so badly, but I don’t want to leave her alone because all she has is me and no one else as my brother doesn’t talk to her.

Another example if something gets ran out of or broken she won’t buy a new one because she’ll think someone will steal it ‘again’. She doesn’t listen to us when we say get help so I have no idea what to do. Whenever she leaves the house she takes all her belongings with her because she’ll think I’ll take them. I seriously need answers because as much as I try to ignore it, it’s still extremely hard for me.

I can’t make a specific diagnosis on the basis of a letter. I’d need to meet with your mom. But you’ve given me enough information to confirm that, yes, she does have a problem. It’s pointless to try to reason with her because her beliefs are irrational. You and the family need to take stronger steps toward getting her help that is helpful.

The first stop should be with her physician. There are a number of medical problems that can cause the type of paranoia you describe. It’s important to check for those before pursuing a mental health intervention. It may be that the problem is as simple as a vitamin deficiency, but it might also be a more complicated medical issue.

If she is medically okay, then it’s time for a mental health evaluation. It must be very difficult for her to live with the level of anxiety and fear that you described. A combination of some medication and talk therapy could help her live more comfortably in the world.

At 17, there is a limit to what you can do. It’s unfair for the rest of the family to leave it to you to manage and protect your mom. I hope you can enlist your father and perhaps other relatives to get her real help. I suggest that the most useful first step is to hold a family meeting without her. Talk about how you can work together to find out what help is available and how to provide the incentives she needs to accept your collective support.

I wish you well.
Dr. Marie

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My Sister Recently Diagnosed with Schizophrenia Believes Our Other Sister Is Evil

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

My younger sister recently diagnosed with schizophrenia believes that our older sister is a sociopath and, amongst many other things, abused her, helped two mysterious men abuse her and our younger brother, got him kidnapped, etc. Before these beliefs, she was absolutely terrified that SHE was the sociopath/psychopath, stating incidences of regular childhood bickering and arguing as evidence of her sociopathy. She has been hospitalized twice, the first time for entering into what we thought was a deep depression (even though this is when she first expressed to me absolute terror at the thought of her being a sociopath, destined to be evil) where she didn’t eat, talk or sleep much and then the second, in which she full-on displayed a psychosis, believing she was dead, she was a psychopath, and lastly, the one that has remained, is that our older sister has manipulated all of us into doing evil things and is a sociopathic mastermind. After her second hospitalization of two weeks, she has since been doing very well. Eating, sleeping, activities, joking around, hopeful for the future. It makes my family very happy to see her doing so well and no longer a danger to herself. The only issue is that she still strongly believes that our older sister is the reason she was hospitalized, that she does NOT have schizophrenia and that our older sister is pure evil. We don’t know how to confront these thoughts in a caring, gentle and helpful way. Every time we broach the subject, she feels attacked and like we are still under the “power” and “manipulation” of our older sister. We are all under the same roof, except for our older sister because we believe it would not be good for either of them to be near each other just yet. My younger sister takes her medicine, though she’s tried a couple of times to see if she can get away with skipping here and there, but refuses to go to therapy to confront these issues. My family is thankful for her great improvements but we worry about my older sister and whether my younger sister will ever accept her. What can we do about these delusions? How can we make the both of them feel heard and accepted and loved? How does one confront these very strong beliefs with helpful and kind truth? Please help

You can’t do anything about her delusions. It’s a symptom of the illness. The last thing you want to do is “confront” her delusions. It’s very likely that no matter what evidence you present, it would make no difference. That is the nature of delusions.

By definition, a delusion is a belief that is firmly held despite evidence to the contrary. Attempting to dissuade her of a delusion may do more harm than good. It may only cause her to become upset with you, create chaos in the family, or make her trust you less, and so forth.

The delusion may eventually go away or may shift into something else. That has already happened once. It used to be that she thought she was the psychopath and now she thinks it’s her sister. It may shift again but for now, avoid the discussion whenever possible. If she brings it up, change the subject. Understandably, that might increase her suspiciousness but the last thing you want to do is attempt to disprove delusional ideas. It’s a battle you can’t win.

Medication helps but it can only do so much. It’s fairly common for individuals with schizophrenia to take medication that reduces most of their symptoms but not all of them. There are often remnants. A different medication might help to reduce this particular delusion but with all the other positive aspects of her recovery, it may not be the right time for her to switch. Discuss it with your sister and her psychiatrist, should the need arise.

I would recommend reading the book I’m Not Sick, I Don’t Need Help written by Dr. Xavier Amador. It’s an excellent book about common issues families face when caring for a family member that has schizophrenia.

In the book, Dr. Amador explains that about 50% of people with schizophrenia do not believe that they are ill because of a condition called anosognosia. Anosognosia is a symptom of the illness. It involves the idea that an individual does not know that they are ill. It’s also referred to as “lack of insight.” It’s not thought to be something that a person is deliberately doing to be difficult. Rather, people with anosognosia truly do not know they are ill.

Anosognosia is also found among people with Alzheimer’s. At some point during the progression of the disease, an individual with Alzheimer’s loses the ability to recognize that they are ill.

If an individual doesn’t think they are ill, it logically follows that they would not believe that they need treatment for an illness that they don’t think they have. Thankfully, your sister continues to take medication, however, you did mention that there are times when she tries to skip it. That’s fairly common among people with schizophrenia. One has to be careful not to skip medication, especially with schizophrenia. Stopping medication can cause a relapse. It is a very common problem among people with schizophrenia.

I think that you’ll find the aforementioned book helpful for gaining a deeper understanding of schizophrenia and how families can best interact with a loved one who has the illness. It contains many great tips and ideas for family members in situations like yours. There are many other good books in addition to resources on the internet.

You mentioned that your older sister is currently not living in the family home because of your sister’s delusion about her. That’s probably a good idea for now. As mentioned previously, her delusion may shift or potentially go away but only time will tell.

The most important thing is to encourage your sister to continually take her medication and to remain in treatment. That can often be difficult to do especially if an individual does not believe that they have an illness. When it comes to schizophrenia, continuous treatment is of paramount importance. Consistent treatment is correlated with fewer episodes and hospitalizations and an overall better prognosis.

I hope this helps. Please write back if you have additional questions. Please take care.

Dr. Kristina Randle

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Sister Doesn’t Understand My Mental Illness

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I have a way older sister that I am close to. We don’t live close, in fact, in different sides of the USA, but we are still kind of close to each other. We are close emotionally I mean, as sisters. Anyway, I have schizoaffective disorder and I have tried to talk to her about it. Although she doesn’t think I have it. We haven’t lived in the same house actually since she went off to college years ago before I got diagnosed. I got diagnosed at 17. We haven’t lived in the same house since I was 9, but we are still kind of close. We talk at least once a week a bit, sometimes more. I’ve become a lot more reclusive since I’ve been diagnosed and have kept and continue to keep things to myself. She believes I only suffer from depression or anxiety and has questioned whether I just make my, diagnosed, delusions up for attention.

Since I was about 20 I stopped talking about my illness with her and some other family. Though she knows some things because of my numerous hospital stays but I quit talking about it one on one with her because I think she thinks I fake it or something. Which I don’t. I’ve been to numerous doctors and hospitals that have confirmed my diagnosis since I was 17. I have at one point questioned my diagnosis but after so many opinions and hospital stays, I realize it is true.

By now I’m wondering if she just has a hard time accepting it rather than genuinely think I’m faking it. What do you think?

She does not talk about it when I used to mention it. She doesn’t hold the conversation when I used to mention it… so I think it kind of makes her uncomfortable, too. I can mention my sadness or something and she’ll talk with me but the psychosis part, I wont get a reply on. I kind of feel disappointed but mostly not because it’s embarrassing for me. I think she may think I don’t have it too because she doesn’t live with me and is not around me to see my episodes (has never been around first hand to), but she doesn’t seem to want to talk about it either. I don’t push it, anyway. I live with another family member though that does believe I have it. I have lived with them for a long time though anyway; my whole life.

The reason it disappoints me is because the part she doesn’t want to talk about is a major part of my life.

What do you think?

I think you are a resilient and brave person and it would behoove you to have either a family therapist or the doctor who diagnosed you to have a meeting with you and your sister. Involve any other family members who are interested so they can ask questions, get information and understand a little bit more about your struggle and courage in dealing with this. Having information coming from a professional is often a better way for family members to learn and understand.

Wishing you patience and peace,
Dr. Dan

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Can Someone Have Schizophrenia and Borderline Personality Disorder?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I have a client that I am trying to help get in touch with mental health services. He has previously been diagnosed with schizophrenia, PTSD, and borderline personality disorder. I was recently told that it isn’t possible to have both schizophrenia and borderline personality disorder. Is this true, and if so what is the reasoning?

I am not aware of any “rule” that says that individuals diagnosed with schizophrenia cannot be diagnosed with borderline personality disorder.

Psycom’s website states, “Schizophrenia and borderline personality disorder (BPD) can share symptoms. One study found that both patients with schizophrenia and patients with BPD experience hearing voices. The difference between the two being that paranoid delusions occurred in less than one-third of patients with BPD, compared with two-thirds in schizophrenia. The study also found that auditory hallucinations are common in both populations. According to the results of this study, schizophrenia and BPD frequently co-exist. Accurate diagnosis of either or both conditions plays an important role in establishing an effective treatment plan.

As stated on Psycom’s website, “The term “borderline schizophrenia” does not refer to an established diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. It is sometimes used, however, to refer to an individual who meets some, but not all, of the criterion for schizophrenia or to refer to parallel symptoms of borderline personality disorder and schizophrenia. As noted previously, schizophrenia and borderline personality disorder (BPD) can share symptoms: one study found that both patients with schizophrenia and patients with BPD experience hearing voices. The difference between the two being that paranoid delusions occurred in less than one-third of patients with BPD, compared with two-thirds in schizophrenia. The study also found that auditory hallucinations are common in both populations. According to the results of this study, schizophrenia and BPD frequently co-exist, however, accurate diagnosis of either or both conditions plays an important role in establishing an effective treatment plan. While BPD is characterized by a pattern of instability in interpersonal relationships; schizophrenia is characterized by a range of cognitive, behavioral, and emotional dysfunctions.”

Perhaps the person you learned this information from incorrectly believes that borderline personality disorder means that the individual is “bordering” between neurosis and psychosis. Under this theory, a person could not be schizophrenic because they have not crossed the psychosis threshold (i.e. their bordering between neurosis and psychosis), a required feature of a schizophrenia diagnosis. “Borderline” does not mean that an individual is teetering between neurosis and psychosis, although some believe this. People with borderline personality disorder display certain symptoms such as mood and self-image instability, difficulty engaging in relationships, anger and depression, “all or nothing thinking”, and so forth. A person with schizophrenia can display these aforementioned symptoms, in addition to psychosis, as well as some of the other symptoms of schizophrenia. The two disorders are not mutually exclusive meaning that if a person has schizophrenia, then he or she cannot be diagnosed with borderline personality disorder. From my understanding, it is possible for an individual to have both disorders simultaneously. It may not be common, per se, but it’s still possible.

Lastly, to further illustrate BPD and schizophrenia similarities and differences, study.com summarizes, “People with any personality disorder (such as BPD) tend to lose the normal flexibility of personality. They are relatively coherent, and can think for themselves. Their thoughts make sense, more or less, and they can interact at some level of normalcy. Their problem is that their minds are stuck in a sort of psychological rut. In the case of the BPD sufferers, that rut is right on the edge of complete instability. Their relationships tend to be intense and difficult, because their thoughts and emotional reactions make intimacy difficult, yet they cling desperately to the people who are willing to spend time with them. Schizophrenia is not a personality disorder, in the way we described BPD. People who suffer from its various forms are losing touch with reality, altogether. Instead of having personalities that cause difficulty by becoming rigid and inflexible, the schizophrenic personality begins to dissolve. The BPD individual may walk a strange ‘road’ of inconsistencies in his life, but the schizophrenic may walk no ‘road’ at all. His day is often spent in constant distractions, confusions, distortions, and contortions caused by the fragmented activities happening in the various areas of the brain.”

I hope this information helps. Thank you for writing.

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Paranoid Schizophrenic Father Told Conflicting Diagnoses

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

My father has had paranoid schizophrenia for about ten years now, but it was hidden from me until recently. It isn’t severe enough that he is suicidal or has hallucinations, from what I’ve seen. He has been taking Abilify. Around the summer of last year, his psychiatrist decreased his dosage. (I think his psychiatrist at the hospital also changed around this time.) Afterwards, his symptoms were exhibited more strongly again; he was very anxious, and began to call certain types of food poison.

His psychiatrist prescribed him a higher dosage of Abilify again. However, once he got this prescription, he refused to take the medicine. He called it poison and read through the entire side effects list, claiming that it would kill him. He refused to eat food that was cooked more than a day ago. We basically had to force him to take his medicine though he did it before.

When I went back to school 2 months ago, he was taking his medicine regularly again. Before I went back home again at the end of March, he started to refuse his medication again. A random doctor friend of his referred him to a psychiatric specialist that came to his office. This specialist is of the same ethnicity as us and, according to my dad, did a bunch of tests. He then deemed that my dad didn’t have to take Abilify anymore. Since he received confirmation from a professional, he completely rejected any suggestions to take his medicine.

I’m really worried about a relapse. Although his symptoms are not very severe right now, he still is very picky with his food and seems to have slight depression because of work. His original psychiatrist continues to call to get him to go to an appointment (he has skipped the last two), or else they will have to send a mobile team to check up on him at home. This may lead to him being admitted to the hospital but he will then possibly lose his job. I have explained to him multiple times that he needs to tell his original psychiatrist what the new psychiatrist said. He just deviates from the topic every time or just doesn’t respond or shrugs it off. Please help me with this confusing situation.

You are dealing with one of the main challenges of caring for a loved one with schizophrenia: not wanting to take medication. It is very common among people with schizophrenia.

There’s a variety of reasons why people with schizophrenia might not want to take their medication including: they don’t like the way it makes them feel and they don’t believe they need it.

About 50 percent of individuals with schizophrenia don’t recognize that they are ill. This neurological condition is called anosognosia. Because they do not believe they are ill, they conclude that treatment is unnecessary and often subsequently refuse all treatments.

You should continue trying to convince your father to take his medication but as you recognize, this is difficult. You cannot force him to take his medication even though you know that it can stabilize his symptoms. This is one of the most difficult emotional aspects of caring for a loved one with schizophrenia. You know the medication helps because you’ve seen it work, yet your loved one won’t take it and becomes sicker and sicker. It’s the tragic reality that characterizes so many cases of schizophrenia.

Ultimately, the mobile team may have to come to the home and admit him to the hospital. Obviously, that is not the ideal outcome, but at least you will know he’s safe in the hospital. The hospital staff will constantly monitor and treat his symptoms and keep him safe.

If he loses his job, then you may want to contact an attorney to assist your father in applying for Social Security Disability Insurance (SSDI). SSDI is a federal program that, if approved, will provide your father with health insurance and a monthly stipend.

For additional assistance, I would recommend contacting your local National Alliance On Mental Illness (NAMI) support group. NAMI is a free support group for people who are caring for a loved one with a severe mental illness. Virtually every community has a NAMI presence. I would also recommend the book I’m Not Sick I Don’t Need Help: How To Help Someone With Mental Illness Accept Treatment by Dr. Xavier Amador. The book provides practical assistance to family members dealing with the challenge of caring for a loved one, with mental illness, who does not want to take their medication.

If you have additional questions, don’t hesitate to write again. Please take care.

Dr. Kristina Randle

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I Have GAD

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

So my name is Lillyan, im 19 years old I have GAD. (General anxiety disorder) And it first started about 6 months ago, It hit me like a train, worse thing ive ever experienced in my whole life. It was crippling anxiety my family had no idea what to do and neither did I. (Still kinda dont) My i have super bad tremors and I still havent went back to work yet. Sometimes I have off the wall thoughts. Like ill be laying in bed and ill hear a sound or ill just automatically think there’s a shooter in the house and then the image will pop into my head. I wont see it as if I was like seeing things but it will pop into my head. I have to constantly have something on to block out any sound so i dont get nervous.Is that normal to have thoughts and images pop up like that? my worst fear is that ill end up crazy or Schizophrenic. I never once have heard or seen anything other than me making myself nervous and thinking i seen something and it really just being a lamp. This is all new to me, and its hard to talk to my family about it because they think im full of it i will be seeing a therapist next week but id really like some clarity now.

You mentioned that you are seeing a therapist next week. I’m wondering if you had seen a therapist previously since you have identified yourself as having generalized anxiety disorder (GAD). I highlight this only because it’s ill-advised to self-diagnose. Your therapist would be in the best position to give a proper diagnosis.

You described an experience where you had crippling anxiety coupled with “super bad tremors.” These “super bad tremors” were so bad that they kept you from returning to work. It’s possible that you are describing a panic attack, something that I will describe more in depth below. But it’s also possible that you are describing a medical condition. It would be prudent to consult your primary care physician. They will rule out any possible medical conditions.

Regarding panic attacks, the Diagnostic and Statistical Manual for Mental Disorders (DSM), the guidebook used by mental health professionals to diagnose disorders, provides this definition. They define a panic attack as an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes. Individuals who have recurrent panic attacks may be diagnosed with panic disorder.

GAD, on the other hand, involves excessive anxiety and worry occurring more days than not for at least six months about a number of different events and activities. Individuals with GAD find it difficult to control their worrisome thoughts. In addition, they experience a number of other symptoms including but not limited to sleep disturbances, irritability, restlessness, and so forth. The anxiety common among GAD sufferers interferes with daily life activities and causes a significant level of distress. Having a panic attack is not a symptom of GAD. GAD and panic disorder are two different disorders.

It’s also not uncommon for people prone to anxiety to worry that they are developing schizophrenia. In fact, it is one of the most common concerns that I see here at Psych Central. It’s probably due to the fact that people with anxiety disorders tend to worry about developing all sorts of ailments. Schizophrenia, in the minds of some people, is considered a very frightening disorder. Thus, it makes sense individuals with anxiety would be drawn to what they consider to be the worst possible scenario. None of the symptoms you described in your letter would suggest schizophrenia.

I provided the aforementioned information to provide some insight into what clinicians consider when diagnosing mental health disorders. Gaining the proper diagnosis is important however, what might be most important, is treatment. The fact that you will be seeing a therapist is great news. Anxiety disorders are highly treatable conditions. Many people find therapy, and, in some cases medication, to be quite effective in treating their anxiety symptoms.

You are on the right track. You recognize the problem exists and you’re seeking treatment. You are doing what you should be doing. I wish you luck with your efforts. Please take care.

Dr. Kristina Randle

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Fear of Schizophrenia

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

So I’ll start by saying that about a year and a half ago I suffered an intense panic/anxiety attack whilst on cannabis. This was catalyzed by an intense fear that I’d somehow triggered schizophrenia by smoking and I was basically doomed. Since then I would say that I’ve developed a phobia of having schizophrenia, I guess you could call it a schizophrenia OCD, where I always fear I’m developing delusions, hallucinations, paranoia, etc; a fear that i’m in the prodrome of schizophrenia essentially.

After this panic attack I felt spaced out and dissociated (depersonalization/derealisation), which led me to continue to worry that I was becoming insane. I sought professional help via a psychologist, who diagnosed me with GAD and health anxiety after an evaluation and an extensive 200 question screening test that came back to show that I undoubtedly had an anxiety disorder. I continued to see him over the course of a few months and even at my worst, when I definitely thought I was delusional, he still maintained that I had anxiety.

My concern is (now) this: about 4-5 years ago, around the age 20-21, I went through a pretty rough time in my life where I was pretty down and had low self esteem. I guess looking back you could say that I was self medicating through alcohol and cannabis, but I thought I was just living it up with my friends and “being young” at college. During this time I was receiving benefits from the government for my degree and also working a cash-in-hand job, so I was earning a decent enough wage. I began to worry that I would eventually be caught for this tax evasion, as I had earned a sizeable amount of undeclared cash, and I was concerned that the tax office would somehow find out about my indiscretions and I would either receive a hefty fine or have some sort of criminal punishment if I couldn’t pay the fine (which I couldn’t). I even was hesitant to speak on the phone about my hours and how much money I was earning incase the tax office cracked down on tax evasion and obtained a bunch of phone records etc.

I wasn’t delusional/paranoid beyond rationality, and when I spoke to my friends/family about my concerns they were able to talk about the options and the likely hood of this actually happening, which helped. It didn’t rule my life or significantly impact on my life, but I guess I just felt really guilty that I was breaking the law?

My question is…maybe this worry/paranoia that I experienced a few years ago is somehow linked and I was experiencing prodromal psychosis way back then, but I didn’t realise. I chalked it up to being pretty down and feeling pretty worthless, coupled with the fact that I WAS in fact doing the wrong thing.

I receive many letters from people who experience similar fears about having used drugs and subsequently developing schizophrenia. It seems to be a relatively common fear.

The letters that I receive are anecdotal evidence of the danger of drug use. The most dangerous aspect of using street drugs is that they are unregulated. They may contain any number of poisons and you simply don’t know where they come from and how they have been treated.

Your episode of concern occurred years ago. You became “paranoid” about your engaging in tax evasion. Strictly speaking, your paranoia was warranted. You were engaging in illegal behavior and were worried about getting caught. Your concern was justified.

The difference between your paranoia about tax evasion and the paranoia that people with psychotic disorders experience, is that yours was warranted and theirs is not. People with psychotic disorders are frightened of something occurring to them that in fact has very little or no chance of occurring. Their concerns are not based in reality. They believe something to be true that in fact is not true and has no basis in reality.

The diagnosis of schizophrenia requires a certain set of symptoms for a specific length of time. I cannot provide a diagnosis over the Internet but what you’ve written does not seem to be suggestive of schizophrenia. To further support that, you were evaluated by a psychologist who asked you over 200 questions and it was determined that you had anxiety and not schizophrenia.

If you continue to have anxiety, then it would be wise to begin counseling. Counseling can be quite effective for anxiety, particularly by helping you stay focused on reality. I hope that I’ve answer your question but if you have additional concerns please don’t hesitate to write again. Please take care.

Dr. Kristina Randle

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How do you confront a Schizophrenic?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

My brother-in-law is demonstrating symptoms of schizophrenia. It appears that he has been diagnosed as such, since he has prescriptions for several anti-psychotic medications. However, he does not personally believe that his is mentally ill. What he DOES currently believe is that he is being stalked by people who are intent on tormenting him. These people talk to him through the walls, look in through the windows, walk on the roof at night, shine flashlights at him, and know everything he does, everywhere he goes.

This has been an ongoing psychosis for several years. Every member of his family has requested that he be evaluated, which he does, receives medications, then promptly becomes non-compliant, as he does not believe he needs to be on them.

Lately, he is also becoming very depressed, as he feels that his tormentors have taken his life from him, and not allowing him to live normally. He has dependency co-factors, as he drinks alcohol, smokes marijuana, and smokes cigarettes. There may be other drug interactions that I am not aware of.

How do I confront him and help him understand that these tormentors exist inside of his head, and aren’t actually crawling all over my house? I’m sure that if he would become compliant on his medications, he would be able to live the life he wants to live.

The simple answer to this complex question is that you do not confront an individual with schizophrenia. Nothing good or productive can come from such a confrontation.

With at least half of the people who suffer with schizophrenia, they actually do not know they are ill. They are not denying they are ill to be difficult or cause problems in the family. There have been over 100 scientific studies that show that at least half of people with schizophrenia do not know they are ill. Scientists think that these 50 percent of individuals with schizophrenia who do not know they are ill suffer with anosignosia (lack of insight), a brain defect related to the frontal lobes that makes it impossible for them to recognize their illness. While it can be frustrating to deal with an individual who lacks insight into their illness, know that his is not something that is done deliberately by the individual with schizophrenia. Lack of insight into their illness is thought to be a symptom of the disorder, like delusions are symptoms, or paranoia. Also, their denial is NOT analogous those suffering from addiction, in which it is thought that those suffering with addictions are in denial of that addiction.

To be perfectly honest, you will be wasting your time and energy putting together strategies to prove there is nothing crawling all over your house. No amount of evidence you could compile would be enough to prove that you are right and he is wrong. I also believe that you will also be wasting your time if you try to convince him that medications will be of help to him and that they will help him lead the life he wants to live. Using logic to help an individual who is psychotic, and by definition, not able to be logical, and who is unable to recognize their illness, is a tactic that will be unsuccessful in this situation. The best strategy you can employ is to find some way to leverage him into taking his medications and not focus on getting him to admit or recognize that he is ill. Let me explain further.

I worked with a family who had a mother who suffered from schizophrenia and could not recognize her illness, just like your brother-in-law. For years, she would go in and out of hospitals simply because no one could convince her that she was ill and that medications could help her. The family, because they did not know any better, let her decide if she wanted to the take the medications. Of course, she never did. This went on for years-getting ill, being hospitalized, being released and her not taking her medications. To be fair, they tried over the years all sorts of tactics to try and get her to take her medications. They pled with her, they begged, and even on desperate occasions, tried to put the medication in her food. They spent many years trying to make the logical connection for her between her many hospitalizations and her medication noncompliance. It seemed obvious to them that when she did not take medications, she would be right back in the hospital, the place she feared and despised the most. Unfortunately, none of their efforts worked and the mother could never seem to understand that she was ill and that when she stopped taking her medication, this led to her subsequent hospitalization. Overtime, they grew exhausted at trying to get her to see the connection. Her refusal to admit she was sick, as they saw it at the time, frustrated the family tremendously and they would often become angry at her for not seeing that the medications could be helpful.

What the family did not realize until many years later is that she was not able to recognize that she had schizophrenia. It was not done deliberately by her, but it was part of the disease. Once they realized this fact, they were able to take a different approach to trying to keep her well. Until then, they had essentially blamed her for her many hospitalizations.

Finally, one day the family took a stand with her. On her 23rd time coming out of hospital, they told her that they would be in charge of her medication and that they would ensure that she took it every night. They informed her that she could only come back to live with them if she agreed to follow their plan (i.e. they controlled the medications and she took them every night) or she would have to go live in a group home. At harsh at this threat sounds, and as guilty as they felt in giving her this ultimatum, they had to do it. It was the only way they could get her to take the medication. The family assigned each other specific days. On each person’s specific day, he or she would take responsibility for ensuring that the medications were consumed. The family did mouth checks and they were even able to get medications from the psychiatrist that dissolved in the mouth within five seconds so there could be no “cheeking” the drugs. At first, she resisted the new plan. After a few weeks of her resistance, the mother finally was okay with the situation. Her resistance wore down and it no longer was an issue.

It has been over two years since this family plan was enacted. Prior to this plan, the mother relapsed with seemingly never-ending frequency. To this day, the mother still does not acknowledge that she has schizophrenia but to the family, this hardly matters. The only thing that matters is that she takes the medication and no longer relapses.

Let me point out that the only way this plan has worked was because each member of the family was committed to making it work. This meant for some of them, they had to drive out of their way to make it over to the mother to give her medication. Sometimes they had to cancel plans because their plans conflicted with the time the medications needed to be given. They made sacrifices. But these scarifies were necessary and frankly, the only reason their plan worked so brilliantly.

I tell you this to illustrate some key points. First, confronting the person with schizophrenia will never work. There is truly no amount of evidence or proof that you could produce that would help convince a psychotic individual that you are correct and that they are wrong. This is a waste of your time or energy. Second, persons with schizophrenia who deny they are ill are not doing it on purpose. Realizing this may help ease the frustration that comes along with many of these issues. Third, if you truly want to help your brother-in-law take his medications that he believes he does not need then you and the family will have to come up with a similar plan that was mentioned above. This usually means a serious commitment and sacrifice on the part of the family. I am not saying the plan I wrote above will work for everyone in every situation. But I believe that a variation of this plan can work and I say this after working with family who truly turned what appeared to be a hopeless situation into a plan that likely saved the mother from years of psychotic episodes and hospitalizations.

I hope this helps shed light on this very complex situation. If you have any questions or need clarification about something I wrote, please write again.

Take care.

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Schizophrenia or Anxiety?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

It all started with me intaking a syrop that contained THC, I was told that I would not experience any feelings of being high but it would help with my pain. ( I have pelvic floor dysfunction). As I took it, about two hours later I started to get a Panic attack , my heart would beat really fast and I thought I was going insane and dizzy. After that I had a feeling of derealization, not depersonalization that I did not feel like in my body, but that everything seemed weird strange, and in a fog almost dream like. I thought that this is what THC caused me to feel like (Never did it before). Next day I was fine but I found out my co-worker has passed away due to heroin overdose. Since then I had no symptomps of anything. Two months later, I started to get panic attacks and anxiety after my boyfriend’s fathers death. I had heart palapation, dizziness and lightheadeness. Once I found out that it was anxiety I learned to deal with it. However the derealization happened again once and made me feel like in a constant fog. Soon this went away as well but these intrusive thoughts won’t go away. Especially at night time where I think what if I am not really here, everything seems strange and weird around me. Not as much as that night that I took the syroup but sort of. IT’s just these thoughts are scaring me and make me think that I might be getting schizophrenia , or the onset of it…This is all I can think about, I try to go out and there are days where I have better days and seem happy and normal but then the worse days come too. I also thought I have schizophrenia because as I was falling asleep I would have a lot of chaotic thoughts in my head, not voices but random song lyrics popping up , scaring me to think I’m going crazy. Please I need some advice.

I cannot provide a diagnosis over the Internet, but nothing in your letter would suggest schizophrenia. People who are prone to anxiety commonly think they are developing schizophrenia. In fact, it is one of the most common questions that I receive.

You had a number of experiences that seem consistent with anxiety. It’s possible that you have anxiety and not schizophrenia. Consult a therapist, in-person, to determine what disorder, if any, you may have.

These problems seem to have been triggered by your consumption of the THC-laced syrup. You may have had a negative reaction to it and its side effects may be still impacting you. When it comes to anxiety, it’s always best to be proactive. If you’re worried about your mental health, then it’s wise to consult a mental health professional. They can design a treatment plan to address your symptoms. I would highly recommend consulting a professional. It will help you to feel better.

Treatments for anxiety disorders typically include counseling and medication, but not everyone needs both. Counseling will help you learn how to calm yourself when you’re feeling distressed. These skills are particularly important for people who are prone to anxiety. Please take care.

Dr. Kristina Randle

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Is My Mother Mentally Ill?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I am here because I’m losing hope and I’m running out of options. I’m here because u have many reasons to believe my mother is a paranoid schizophrenic. She is a single 56 year old woman with 4 children. Three boys and me, the youngest and only daughter. I have a very bad relationship with my mother because she lacks trust with me and she always thinks I’m out to get her. For example, I don’t live with her and I barely go visit her, but for ae reason she constantly accuses me of stealing her things from her home. I don’t have a key to her home so there’s so wat I can get in her home if she’s not there, and when I am over there visiting she follows me around the house. One she left a very belligerent vulgar message on my answering machine accusing me of stealing her credit card and paying my cellphone bill. She then called me apologizing saying it was a misunderstanding. I was completely in awe. Then another time she cursed me out saying once again I stole her credit card and went to Wal Mart and tried to buy some contacts. Mind you, I don’t wear contacts or glasses. I don’t have acces to her card info or any of her personal information. I’m not the only person she accuses of stealing from her, she will say things like “someone’s been coming in my house and stealing my DVDs.” One time she even said “someone” been driving her car. My brother and I told her that rediculous, and no one is gonna steal her car and then return it. There is another time she called me and she was very upset. She told me she went to her friend of 20+ years house and saw a picture hanging on her wall that belonged to my mom. My mom said her friend was recently at her house and she believes she stole the picture from her house. She called her friend accusing her and telling her she’s no longer welcomed in her home anymore and that their friendship is over. I told my mom she sounds crazy and there is no way her friend could’ve taken the picture without her noticing, seeing how the picture is about 32 inches long and wide. I told her to check her hallway closet and she found it. I told her she needs to call her friend and apologize and she needs to seek help. Whenevere or my brothers tell her she needs help she tells at us and won’t speak to us. Another thing I notice about my mom is the way she speaks. She sometimes reminds me of a child, especially the way she puts her sentences together, they sometimes don’t make since. She mis reads words all the time and also speaks words wrong a lot. If this is any helpful information she worked at a mental institution for over 15 years. She often brought her problems at work home with her and would take her anger out on me and my brother. She spends a lot of time by herself and pushes away a lot of her friends. She has been single for about 10 years. Another thing my brothers and I notice about her is that she often fabricates stories or she seriously over exaggerates them. She believes her lies, I think. One thing I don’t understand is how she treats my brothers like royalty, but treats me as a untrustworthy criminal that’s out to get her. The way she is to me makes me not like my mother or want anything to do with her. I’m seriously concerned with her and I need answers.

It’s possible that your mother has a psychotic disorder such as schizophrenia but such a late onset is unusual. You said that she was 56 years old. The typical onset of schizophrenia is late adolescence or young adulthood. It’s rare for an individual to begin experiencing symptoms for the first time in middle adulthood. It’s possible but not common. Perhaps this is not the first time she has behaved in such a manner but without being able to interview you in person, it’s difficult for me to know.

One thing is certain, she is not well. It may be due to psychological problems, delusions, hallucinations or paranoia. Several other possibilities exist which include an organic brain disorder, early-onset dementia or illicit substance use.

You stated that you do not live with your mother and thus intervening may be difficult. Encourage her to be seen by a medical or mental health professional for an evaluation. If you cannot convince her to be evaluated, perhaps one of your siblings can. You stated that she doesn’t trust you but she may trust another member of the family.

Hopefully, someone in your family can convince your mother to seek treatment. Otherwise there’s not much else you can do. Unfortunately, when we see one of our family members acting bizarrely and perhaps putting themselves or others in danger, it can be difficult to force them into treatment. Try your best to encourage her to seek help and hopefully she will listen. Do all you can and realize that your power is limited. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

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Is My Partner Schizophrenic or Just Very Religious?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

Hello, my name is —- and I have a question regarding my partner’s mental health. I’ve been worried about my boyfriend for the past few weeks, as he very recently seems to be displaying psychotic issues. I’ve been dating him for about 4 mos, and he, in the past few weeks, has been acting oddly. For background, we are both 20 years old. In the past year, he was kicked out of his mothers house for being transgender, and has spent some time being homeless. He recently got into an apartment, and registered an emotional support animal. He also says he is very happy in his relationship with me. So things seem to be looking up in his life, yet his mental state gets worse and worse. A few months ago he told me that schizophrenia runs in his family, but the symptoms he described his relatives as having didn’t line up with schizophrenia at all (no paranoia, hallucinations, disorganized thoughts/speech). I told him that maybe they were misdiagnosed, and that seemed to ease his mind a bit.

Now, we are both Wiccan (this is how we met), but lately his religious beliefs seem to be taking over his life. Two weeks ago, we got in a car accident. He had some sort of panic attack where he went non-verbal, and when he could speak, none of the words made sense with each other. Like, they didn’t form complete sentences, or follow any grammatical rules. Later, he began saying that the Goddess was trying to kill him in that accident, because he claims that she never intended for him to be born. Later that week we were hanging out, and out of the blue he became very distressed, saying there was a demon in the house. He kept asking me if I saw the ‘thing’ in the corner of the room, and pressed his back to the wall, saying if he did not he would be open for attack. He also says that the thing he saw was an Egyptian demon from an episode of courage the cowardly dog? which is very confusing. He asked me to ward the room, which I did because he was very upset. This calmed him down somewhat.

Now, I don’t want to discount his religious beliefs. Again, we share (or used to share?) the same ideas about spirituality. But this is not in line with anything he used to believe, or even in line with the beliefs of most Wiccans. He now regularly talks about this demon following him and has had more non-verbal episodes like the one I described. He has not, however, claimed to have seen the demon since.

I am obviously very worried for him. I love him very much, and want to do whatever I can to help, but I feel very scared and out of my depth. He is quite convinced that this thing is real, and I am afraid that confronting him might alienate him from me. Is it possible that this is just a product of life stresses and nothing to worry about? If I DO need to confront him, how should I go about it? Any advice you have would be GREATLY appreciated.

Reactions to stress vary greatly person to person but his are unusual. Believing in demons and goddesses suggest the possible development of paranoia and delusions — symptoms associated with psychosis. Psychosis is a break with reality. It can happen apart from more serious mental illnesses or it can be a sign of the development of a serious mental illness. Only time will tell which one may be the case.

It is also important to say that I only have a limited amount of “second hand” information about this case, so I cannot know with certainty if he is experiencing psychosis. I would not “confront” him in any manner because a confrontation suggests something jarring and negative. It would be better to suggest that he seek treatment.

Of course, a therapist will attempt to determine the difference between delusion and reality. Put a different way, the therapist will attempt to determine false beliefs from reality. What is real and what is not real? There either are gods and goddesses and demons or there are not. If there really are demons then there would be nothing unusual at all about one hiding in a dark corner. If there are not demons then logically, none could be following him or hiding in a dark corner of a room. But if there are demons, as he believes, then why would it be unusual or delusional for one to be followed by a demon?

Do you recognize the dilemma that a therapist would have in this situation? The therapist cannot accept the legitimacy of demons and goddesses and the efficacy of wandering a room and then deny them at the same time. A therapist must constantly challenge false beliefs. For instance, if someone believes that they will die if they leave their home the therapist will challenge that belief. The therapist will need to prove to the client that their fear is not founded in reality. If the client claims that it is their religious belief and that their fear of leaving the house is founded soundly upon religious beliefs, the therapist will nonetheless need to prove those religious beliefs to be false.

I hope you understand what I’m telling you. You need to believe only that which is real. You are never entitled to believe something to be true without proof that it is true. If you do not know if something is true, then you do not know if something is real.

In reality, you are not entitled to believe anything that you choose to believe. That applies to absolutely all areas of life. You are not entitled to believe that anti-freeze, is good for your health, even if it is a part of your religion. Why do I say that you are not entitled? Because no one is entitled to disagree with what is real. There will be a penalty to pay. Anyone, who partakes in a refreshing 16-ounce glass of antifreeze for its healing and medicinal properties, even if the ingestion of such is highly recommended by one’s religion, will be severely punished by reality. That punishment, is usually violent death.

Reality does not take second place to religion. Is this last example too extreme, too ridiculous? Of course not, that’s exactly what happened in Jonestown, where religious followers drank poison for their religious beliefs.

Please allow me to be as succinct as possible. If it’s okay with you for your boyfriend to believe in demons, then why isn’t it okay for him to see them? I wish you both the best of luck.

Dr. Kristina Randle

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Schizophrenic or Just Paranoid?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

Hello, I’ll just introduce myself as Mars.

I’m a 17 year old girl, currently focusing on my studies in College (health and Social care on the way to Nursing). Where to begin, exactly? When I was a child (about 4) I started seeing things, this one time I was looking out of the window and I saw a woman, a spirit-like woman floating in mid-air,staring at me and I tried to force myself to believe that it was a ghost and tried to forget about it. Just to add, I would hear voices (two people arguing) about the same thing although, their conversation were always a blur.

When I was about 6/7, I was taken to a funeral, It was my first time to experience a real life dead corpse laid out in front of my very eyes and at first I couldn’t even step inside of the house and when I did, i saw a glimpse of the corpse’s arm and after that, I was shocked. I never spoke until we got home, seeing half of the face of that woman in the coffin made me shiver, that night I saw her laying beside me, floating once again and a green shadowy smoke came off of her. Was it all hallucinations? Few years later (9 yrs old) I saw the same person when I was 4 passing by across the kitchen door and I checked and there was only a solid wall, so did it go through it? that’s impossible, right? So what was it?

Years later, when I was 12, I started self-harming because of me finding hard to trust people and always being suspicious. Bullying became an issue, I started having suicidal thoughts but because of friends and family, slowly and gradually I was able to get hold of myself. Also, I’ve noticed how my moods and emotions switched to high and low in just few weeks time. I would be ecstatic and very manic but also very irritable with everything, I would pull an all-nighter not purposely but because I can’t sleep, never sleep and would do random things like wave to everyone I see on the streets. Weeks later, I would depressed and lethargic, not being able to care about anything or about my health. I would lose my appetite.

And back to the present, I don’t hear voices or hallucinate that much but definitely feel like I’m being watched, insects in my body and always suspicious of everyone. Is that normal? I’ve had all the chances in the world to go up to a doctor and ask to be diagnosed but never had the courage because I’ve been told that’s it’s harder to find a job at this rate, it would be harder for people to accept me in because of my mental disorder (if i have one) because they might think, i’ll lose focus or hurt someone but I’ve never physically hurt someone unless its playfully.

In conclusion, what do you think is wrong with me? Is it just paranoia or am losing it? Traumatic event (but it doesn’t explain what I’ve hallucinate BEFORE the funeral) 6th sense? I’m very confuse, I always wake up begging for answers.

Thank you, please get back to. It’s urgent.

You may be experiencing paranoia or other symptoms that may indicate psychosis. These are not normal symptoms because most people don’t have them. They could indicate that a disorder is present.

What’s most important when dealing with a potential psychotic disorder, is early intervention. Study after study has shown that the earlier psychosis is treated, the better the prognosis. Whenever possible, psychosis should be prevented and that is possible with treatment.

It’s unclear what may have happened during your childhood. If you sustained trauma, perhaps that could explain your experiences. Research suggests that approximately 10% of the population experiences hallucinations throughout the course of their lives. These experiences, on their own, may or may not indicate that a disorder is present. We also know that some people experience things for which there is no easy understanding or explanation.

I would highly recommend consulting a mental health professional. You should have no fear about consulting a professional. They undergo many years of schooling learning about how to treat psychological problems for the sole purpose of helping people overcome these problems. They want to help you.

Your health records are completely, 100% private. This was not always the case but it is the case now, assuming you live in the United States. If you do not, check the laws in the country in which you live.

Gaining a diagnosis will not hinder your chances of work. In fact, it will only help your circumstances. Treatment will allow you to resume your life without the hassle of bothersome symptoms. It will free you to do what you want, to work wherever you want and to have a higher quality of life. Please take care.

Dr. Kristina Randle

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Anxiety about Schizophrenia

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I have a question about state i am currently in. I’m 22 year old female, engineering student. 2.5 months ago my relative had a psychosis and was diagnosed schizophrenia. As i am a member of family i heard a lot of symptoms that she had experienced. The ones that were extremly frightening for me were the hearing voices part and the part of “someone is watching her”. As time passed i couldn’t help myself not to think about all those symptoms and they were so scary for me.

First i was thinking about hearing part and was very anxious imagining how is it to hear them, how can that happen…why it happened so suddenly to her(my relative…inlaws). I started feeling so scared imagining what if that happens to me. Sometimes when i hear some noise outiside it made me think about hearing voices and i would automatically connect that situation with the symptom and start worrying evendough i know nothing is wrong it made me nervous because of the fact i’m thinking about it.

At this moment i am less worried about hearing voices, but a 2-3 weeks ago i suddenly started thinking about “beeing watched part” and i honestly think it is soo much scarier than hearing part.I know she was talking that she felt someone is watching her trough closed door and trough some things on walls. When i started thinking about it i felt so anxious and scared. That tought went so deep in my brain and mind…that now things are reminding me of that symptom i heard she had.

For example: when i look at closed door i think about “someone is watching u symptom”. Of course i know nothing is happening to me but thinking of it and the fact that things started to remind me of these toughts really makes me anxious. Two days ago i went to the cinema and when i sat down i saw a speaker on the wall. I don’t know why but it automatically reminded me of the things my relative said about someone watching her trough things on wall. That made me feel so nervous because i even tought of it in such a great moment…and that didn’t stop bothering me till now.

Toughts of that symptom are so present in my mind and i don’t want to think about that. I have so many better things to think about. I really know that its not good for me to think about these things …and now another fear appeared. I feel like i’m thinking too much about that symptom and keep my mind bothering about it …and i’m sooooo scared that my mind could break and i could start feeling those things for real beacuse i think of it soooo much. That is my number one worry right know. What if this happens to me because thinking about it soo much.These toughts about really experiencing symptoms beacuse of thinking about them, are the one that produce the most anxiety(palm sweating, choking, trembling). I am worried because it became my obssesion and very worried because it is related to mental illness. I produce toughts about mental illnes in my mind and that makes me panic that maybe in one moment my mind wont know what is tought and what is really happening. Writing this and even just imagining this makes me panic. I want my normal life back! I want stop thinking about this.

I’m also very annoyed by the fact that stupid things like closed door and speakers on the wall remind me of the symptoms that my relative have. The huge problem is the fact that all this affect me in way i feel anxious and stressed and sometimes angry beacause it happens to me. I also feel so much stress because i can not stop thinking about it.

In a moments when i feel happy and imagining or planing something…these toughts just pop up. ” I feel so happy because of it….and so on…suddenly…”watching u symptom comes to mind….and the no1 fear “what if i make myself sick…really start to feel watched because of thinking about it so much!” Another tought is : “why am i stuck to this tought….maybe there’s another reason…maybe i already made harm to my mind that can not be helped”! I’m frustrated because i know i dont want to feel this way and don’t want to think about those things and now i’m started to worry that i wont be able to get rid of these toughts.

So in conclusion:
1. Can u give me some kind of advice how to struggle with all this by myself… can i stop these thoughts by my own mind?
2. I don’t really want to take medication for anxiety….what are other ways to calm myself when feeling anxious?
3. Pls tell me can i start experiencing symptoms if i think about them so much….will i turn these toughts in some severe mental disorder (thats my no1. worry right now)

The best way to combat anxiety is to be sure that your thoughts are true. Anxiety can develop when you believe in thoughts or ideas that are not true. Do you have evidence to support your beliefs? Are you beliefs logically consistent with reality? Perhaps you can do the evaluation yourself or perhaps not. Either way, it would be far easier and quicker to see a therapist. A therapist will be the objective voice that will have the training and experience to help you.

Your anxiety might match a particular type called obsessive compulsive disorder (OCD). In fact, it’s relatively common for individuals with OCD to believe that they have schizophrenia or other condition. Schizophrenia is a relatively rare disorder. It affects approximately 1 to 2 percent of the population.

It is statistically unlikely that you have schizophrenia or that you will develop the disorder. My recommendation is to see a therapist. I know that you want to solve this problem on your own but it would be much more efficient to see a trained specialist.

If you do have OCD, it unlikely to simply go away. For many people, it becomes worse over time.

There are many effective psychological treatments that could help decrease your symptoms or eliminate them. Receiving formal treatment by a trained specialist could help to eliminate it from your life. I hope that you will consider it. Please take care.

Dr. Kristina Randle

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I Need Help for My Brother

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

My brother is a paranoid schizophrenic with bipolar disorder autism and adhd. His schizophrenia comes with homicidal thoughts. He’s been admitted into a hospital before and was being treated for years. About a year ago now he went off of his meds and it’s been downhill from there. He’s currently in a manic state and has been for months. He refuses to get back on his medications and it’s taking a toll on him and everyone else. He’s violent, combative, and just dangerous. Anyone he sees in his way is a target. He has harmed my mother’s dog. Tried to hurt my toddler (he is no longer around her anymore at all). He’s choked my mom stolen her car, loosened the lugnuts on her tire and when she went to drive away her tire fell off. He’s assaulted a police officer threatened multiple times to kill people. It hasn’t gotten to the point where even my mom had to move out. We’ve called the crisis line, the police, even adult protective services and no one will do anything about it. He’s going to seriously hurt someone or himself and I can’t bear the thought of standing back and watching him drown. He’s destroyed his apartment and belongings. We are at a loss for what to do. We can’t force him to get back on his medications because he is still his power of attorney. We can’t force him to seek treatment at all. Is there anything we can do? He keeps racking up charges for himself and jail is not the place he needs to be. He is a really amazing docile person when he’s medicated, but when he’s not he’s one of the scariest people I’ve ever seen. What can we do?

Desperate times call for desperate measures. If you haven’t tried this already, contact an attorney who specializes in guardianship/power of attorney and explore having your brother declared mentally incompetent. Generally speaking, an individual can be declared incompetent when their mental capacity inhibits their ability to make decisions that are not in their best interest. Each state likely has specific guidelines for what constitutes this type of declaration. An attorney who specializes in these matters should be able to assist you to determining if this is the right move for your brother.

In the meantime, there are several things you can do that may help. One is contacting the Treatment Advocacy Center. On their website, you will find information about the laws and standards regarding involuntary commitment in your state. They also have resources for families who are dealing with situations like yours. There’s also great information on their website about guardianship, emergencies, etc.

Using the aforementioned website, you should be able to determine whether your state uses some form of assisted outpatient treatment (AOT). AOT involves a judge mandating that an individual, who had been previously hospitalized and who is now living in the community, adhere to their treatment plan or be rehospitalized. AOT may be applicable in your situation.

Try to determine if your county has a mental health court via a Google search. Mental health courts are specialty courts for individuals with severe mental illnesses who have violated the law. Generally, they only admit participants who have committed a crime however, they may be able to help your brother since he has a history of being in jail. Given his involvement in the legal system, he may be eligible for mental health court which, if accepted, would mandate treatment compliance or risk going to jail. If that is not a possibility, the people who work for the mental health court may be a good resource for your family.

I would also recommend contacting your local National Alliance on Mental Illness (NAMI) group. NAMI is an advocacy organization that specializes in assisting families who have loved ones with severe mental illnesses. They offer free support groups in local communities. Many of the NAMI members are seasoned veterans who know how to navigate the mental health system. They can provide both peer support and guidance.

It would also be wise to proactively contact your local crisis team. It’s good to make them aware of your situation and concerns. You might do the same with the local police department. These preemptive steps might help everyone be more prepared in the event of an emergency.

It’s important to keep yourself safe. Research indicates that when individuals with severe mental illnesses do engage in violent acts, it is often directed at their family members. Perhaps that is because family members are quite literally in the vicinity, making it easier for them to become targets. When someone is actively symptomatic, they are not behaving as they normally would. They might do something that they wouldn’t otherwise do.

I’m very sorry that this is happening to you. I have worked with families dealing with this very type of situation. I know how difficult it can be. Few truly understand what you’re going through. There are simply not enough resources available for families faced with this situation. I hope that some of my advice has helped, if only a little.

Please don’t hesitate to write again if you have additional questions. Stay safe and please take care.

Dr. Kristina Randle

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Am I Maybe Schizophrenic? Advice Needed!

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

This is what i believe,i am going to a therapist soon, how should i bring this up? The Canadian government, and the RCMP are after me.There are camera’s in my house and room and microphones that are implemented in my clothes so that they can listen to what I am saying, they also have the power to listen in my mind and they know what I am thinking. Writing this is extremely hard because now they will know that I know. Whenever I go out they are always following me switching and people all the time. The guy sitting on the bench “reading” his newspaper, works for CSIS. If I go into a store they follow me in, I try to lose them but they will always find me. No where is safe. They are trying to leave me messages in patterns which I am still unable to understand. I clear my browsing history all the time and constantly make new social media profiles so it is harder for them to find me. They went my special powers. I don’t know yet what the powers are but it must be something big otherwise why would they care? This is really hard, i don’t want to let them win but i want to stay away from me. I think they are trying to control my mind and brainwash me because there are so many things I forget in the short term for example I couldn’t remember what we had had for dinner just a few days before when it came up in conversation, i think they are also trying to talk to me because I’ve been hearing a voice, I have only been able to tell what they are saying a few times: they asked me: Why are you whispering? In a terrible and scary voice which didn’t seem to have a gender, It sounded like a loud whisper. I have also heard them say what now? But this time is wasn’t at all scary and I was a women voice. I also think that my dad is trying to kill me poison me by putting things into my food but the reason I dont die is cause I have an extremely good resistant rate to the poison. I also feel things, generally its stuff like animals brushing up my leg or bugs landing on my skin

Yes. You should tell your therapist everything you have written in this letter. This is exactly the type of information they need to know. Your therapist might also recommend medication, in addition to therapy, to treat your symptoms. Both therapy and perhaps medication can eliminate these problems.

You might be experiencing paranoia and related symptoms, but they are treatable. The more information you can provide to your therapist, the more specific and targeted your treatment plan will be.

In the meantime, do your best to stay grounded in reality. Challenge your beliefs and insist on proof. For instance, you wrote that the Canadian government is after you but what proof do you have? Finding proof can be difficult because mental illness confuses and tricks you into believing something that is not real. It’s important to challenge your beliefs, demand proof but most importantly, get help from professionals. They will know how to help you. They will teach you to identify false realities.

Hopefully you have trusted friends or relatives who can help you to feel safe and supported. If not, your therapist will fill those gaps. I wish you the best of luck. Please take care.

Dr. Kristina Randle

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Is There Something Wrong with My Mind?

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

As a child I was sexually abused for 4 years. No one knows. The only reason it stopped was because he died. Whilst that ended by the time I was 11 I still think about it and get upset. Lately however some feelings have developed that scare me. My family is very traditional. We all sit and have dinner in silence, father is the head of the household, and I am expected to be a sort of stepford daughter. I get straight A’s, don’t date boys (mostly because I am rarely allowed out of the house), hold a part time job, don’t drink, smoke or do drugs and I don’t so much as ask them to drive me places or give me money. I don’t treat them with disrespect but I constantly feel as if they believe I am a bad daughter. I think they are disappointed no matter how much I try and they don’t understand anything about me.

Because of this confined feeling I have started to develop a feeling of something or someone else inside me. It is part of me but separate at the same time. I am known as rational and responsible, organised, boring even, but the thing inside me is not. It feels like it is coiled up inside my skin, crushed inside the frame of my bones, but is constantly moving about, trying to scratch its way out. The thing inside me is always hungry, always angry, always excited, passionate, desperate, scared. I like to sink into the background and become invisible, but the thing inside wants to scream and cry for no reason. I feel its power sometimes reach my fingertips, or my spine or neck, as if it is trying to take over control.

Is this just a weird teenage thing that might go away? Or do you think I should seek more help? It really scares me. I want to set the thing free at the same time as wanting to just hide it away. Because i am part of it I want the same things that it does, but the rational me constantly worries about the consequences of feeling released for just a small amount of time.

I am really genuinely scared, what should I do?

I admire the strength and self-reflection you have. You are a very resilient young woman. No one deserves to be abused the way you had been and I am sorry an adult betrayed you. There are terms that describe what you are feeling, but rather than use labels let me just say that your feelings make sense to me. Four years is a long time, and however many years is an even longer time to keep a secret. It is time to talk to someone about all this. Writing us here was an excellent first step. Now I would find someone to talk to about this. The find help tab at the top of the page should have some contacts in your country. Alternately you may want to talk to your physician. He or she should be able to point you in the direction of a competent mental health professional.

Wishing you patience and peace,
Dr. Dan

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Is this Schizophrenia?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I know you get questions about Schizophrenia a lot, and I apologize for taking your time, but I couldn’t find any answered questions similar to my situation. I believe I may be suffering from Schizophrenia, but I’m not sure. I was wondering if you could tell me if my situations sounds like Schizophrenia at all. I’m seeing a therapist soon because my mother thinks I have anxiety and depression (and I agree) but I think I may have something more.

Here’s my situation: I talk to two people inside my head. Sometimes I hear vague, hard to make out whispers aloud, especially at night, but they speak very clearly inside my head at all times. They tell me all kinds of things that seem crazy saying aloud. They say that they are angels, and that I’m one too. They tell me to kill myself so that I can “come home” and see them again. I should mention, I have never been a religious person. My brother actually taught me to be an atheist, and I believed in nothing of angels or an afterlife until these voices started. One of them sometimes encourages me, ensures me that everything will be okay, and helps me get through the day. The other more often tells me negative things, like that I’m worthless and stupid. Both of them tell me to kill myself and harm myself. I obey them all the time, I actually stop whatever I’m doing and cut myself almost whenever they tell me to. Sometimes, the one tells me to hurt other people, but I never act upon these commands. I could never hurt anyone. But I fear that I might start listening to them when they tell me to hurt people. I’ve begun to have dreams almost every night of killing my friends, family, and self. I have also in recent months started to develop strange habits at their instruction. It’s just little things, like choosing a certain dish out of the cabinet instead of a dozen identical ones, making sure the objects on my nightstand are in the exact same place every night, etc. These habits don’t harm anyone, but they’re strange, and I feel extremely uneasy and scared when I don’t follow one of these routines.
Does this sound like Schizophrenia? Should I bring this up to my therapist? Thank you so much for your time.

Never hesitate to write with your questions. We are here to help. I’m glad you wrote.

Your symptoms are unusual and concerning, but at 14 schizophrenia is unlikely. It’s rare for individuals under 17 to develop schizophrenia. It does happen but all other explanations need to be exhausted before schizophrenia or any other mental illness should be considered.

What’s most important is that you speak to your therapist about your symptoms. Your therapist only knows what you reveal to him or her. Without your honesty and willingness to be forthcoming about all of your symptoms, he or she might focus on treating lesser symptoms. That might not be enough to help.

For now, don’t jump to conclusions about a diagnosis. It’s good that you are asking for help but your next step should be discussing your symptoms with your therapist. He or she is in the best position to determine what’s wrong and perhaps more importantly, how to treat what’s wrong. Please take care.

Dr. Kristina Randle

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When Does Schizophrenia Show Up in Women?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

Both of my parents are mentally ill, my mother suffering from Schizophrenia and my father from Manic Depression. Both of my parents had regular auditory hallucinations and paranoia.

At 21, I’ve yet to suffer from any of their symptoms, but have been struggling with PTSD and related anxiety. Since I was aware enough to know my parents were ill, I’ve constantly monitored myself to make sure I wasn’t sick like they were.

From reading on this site and others, it appears that Schizophrenia shows up in women later than men. Could someone please talk about this more? Since I’m a 21 year old woman, I’d like to know if it’s possible for me to still develop Schizophrenia (though I show no signs of it now and haven’t in the past). I also just want to know at what age can I finally relax and know I’m past the threshold.

You are correct. Schizophrenia does tend to occur later in women than in males. The average age range for a female to develop schizophrenia is roughly ages 25-29 (18-21 in males). The reasons for the age difference between genders are not well understood.

Not every male or female who ultimately develops schizophrenia does so within the above-mentioned age range averages. Males can develop schizophrenia later than late- adolescence and females may get it sooner than their late twenties.

But you must know that just because both of your parents had a mental illness in no way means that you will be mentally ill. One does not necessarily lead to the other. It is true that people whose parents have a mental illness are at a greater risk for the development of a mental illness. Heredity does seem to play a role but there are many more factors that contribute to the development of a psychiatric illness.

The environment an individual grows up in can affect whether or a not a disorder develops. The majority of people with schizophrenia, for instance, report childhood physical, sexual or mental abuse. This is not to say that all people who are abused go on to develop schizophrenia. This is clearly not the case. But in some instances, the abuse could have possibly contributed to the development of the disease. Maybe if these individuals had never been exposed to abuse they may not have developed schizophrenia.

Drug use can also play a role in the development of schizophrenia. Drug use is commonly associated with schizophrenia, as well as bipolar disorder. I am familiar with a case in which a “normal” young adult male spent his weekend using LSD. By the end of the weekend, his LSD “high” never wore off. He never returned to his “normal” state of mind and subsequently suffered many psychotic breaks and was later diagnosed with schizophrenia. No one can be sure that his drug use definitely led to schizophrenia but it is a distinct possibility.

You are not doomed to develop the disease just because your parents did. You mentioned you have some other psychiatric issues, such anxiety and PTSD but neither of these are signs of schizophrenia. You also mentioned you have no other symptoms that would lead you to believe that you have the disorder. Please know that realistically, your chances of developing schizophrenia are very slim.

It’s unhealthy for you to constantly worry about this issue. By constantly focusing on this fear, you are keeping it alive and helping it to grow. If you do continually worry about this, it would be helpful for you to contact a therapist. You may feel better if you had someone you can discuss these fears with. A therapist can also help you with your anxiety issues as well as the PTSD. I hope this helps.

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Boyfriend with Schizophrenia

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

My boyfriend has been institutionalized twice already over the past 2 years. He has had trouble finding a job, he had one but he was fired because he wasn’t able to concentrate and finish the work. I know there he had stopped taking meds again. The first time he disappeared but tried to break up with me 3 times prior that. After he left the hospital the first time he had problems with the meds for a few months, he didn’t want to take them. The second time he was committed again because he lied about taking meds and he started acting up again. After that time which was around christmas he continued taking the meds through supervision of his mom, she did though trust him to take it on his own and he lied again. Little things he did, laughing by himself, not eating leaving unfinished food everywhere and not being able to sleep, pacing around a lot. He started to Skype with other women and talking on Facebook. I felt offended and i called him out on it. After this he decided to travel out of the blu to new york to find a job. we went out one wed and he told me then and flew out to NY on thursday. He left with a one way ticket and it hurt me lots. I didn’t know if he was coming back. I know he didn’t take the medication while there because he told me. We have been going out for three years now going into four, we have never had relationship issues. I stood by him because i love him and i still would but this issue about cheating is becoming big and it has affected our relationship. His mom and i are close, we have talked about maybe him going back to the hospital so he can get help and maybe this time he can accept the fact that he has an issue. I don’t know what else to do, It is affecting me more than i though, i always worry about him. I have tried to help but i feel like it doesn’t matter.

It’s important to try to separate the illness from the person. Some of the behaviors he is engaging in are likely due to his current instability. For instance, buying a one-way ticket may not be a sign that he doesn’t love you but rather a sign that his illness symptoms are not well controlled. Understandably, it’s difficult not to take his actions personally. Obviously, the cheating is a problem for the relationship but he’s unstable and not thinking clearly.

Please don’t misunderstand. His instability is not an excuse for the fact that he may have cheated but his illness symptoms could be affecting all of his behaviors. His uncharacteristic behavior might simply be an artifact of his untreated symptoms.

It’s going to be difficult for him to function in a relationship when he is unstable. It’s part of the challenge of being in a relationship with someone who has schizophrenia.

Encourage him to take his medication and to be hospitalized, if necessary. You will likely see a significant improvement in his behavior when he is stable and receiving treatment.

You may benefit from attending support groups at your local National Alliance on Mental Illness office. Many support group members are caring for loved ones who have mental illnesses. Some of the support group members may be facing similar issues. It would also be helpful to educate yourself about schizophrenia. The more you know about the disorder the more you will understand his behavior. Please take care.

Dr. Kristina Randle

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Are people with schizophrenia violent?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

A friend of mine from high school has since become a paranoid schizophrenic. He has been homeless and on the streets for years, jobless, and has been addicted to multiple drugs and an alcoholic since I have known him.

I try to keep contact with him limited, although I recently found out from his family that he is traveling hundreds of miles of foot to see me because he believes that I can help him. He is not on medication and seems to be in an ongoing “episode” that never stops.

He is extremely paranoid and delusional, and the drug addiction doesn’t help matters any. He has a long history of family physical abuse and has been arrested for abuse of a girlfriend. He has never taken any medication or been treated, because he doesn’t believe that he truly is schizophrenic.

I am wondering how much of a threat he is to me, and how much danger I am in? I have received conflicting information- that paranoid schizophrenics are rarely violent, and on the other hand that, unmedicated, they are frequently prone to violence and that the violence is usually directed at loved ones, which I would be considered a “loved one” to him.

Any information you have is appreciated, although I assure you I am taking extra precautions to protect myself in the event that he does find me and possibly try to harm me. Thank you.

You have asked an intriguing and difficult to answer question. From my research and personal experience, it is my contention that individuals with schizophrenia are no more dangerous than the average person except when they are actively psychotic, unmedicated, unable to recognize that they are ill and are using drugs and alcohol. Your friend has all four of these risk factors simultaneously putting him at a high risk for violence. This in no way means that he will become violent towards you; it only means that he has an increased risk for becoming violent. Another helpful indicator in determining his risk for violence is whether or not he has acted out violently towards others in the past. Studies show that past violence is a good predictor of future violence. The other risk involved with your friend is that he may also try to harm himself.

The truth of the matter is that it is extremely difficult and practically impossible to predict your friend’s future behavior towards you, himself or anyone else. What is most important in this situation is trying to get him into treatment. I realize that this is a monumental task, one in which you may not be up to fighting. Civil commitment laws in most states make it nearly impossible to for someone like your friend to get help BEFORE something bad happens. It is almost always the case that something bad has to happen before an individual would be eligible for psychiatric help.

Despite this, I would strongly encourage you to try to get him help before he hurts himself or someone else. If you are not willing to try to get him help, then I would advise you to take extra precautions (as you are already doing) and to call the police anytime you feel it is necessary. I am not telling you to call the police to have him arrested; it is just that the police, in many communities, are often the first-line responders in situations regarding individuals with psychiatric disorders. Police show up at the scene and call for help usually from trained, mental health crisis assistance teams. The mental health crisis teams try to get individuals into treatment and are trained to work with individuals just like your friend. I hope this helps to answer your question. Please write again if you have any more questions or needed further clarification about my answer. Take care.

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