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My Mum Is Putting Salt Everywhere

by Kristina Randle, Ph.D., LCSW February 21st, 2024
written by Kristina Randle, Ph.D., LCSW

It started 6 months ago, now I live with my grandparents because of this issue. Basically, my mother started getting into card readings and then she started to buy crystals. After that she started to say that our house was haunted and started screaming Jesus quotes in the middle of the night around 11pm to 3am. Then she started to put salt all over the floor and around the sofa and started sleeping there instead of her bed I heard her whispering to herself and she said she wasn’t crazy and just writing a story (which I didn’t believe). At this point I was 1 week into the summer holidays towards the end of July, she then started coming into my room and asking if she could sleep in my bed because she was scared and poured salt in my bed so i decided to swap rooms with her so i didnt have to sleep in a bed with salt everywhere. Then she suddenly came into my room and said were moving house and going to LA which took me by suprise and left me speechless and upset. She then went on to say we cant bring any of our belongings from that house with us because evil entity’s were in them and she said that she would buy everything again. After that she said we were gonna be picked up in leeds we went there and waited for 9 hours. I kept asking when they were gonna come but she kept ignoring me, after the 9 hours had past she ordered a taxi and i asked where we were going but again she never answered till she said to the taxi driver the address of my grandparents then we stayed at there house for 2 weeks, After that my mother left to stay with her old high school friend and then got married 2 weeks later. I decided to stay with my grandparents and because of this i had to move school and lose everyone i know and start over. I also went back to the house to get some electronics for me and my siblings, I gave my brother his 2DS and my mum lied to my face and said it was broken when i was using it earlier and put it in the bin. Then she said there was a devil pit under the sink

Your exact question is unclear so I will provide a broad answer. I am sorry that this is happening to you and your family. Certainly, this has to be challenging for everyone involved.

It’s difficult to know what might be wrong with your mother. It could be that she’s experiencing severe psychological distress and/or a psychological condition. She seems unwell. Going to live with your grandparents was a very wise idea. You should stay with them as long as you can or need to do so. Hopefully, your siblings are living there too or found a stable and safe place to live.

In the meantime, encourage your mother to seek help. She may take your advice but be prepared for the fact that she may not. If she is psychologically unwell, she might not be able to recognize her symptoms as being problematic or appreciate how her behavior is affecting the family.

You should also partner with your grandparents and siblings to encourage your mother to seek help. Consider it a family intervention. If you were all to take a unified stance, it might help her to realize that she needs help. You might also try family therapy. She may not be willing to go to one-on-one counseling but she might be willing to try family therapy. If everyone is willing to go, she might be willing too. I hope this helps you. Don’t hesitate to write again, if you have additional questions. Please take care.

Dr. Kristina Randle

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Comorbity? Overlapping? Overreaction?

by Kristina Randle, Ph.D., LCSW April 7th, 2022
written by Kristina Randle, Ph.D., LCSW

I was professionally diagnosed with ADHD and I’ve struggled with it since childhood. Later I was diagnosed with BPD and GAD, and a different doctor diagnosed BD2. I am certain about the BPD and ADHD, but I think I might actually have MPD (not GAD and BD2) and I’m concerned. I always hate telling my parents or my doctors about problems I think I might have for fear of looking dramatic or “wanting to have problems.” I fit every description in the DSM5, but when I think of MPD I immediately picture the movie Sybil and I know I am not nearly as severe as her. I would like to get help but like I said, I’m afraid it will be seen as one of my “attention seeking behaviors” (but I’m extremely aware of those, and I’ve been making them healthier behaviors as much as I’ve been able) I wouldn’t even know what to do if it were MPD, all the treatment options sound so scary and the thought of being labeled as one of the so-called “crazy” disorders is also scary.

By MPD, I’m assuming you mean multiple personality disorder. MPD is now called dissociative identity disorder (DID). DID is a rare condition in which two or more distinct personalities are present. Each personality usually has distinctly different names, identities, temperaments, interaction styles, and so forth. The personalities alternate within an individual’s consciousness often causing significant memory lapses and frequent episodes of forgetting. The cause of DID is unknown but it is strongly associated with childhood trauma and abuse.

It is important to remember that the movie Sybil was a dramatized production. It may not be an accurate portrayal of DID and should not serve as the basis for diagnosis. In fact, there’s controversy over the case. Sybil’s real name is Shirley Ardell Mason. Ms. Mason’s psychiatrist, Dr. Wilbur, did not write about this unique case in a scientific journal. Instead she hired a writer and the story was ultimately made into a movie.

A psychiatrist who treated Ms. Mason, while Dr. Wilbur was out of town, did not think Ms. Mason had multiple personality disorder. He described her as “hysterical.” A psychologist at the John Jay College of Criminal Justice, listened to the taped recordings of the therapeutic sessions between Ms. Mason and her psychiatrist and concluded that “it is clear from Wilbur’s own words that she was not exploring the truth but rather planting the truth as she wanted it to be.” You can read more about the case, and its skeptics, in this New York Times article.

Nothing you’ve written in this letter would suggest that you have DID, however if you believe it is a possibility, then you should discuss it with a mental health professional. He or she would be in the best position to determine if you have the disorder.

Even though cases do exist, I suspect that the majority of clinicians have never come across anyone with DID. That’s because people who have DID probably don’t realize they have it and thus don’t seek help from a professional. You might try consulting a DID or a trauma specialist, if one is available in your community. Please take care.

Dr. Kristina Randle

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

by Kristina Randle, Ph.D., LCSW September 10th, 2021
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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Paranoid Schizophrenic Father Told Conflicting Diagnoses

by Kristina Randle, Ph.D., LCSW August 14th, 2021
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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Can Schizophrenia Cause Transgender?

by Kristina Randle, Ph.D., LCSW March 25th, 2021
written by Kristina Randle, Ph.D., LCSW

I have auditory and visual hallucinations. I hear at least three voices commenting on my actions and commanding I do things. I see these things I call shadow people. It’s just a regular looking body shape, but they have no face. It’s just blank. My first experience with this was second grade. I called the figure “blank face guy”. He follows me. I also have disorganized thinking and incoherent speech. I’m also transgender. My dad thinks my mental illnesses are what caused me to conclude myself as transgender.

Schizophrenia is a disorder characterized by delusions. Delusions are a consistent collection of thoughts that would lead someone to form an incorrect conclusion. Delusional thinking and thoughts are not based on what is real. Quick research on the internet will make the Diagnostic Statistical Manual (DSM) available to you. It is the most comprehensive description of mental illness that is available and it is the standard for mental illness diagnoses made in the United States. All of the delusions associated with schizophrenia are listed in the DSM. None of the delusions listed, have anything directly to do with one’s perception of gender.

You have auditory and visual hallucinations and hear at least three voices. You also have disorganized thinking. All of these things interfere with your clarity of thought. Not all thoughts of a person with schizophrenia are delusions. Some are real and some are not. The problem is that all of them seem perfectly real and reasonable. However, they are not. Some are and some aren’t, but for someone suffering with schizophrenia it is impossible to know which are real and which are false. It is important to be able to trust someone in helping you to determine what is real and what is not.

When someone with schizophrenia, clearly hears something and sees something with their very own eyes, it is exceedingly difficult to convince them that what they’ve heard and seen is not real. I think the lay public, fails to appreciate what I’ve just described.

Imagine how difficult it is when someone clearly sees and hears someone walking by their room but their mother or brother or father tells them that there was no one there. It was a delusion or a hallucination. It is far easier to believe that one’s mother or brother or father, is lying. Remember, the person suffering from the delusions of schizophrenia, both clearly saw someone and distinctly heard the footsteps. Family members, who were with you in the room, deny it. They tell you that no one passed your room. And you begin to wonder why they are lying to you and, soon, why they are all lying to you. This is how paranoid thinking develops in individuals with schizophrenia.

I do not know you. I cannot diagnose you without meeting with you in person. No one can. I don’t know the thoughts that you possess which are real and the ones that are based on delusion. Trust your therapist and those who love you. For everyone with schizophrenia, it is a confusing time. But with the passage of time symptoms should be reduced or eliminated and when this occurs you will have far further insight into thoughts of gender. Good luck my friend.

Dr. Kristina Randle

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Dealing with My Schizophrenic Brother

by Kristina Randle, Ph.D., LCSW February 26th, 2021
written by Kristina Randle, Ph.D., LCSW

I don’t know how to deal with my schizophrenic older brother anymore. I’m now the only person in the family who will have anything to do with him. Our parents have both died. Every so often he decides he’s been cured and doesn’t need his antipsychotic medication anymore. This is always against medical advice, but they can’t force him. He then deteriorates to the point where the police are involved due to his aggressive and alarming behavior and then he is sectioned and back in hospital. This cycle repeats itself every couple of years. I obviously get very concerned about his well-being when he’s off meds but he cuts me off and becomes very paranoid and abusive often making false accusations.

This time around (he’s just been sectioned yet again), I’m seriously feeling I can’t take anymore of him! Everyone else in the family has run a mile so why shouldn’t I? All my patience, understanding of his illness and sticking by him seems to be a waste of time. How do I deal with this anymore? I don’t feel I can talk to anyone really because I feel partly so angry about it all and then guilty that I’m angry at someone who is ill and who has no insight into the fact that he is ill.

I understand your dilemma. I was once a part of a research team tasked with recruiting people with schizophrenia and one of their family members, to participate in a study. We ultimately had to expand our search to include people with schizophrenia who had a paid professional in their lives. We had extreme difficulty finding people with schizophrenia who had close connections with any one of their family members. In the majority of cases, they had lost contact with all of their family members and only had close connections with paid professionals.

Having “burned bridges” wasn’t just a phenomenon in our study, it’s like this for many people with schizophrenia. The “revolving door” aspect of your brother’s illness is common. It is, in part, what makes schizophrenia such a complicated illness. Having ample social support is immensely helpful in the recovery of many mental health disorders but supporting a person with schizophrenia can be very hard. Family members often feel the need to eventually cut ties with their loved one with schizophrenia in order to protect their own mental health and well-being.

It is important that you separate the person from the illness. Your brother does not stop taking his medication to be annoying or difficult. He can’t help it. It’s part of the illness. Not being able to recognize one’s illness is a symptom of schizophrenia called anosognosia. Anosognosia is a brain impairment that inhibits the ability to perceive one’s illness. It’s estimated that at least 50% of individuals with schizophrenia have anosognosia, and therefore lack awareness of their illness. Anosognosia is also common among other disorders including Alzheimer’s and Huntington’s disease. It is a possible side effect of a stroke.

There are books you can read about this subject. One of the best books is by Xavier Amador called I’m Not Sick, I Don’t Need Help. There are also organizations that may be of assistance to you including the National Alliance for the Mentally Ill (NAMI) and the Treatment Advocacy Center. NAMI has family programs, supports groups and many other educational materials that can help you learn how to cope with the challenges of loving someone with a severe mental illness.

Finally, you may also want to consider counseling. A counselor could help you to explore the emotional aspects of caring for someone with a severe mental illness.

When you deeply feel that your efforts are of little or no worth to the person that you are trying to help, then you are almost assuredly wasting your time. Be patient. Your life and the hours that comprise it are as valuable as those of the person you are trying to help. When you have tried and tried and tried again and nothing you do makes a real difference, it’s time to stop. That’s my most sincere opinion but only yours really matters.

Please take care.

Dr. Kristina Randle

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My Husband Sees Dead People

by Kristina Randle, Ph.D., LCSW February 22nd, 2021
written by Kristina Randle, Ph.D., LCSW

My husband’s mother died 2 years ago, but yesterday he told me that he had an hour long conversation with her. He said he’s been seeing her everywhere, and that she’s trying to tell him something. He also said that’s he’s been hearing voices who are not his mother, not constantly, that are always negative or fear based (they’re lying, Run, don’t touch that). I know these things are indicative of schizophrenia but he’s 28 and he’s been psychologically screened before (5 years ago). In addition to these apparitions he’s also been accusing me of saying/doing things that I didn’t and can prove that I didn’t (he says I’m lying) and keeling secrets when I literally do nothing that is not directly associated with taking care of the house and the family. He knows that, and yet he is always punishing me for these made up scenarios. I asked him to go to therapy, and he accused me of trying to fix him. I’m afraid of what’s going to happen if I can’t get through to him, he has a bad temper and substance abuse problems and now he’s completely losing his grip with reality. If you have any advice about how I can handle my husband and his terrible version of the world(and me) I would great appreciate it.

Your husband’s symptoms are concerning. I can’t diagnose him over the Internet but his symptoms might be indicative of psychosis, which is a break with reality. Psychosis is associated with schizophrenia, bipolar disorder and other related disorders. His last psychological screening was five years ago and a lot could’ve changed since then.

He has substance abuse problems but you didn’t say what he was using. Substance abuse can contribute to psychosis. It could explain his behavior.

You suggested to your husband that he seek psychotherapy but a psychiatrist might be a better option. Traditional talk therapy is often not an effective treatment for psychosis. A psychiatrist can prescribe medication which can reduce or eliminate symptoms of psychosis. Once the psychosis is treated, he might then benefit from talk therapy.

The aforementioned discussion assumes that your husband is willing to participate in treatment. Thus far, he has not been willing and therein lies the problem. Some people with psychosis don’t believe they are ill and subsequently refuse treatment. Their unwillingness to participate in treatment makes it exceedingly difficult for family members to effectively intervene. They are left with few options.

I would recommend the following: ask if he would be willing to see a psychiatrist. If he’s hesitant, offer to go with him for support but if he’s suspicious of you attending the appointment, let him go alone.

If he adamantly refuses any form of treatment, then I would recommend contacting the local mental health crisis team to ask for their advice. Another option is to contact your local mental health community center.

You correctly recognize your husband’s need for treatment. It’s also important for you to recognize that you are not a mental health professional and thus are not equipped to treat his condition. Leave this to the professionals. If he’s unwilling to seek help, then you should consult a mental health professional because it would help your understanding of the situation and of your options.

Also be aware of the potential risk that he may pose because of his anger, accusations and substance abuse. People under the influence of illicit substances, who are psychologically unstable, can be aggressive and unpredictable. You must protect yourself from this potential risk and call the police if you feel that you are in danger or that your husband might be a danger to himself. Understandably, you may not want to call the police but there exists the realistic possibility that illicit substances can lead people to behave in ways that can be dangerous.

Finally, contact the local National Alliance For Mental Illness (NAMI) support group. NAMI is an advocacy organization that assists people with family members who have mental illnesses in knowing how to navigate the mental health system. Their services are free and typically available in every community. You can find them on the Internet by doing a Google search for the terms “NAMI” and the town in which you live. If you have additional questions, please don’t hesitate to write again. Please take care.

Dr. Kristina Randle

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My Mother Has Schizophrenia, Please Help

by Kristina Randle, Ph.D., LCSW March 2nd, 2019
written by Kristina Randle, Ph.D., LCSW

Good day. I am an 18 year old Pakistani girl.My mother has been receiving treatment for schizophrenia for almost 25 years .She is a very unique case . She was an extremely brilliant student and was admitted to a well reputed medical college . There , she was unable to adjust because of a sort of phobia of flesh and dead bodies( which were included in anatomy dissections ),watching deliveries worsened her condition leading to a decision of abandoning the medical studies. She graduated privately and joined the teaching profession. She had always been an aggressive person .She was also very arrogant as “she was a perfect beauty with brains” women. Finding out about painless delivery she agreed to get married .She married my father( it was an arranged one).She has revolting point of views about religion, and lives in her own fantasy world .She sort of thinks that every man is after her. She also thinks that people are conspiring against her. She hates her her mother and her brothers .She has been receiving treatment from various psychiatrists but nothing has helped much.She is currently in an institution called Fountain house. But she does not cooperate much with her therapists as she thinks that she is much more intelligent than them.She does not accept her disease and thinks she has Insomia only. Another thing is that she cannot sleep for more than 3 hours a night without medicines. Presently she is taking 5 anti- psychotics .The names and doses are listed below:
ziapine 100 mg 4 daily
seductil 100 2 daily
Ativan 2 daily
Neurolith 1 daily
Dosik 5 mg 1 daily
Kempro 5 mg 2 daily
Clonatril 2 mg 1 daily
Injections ( fortnightly)
Zyclidine 10 mg
Fluefin
Please do not disappoint me. I am myself a medical student and an only child .Dealing with my mother becomes very challenging as she is very very aggressive at times. Thanking you.

I am not certain of your exact question and therefore can only provide a general answer. I have answered many similar queries regarding schizophrenia. You may find it helpful to read through some of my previous answers. Many of my answers about schizophrenia and its impact on families can be found by clicking this link.

Schizophrenia is often considered a family problem. This is because schizophrenia typically has a profound impact on the family. The most comprehensive treatments for schizophrenia usually include the involvement of family members, in some capacity. Based on your letter, I did not get the impression that your mother’s treatment incorporates family involvement. The primary treatment modality for her seems to be medication. I would recommend speaking with her treatment team. Inquire about whether it would appropriate or helpful for you and your family to be part of her treatment plan.

Having a family member with schizophrenia, who refuses treatment, can be very frustrating for the rest of the family. They struggle to understand why their loved one would refuse the very treatment that could make them better. An individual’s refusal to participate in treatment or to recognize that they have an illness makes them seem “difficult.” Families often (understandably) react to the “difficult” family member with frustration and anger. That frustration and anger can unfortunately lead to chaos in the family.

What is important for families to understand is that approximately 50 percent of individuals diagnosed with schizophrenia cannot recognize they are ill. This is due to a neurological deficit called anosognosia. Anosognosia affects the prefrontal cortex of the brain, which is used for insight and understanding of one’s needs. If an individual does not believe they have an illness, they may (and often do) refuse treatment. Individuals with schizophrenia do not refuse treatment in an attempt to be “difficult.” Anosognosia blocks an individual’s ability to recognize that they have an illness. You can read about anosognosia in Xavier Amador’s book: I Am Not Sick I Don’t Need Help! For a deeper understanding of anosognosia and related medical conditions, consider reading a truly fascinating book called Phantoms in the Brain: Probing the Mysteries of the Human Mind by V.S. Ramachandran and Sandra Blakeslee.

If your mother is aggressive toward you, then you may have to limit how often you interact with her. You may want to discuss how best to approach this with the hospital/residential living facility staff. It is important to visit your mother and to be part of her life but boundaries have to be set if she is physically or verbally abusive toward you.

I would recommend educating yourself more about schizophrenia and how it affects family members. I realize that you are not living in the United States but you may find a lot of helpful information on the National Alliance on Mental Illness (NAMI) website. NAMI specializes in support and psychoeducation for family members who have a loved one with schizophrenia or other mental illnesses. Helpful books include: Surviving Schizophrenia: A Manual for Families, Patients and Providers by E. Fuller Torrey and The Complete Family Guide to Schizophrenia: Helping Your Loved One Get The Most Out of Life by Kim T. Mueser.

If you have a more specific question, please do not hesitate to write again. I will be happy to answer any additional questions that you may have. I wish you well. Please take care.

Dr. Kristina Randle

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