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Delusions

Wife Having Paranoia

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

I need some advice about my wife. She’s 33 years old and has never had any issues besides being ADD and having some anxiety. She was on Methadone for 6 years and Xanax for 2 years. She’s in a program now coming off both. Back in March she started thinking someone she meet online was hacking into our computers and email. I did everything I could to make sure we we’re secure but she kept thinking it was happening. Since then It’s gotten gradually worse. She now thinks there is a large team of people following her everywhere she goes and listening to her all the time. She thinks there are hidden cameras in our house, phones bugged, tracking devises on our cars, and people coming in our house when were not there or asleep. She thinks they have certain tv and radio commercials play at certain times to tell her things. She wl go into a grocery store and think the cashier is one of these people. No matter where we go she thinks she’s being followed. She says there was someone on the plane when she was flying to the place she is now and that they are watching her there. I am really hoping it’s the medicine but they have decreased her dose and she still believes all of this. She can’t even go to the bathroom because she believes she’s being watched. My question is would the Xanax cause this or does it seem to be a more serious condition? Also she gets extremely mad at me because I won’t believe her. What should I tell her. In her mind it’s real and she can’t believe I won’t believe her. Many of the things she says aren’t even possible. She doesn’t talk about it around other people so nobody else knows this is going on. I’d appreciate any help as I’m very worried about our family. Thanks!

Your wife seems to be paranoid and delusional. These are symptoms of psychosis. Your wife continues to believe in things that are not real despite evidence to the contrary. That is the definition of a delusion.

Psychosis is a break with reality. Psychosis is associated with several mental health disorders including bipolar disorder and schizophrenia. Sometimes people have episodes of psychosis that are not associated with the aforementioned disorders. Some people have one psychotic episode and never have another. If there are repeated psychotic episodes, then it might be indicative of a specific mental health disorder. Psychosis can be caused by mental illness, drug use, organic brain disorder, tumors, strokes, dementia, and alcohol and drug withdrawal.

What is causing her symptoms is not clear. Her current detoxification may be a contributor but a thorough evaluation is necessary to know for sure.

Report her symptoms immediately to her prescribing physician. It’s also important that she be evaluated by a medical professional. It might not be easy to convince her to have an evaluation but do your best.

Immediate intervention is necessary. Psychosis generally does not improve on its own. If necessary, take her to the hospital. Please take care.

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Continuing Symptoms Despite Treatment

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

Thank you. A month ago (or so) Dr. Kristina Randle helped me answering my question. (Misperceiving reality without medication). After reading the answer I decided to contact my former psychiatrist (the one I used to trust) and started a treatment with her.

I was feeling so much better and wanted to write just to say thank you, was not fine yet, but better, lot better. So thanks 😀 really.

I understand you answered my question, and don’t want to continue bothering you, but I’m in a little despair. My delusions diminished a lot, I think my official diagnosis is Bipolar Disorder with Psychotic features (or something like that), my mood was fluctuating, but was ok.

The thing is that 3 days ago I started to think of myself dead, uh… not sure how to say it. Like I see me killing myself in my mind (hope makes sense), was not feeling depressed or sad, actually I was fine, just this idea, and it started to invade my thoughts and now I just think in it. I don’t want to really kill myself, despite everything, I love my life, my plans. It has been hard to achieve certain stability, and I like being functional, but there’s this image that don’t leave me alone.

Then I started to listen other people’s thoughts (again), but I usually heard the thoughts of one person at a time, and now are a lot of thoughts of lot of people, so I can’t distinguish everything and my head is aching all the time because of the constant noise.

I wrote to my doctor explaining, I try not to call unless is a real emergency I don’t like when I am demanding, anyway I wrote to her, and she told me I have to give time to the med to kick in.

I know I have to be patient, but I can’t concentrate, or work, and I have datelines, and now I am starting to feel desperation, and don’t know how to deal with this until the med works fine, what if the meds don’t work? What if I’m not fine again?

And I ask myself if I really can’t control this or why am I doing it? Why a person would be like imagining things? Listening or seeing things that really are not there or happening? Am I just a freak? Should people be afraid of me? Should I stay away from people, to avoid hurting them?

And I feel so guilty and afraid for thinking of “me killing myself,” I know I like my life now (generally speaking), and was hard to get to this point. And people say that if you say it is just because you want attention, that people who wants to do it just do it. I don’t want to do anything like that, and also don’t want to have this images in my head, but don’t want to like to “call for attention.” How do I know if I have to say it to someone or not? How do I know if is real, and I should be worried or not? I used to want to die, I even try once and barely survived, and I am grateful I did, ’cause some years after my life improved and I liked it, but I feel ashamed as well (of feeling, saying and trying to kill myself and be alive) because it makes me feel like it was fake, that I was fake. Does that make sense? Should I ask for help or just wait until the meds work?

I’m sorry, I wanted to be just a thank you note, and I understand there are other people, and you have answered a question of mine before, so it’s OK if u don’t answer this time.

Thanks a lot for your time and previous advice.

I’m so glad to hear that you contacted your psychiatrist and have begun treatment again. I very much appreciate you writing back and letting me know how you’re doing. Thank you.

Please never feel that you are bothering me. I am glad to help you.

Your symptoms are obviously distressing but they are not your fault. No one would willingly choose to experience what you are experiencing. Those thoughts and images are essentially your brain playing tricks on you. It’s unfair, unpleasant, and frightening, and I’m sorry that this is happening to you. It will stop. It does take time. Be patient but also carefully monitor the suicidal thoughts that are occurring. If you feel that you might attempt suicide, you should call 911 or go to the emergency room. Keep your doctor informed about every change in your thinking.

You were wise to inform your doctor about your ongoing symptoms. Don’t feel like you’re a bother to your doctor. You are not. If you are a bother to your doctor, then she should find a new occupation. No good therapist would ever be upset with your providing the very information that they need to do their very best work. She needs you to keep her informed or she simply cannot do her job. What I am trying to say is you are being a responsible client. Without your self-reporting, she would not know how you are doing. As she noted, it may take time for the medication to “kick in.” Alternatively, your ongoing symptoms may be a sign that a dosage adjustment is needed. It’s important that you continue to inform her about your symptoms. It helps her to know whether your medication needs adjustment.

You may also want to consider the addition of psychotherapy. A therapist could help you to stay grounded in reality. For instance, he or she could help you to distinguish between what is real and what is not, teach you strategies for dealing with distressing hallucinations, voices, paranoia, and suicidal thoughts. During any distressing time, it’s important to surround yourself with a great deal of support. The more support you have, the better you will feel.

Thanks again for writing to let me know how you’re doing. Please consider writing back to keep me posted on your progress. I wish you continued success. Please take care.

Dr. Kristina Randle

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My Mum Is Putting Salt Everywhere

by Kristina Randle, Ph.D., LCSW
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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I Think I Have Antisocial Personality Disorder or Something Similar

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

Hello, I’m 16 and I lack emotion and the emotions I do have seem to be fading away. I have no empathy, sympathy, very little remorse and no grief. I feel joy which sometimes is inappropriate to the situation, anger and irritation most commonly. I took joy when my mom was drugged at a bar because she’s an alcoholic and I felt as if she deserved that. I feel like everyone deserves what they get, and that they’re my pawns. At 14 I started to feel like no one was real like they’re all robots that are programmed to respond to my actions. The people that I feel are actually real consist of my partner, best friend and younger brother. I also lie just to throw trouble elsewhere or just because I can. I don’t take pleasure in that but I do it anyway and I’m highly impatient but I feel normally for animals and I’m vegan… Im responsible and very un-impulsive though.

In addition to my emotions, I feel all humans past 10 are guilty and deserve to die especially alcoholics, drug users and child abusers. My alcoholic mother is included into that. I don’t necessarily want to kill her, I just wish she would die as I see her as a waist of space. She’s stupid with money and an emotional mess. When I become angry though I often imagine torturing the person in which I’m angry with or sexually assaulting them. Sometimes I think of how I would tie someone up and give them both pain and pleasure even if I’m not angry. I don’t feel I’d ever do that though.

A my past included being molested at the age of 5, until 14. I had a concussion at 7 which gave me a stutter that faded, slight lisp and headaches only after. In 8th grade I lost my  best friend due to developing depression and a lack of emotions which resulted in suicide and self harm. I can make friends but they become annoying. My best friend and I are both emotionless so it works well.

I fear cops may show up when I post this so as clarification no I won’t be harming anyone and I will get help, I just need a temporary explanation to all of this. I started feeling this at 14 and it got worse I’m 16 now. (From the USA)

Thank you for having the courage to acknowledge this pain and discomfort. I believe it takes a high degree of bravery to identify and want to change the things that are distressing to us.

Your mother’s alcoholism, poor parenting, and inability to protect you, along with the early sexual and physical traumas, are likely to be a significant source of your thoughts, feelings and reactions.

You have taken a tremendous step forward by writing us here and I would encourage you to find a way to get an appointment with a therapist. If there is a direct way to do this — like telling a guidance counselor at school that you are having problems at home and would like their help in setting up an appointment — I would do that. If that isn’t possible, I’d arrange for you to see your physician and tell him or her about how difficult it is with your mother. This will help the physician help you get the therapy.

Finally, I would also contact the local counseling centers near you that offer services to teenagers directly. Here is a list of those near you that can point you in the right direction: http://www.compassioncounseling.org/resources.php.

You have taken the first step here. I’d now take the next step in dealing with these issues more directly.

Wishing you patience and peace,
Dr. Dan

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Might Have Munchausen Syndrome or Something Else?

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

Hello. So I’m really confused currently. I’ve never really been normal, mainly just an outcast of society. Always been strange and weird.

It all started when I was just a small child; my mother always told me to not trust strangers because stranger danger, you know, the usual things mothers would tell their children. I took it to extremes though, I still do. I don’t trust ANYONE I don’t know. It may seem normal but the thing is, I feel like every person out there that seems suspicious, even just a guy with a few tattoos is out to get me.

When I was about 5 I literally started running away from my friends because a car was coming towards us. It was just driving away.

I constantly feel like I’m being watched and I know who’s doing it. A black and white clown who murders children, I don’t see him, but he is there.

I’m also paranoid about my webcam, I feel like someone is watching me through it so I tend to look at it and talk to it. I once straight up told it to go to hell and I make weird faces at it. I once went as far as to tape it down because I was so scared.

I see things as well. I always find something I love on the internet but in a matter of hours or days my mind turns it completely creepy. I see things strangely out of the corner of my eye. I see faces form in objects but when I look at it’s, they’re not there.

I hear things as well but only if there is noise along with it. I was in class the other day and people were talking and it wasn’t very loud but then other voices joined in. Same with music, I hear voices mixed in between the music but when I stop it the voices stop as well. I know it’s not the music. People read my mind. I talk to two girls in my mind called Ana and Mia, it’s just me talking but sometimes it’s not.

One part of me denies the problem but the other part is screaming that I do have a mental illness and that I’m crazy. But the thing is, I like it. Not for the attention, I don’t want that. It just fascinates me.

Any clue?

Seeing and hearing things are not normal. Nor is believing that people can read your mind or see you through your web cam. These symptoms are concerning.

It’s good that you recognize that a problem might exist. Your next step should be discussing your symptoms with a mental health professional. Ask your parents to assist you in finding professional help. Inform your parents about your symptoms and ask if they’re willing to help you.

Upon meeting with a mental health professional, he or she will gather information about your psychosocial history. It will help him or her to determine what might be wrong and what treatment is most appropriate. Treatments might include medication and/or counseling. Both of these could help you to eliminate these symptoms from your life.

You did the right thing by writing to us at Psych Central. Be certain that your next step is speaking with your parents and being evaluated by a mental health professional. I wish you the best of luck. Please take care.

Dr. Kristina Randle

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Delusions & Hallucinations

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

Hi, I’m a female from the U.S. and since I was little I have had this belief that I could broadcast what I’m doing into other people’s minds, it’s been with me since I could remember. I’ll do crazy and spontaneous stuff because of it and I’ll also get heavily paranoid. I got put on antipsychotics because I was having hallucinations, paranoia and delusions. I don’t have mood congruent hallucinations, paranoia, delusions etc… I have done my research but I refuse to self-diagnose. During these episodes I am not aware I’m acting out of the blue and I have been told by others I have disorganized speech that I jump from topic to topic. Why is any of this happening? I’ve abused drugs (amphetamines) in my past and I had grandiose delusions of being the most intelligent person that was gonna be a big thing. When I went off of them I finally had a psychotic episode and it went untreated until recently. I no longer abuse drugs and I ’m pretty healthy. Why is this happening? Some paranoia seeps out even with medication. My hallucinations are mainly: Walls moving, whispering, shadow people, random lights, letters moving around on phone, or this bloody girl. Delusions: Paranoid that I’m being monitored by a group of people through brain communications, or thinking people have been replaced by imposters

Without evaluating you thoroughly, it’s difficult to know why this is happening to you. I can only theorize based on my knowledge of psychotic disorders.

Past drug use could be a major contributor to your symptoms. Studies show that illicit drugs can sometimes damage the brain. It can also increase the likelihood of psychotic disorders. Despite the possible damage that using drugs may have caused, it was good that you quit. You should never use drugs again.

You mentioned having had unusual thoughts since you were “little.” Perhaps that’s indicative of having had a psychotic disorder that began in childhood. If so, it might explain why you continue to have symptoms of psychosis. As you may already know, the main symptoms of psychotic disorders are delusions and hallucinations. It’s still a mystery why some people develop psychotic disorders and others do not.

You also wrote about continuing to be symptomatic despite taking medication. That might suggest that your medication needs adjusted. It’s also not uncommon to take medication and to continue to experience symptoms. Medication is helpful for reducing symptoms but it doesn’t always eliminate them entirely. That is the reality of some psychiatric medications.

You might also consult a neurologist to rule out an organic brain syndrome. There are rare cases in which physiological problems can cause psychosis. A good example is described by Susan Callahan in her New York Times bestselling book Brain On Fire: My Month Of Madness. Ms. Callahan began experiencing psychosis symptoms seemingly out of nowhere. She was eventually diagnosed with autoimmune encephalitis, a neurological condition that was only discovered in 2007. I am not suggesting that you have a neurological condition, but Ms. Callahan’s story is reminder that all possibilities should be considered.

The end goal for you should be working with mental health professionals that you trust and finding a treatment that facilitates a high-quality joyful, life. It can take time to find the right mental health treatment but it is worth the effort. Please take care and don’t hesitate to write again with additional questions.

Dr. Kristina Randle

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Identity Crisis & Severe Distress

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

For the quick rundown on everything I have a history of self harm I have been told that I am delusional when it comes to remembering events and conversations that took place within minutes of it happening I get frustrated and have random outburst due to it and do things I don’t mean to do like smash my head off the wall behind me with no explanation as to why I did I just kind of happened I have been diagnosed with bipolar depression severe anxiety and stress levels borderline schizophrenia and plausible brain damage to the right side of my brain haven’t gotten that confirmed because I don’t want to know if it’s true I feel lost and like everything is spiraling out of control and I have no idea who I am what is real and what my mind just makes up anymore and am afraid of what I could be or do and I don’t like the person I have seem to become from all this I feel irrational and crazy on a daily basis and break down about as often as when I was a kid and just don’t know what to do with myself or how to act half the time and apparently ignore everything and everyone who is around me at times and just zone out of everything I find large pieces of days I can’t remember and I am getting tired of life and fighting my own mind everyday and trying to tell the difference from reality and fantasy what is true from what I believe to be true and have no idea what to do anymore my thoughts are scattered and even as I reread this I can see that i feel hopeless alone lost and confused and don’t want t feel this way everyday but don’t have the ability or motivation to seek help and to go to psych all the time I hate talking about how I feel and what I think my issues are because I don’t know I can’t tell one feeling from the next because it all ties back to frustration or aggravation it seems that’s all I feel

I understand your frustration and aggravation but your symptoms are treatable. It’s inaccurate to believe that you “should” be able to treat your own symptoms. Mental health professionals receive specialized training to treat these symptoms. There are medications and other treatments that can help you to feel better.

You mentioned not wanting to “go to psych all the time.” That would likely not be necessary. A treatment plan can be developed that meets your needs and fits your schedule. There are many options but one of them should not be avoiding treatment altogether. That would be a mistake.

You might try contacting your primary care physician for a referral to a mental health professional. Another method of finding good treatment providers involves contacting your insurance company. They can provide additional information about resources in your community. Perhaps a friend or a family member knows a provider who could help. Realize that you can be helped. You shouldn’t accept suffering if treatment is available. Please take care.

Dr. Kristina Randle

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Is He Doing These Odd Things Due to Schizophrenia?

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

Hello, my boyfriend is great to me in person. We function well as a couple. However, he does certain things.
He often yells out uncontrollably “I’m not gay, i’m german. I’m a God in the flesh.” He also mentions he’s a genius and the government is spying on him. To remedy this he screams in the shower “Shut up!” He also has a tendency to yell at his computer. This has disrupted my sleep. He’s also claimed he saw the devil leaning on his shoulder whispering the secret of life into his ear while brushing his teeth.
He’s a hard worker. He works 2 part time jobs and owns a small business online selling his art. While I support him, he is obsessed, like he will spend hours and it will get to the point of me telling him to come spend time with me. It’s like he’d rather sit on his computer then have human interaction. That isn’t my biggest concern.
He claims to have “out of body” experiences led by a voice. He refuses to give me the name of said “Voice.” Also, he has a few dozen dream journals intricately written out. A relevant question. When you just wake up, how can you perfectly and legibly write down your dream? Now here’s the last thing that bothers and hurts me. Since I agreed to marry this man, I did a background check. His records clean, he’s not abusive, but he had 3 dating sites stating he was single. I called him out, I printed his profile. I had the proof in front of him and he said I was crazy over and over.
I take 2 trains and walk 1.5 miles to see him (this is until my vehicle is repaired.) I have bought him groceries for nearly a couple months, shown him loyalty and love. He brought up us getting married, which was to early but now at a year I feel it’s fine to get engaged. He’s a bit older than me, i’m 29 and he’s 39.
Iv’e been told that he may have these profiles up related to self esteem or validation issues. He has a tendency to self deprecate himself and often asks me if I love him. I wished you could meet him and you would understand. I’m paranoid you think i’m sounding like a unhappy girlfriend. Why would someone show you such strong devotion in person, yet act insane and persue others online?

Obviously, his maintaining dating profiles on the Internet is problematic, but you seem to be overlooking potentially major red flags about his mental health. His symptoms may indicate psychosis. Psychosis is a break with reality and it is associated with several serious mental health disorders including schizophrenia.

It will be difficult for him to function in a relationship if he is psychotic. Untreated psychosis tends to become worse over time. Some people require hospitalization. Until his symptoms are under control and he is consistently participating in treatment for at least one year, you should postpone your marriage plans. Once it is clear that his mental health is stable and he is willingly participating in treatment, then you might want to revisit your marriage plans. Until then, I would advise against it.

Marriage is a major life decision with implications for the rest of your life. You should consider counseling to discuss these issues in more depth. Given your minimization of his mental health symptoms, my concern is that you have not given much thought to how his possible mental health condition could affect your life as a couple.

Have you considered the following questions regarding his mental health: What if his symptoms worsen? How will you handle erratic behavior? What if he doesn’t participate in treatment? What if he doesn’t think he’s ill despite his symptoms and refuses treatment? What if the “voice” tells him that you’re secretly trying to harm him and that he should preemptively attack you to defend himself? Those are only several questions to consider. Assuredly, there are many more.

If your fiancé does have a serious mental illness, it will greatly affect your life and relationship. You need to be fully informed about his illness and how it could impact your life together and the lives of your children, should you decide to start a family. Most importantly, there needs to be a clear plan for how his illness will be managed. Many people with serious mental illnesses have successful relationships but without treatment, that might not have been possible. Premarital counseling would be a very wise decision. Books and online support groups are also good sources of information. Please take care.

Dr. Kristina Randle

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My Brother’s Behavior Has Been Very Strange and We Don’t Know What’s Wrong

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

This is a long story so I apologize, but I really need some answers. My brother has been excited to go to Lollapalooza all year. He was finally going to go this past Tuesday. Well we got a call from him after only a day of him being there saying he wanted to come home. He was ballistically crying on the phone and saying he “felt the power of the antichrist.” I decided to drive to Chicago with my parents to get him. When we arrived, he was sitting on a bench without his bags. My dad asked him why he didn’t have his stuff and he said he gave it all away to his friends (it was all his clothing and his wallet.) He also said he threw his phone in the river because it was giving him fear. He then launched into a story about how secret servicemen were hunting him down because of his belief in God. The rest of the night, he continued talking about how God was giving him all these “tests” and how he felt like he was in a scavenger hunt. The next day his behavior got worse. He got up very early and started singing loudly (very unusual for him) then started walking around the city with no shirt, no shoes, and a guitar.

Since then, his behavior has continued to scare my family and I for 3 days now. Last night my parents had to escort him to bed because he couldn’t walk on his own, but then 10 minutes later I heard him singing loudly in his room and talking to himself. I am very afraid for my brother’s state of mind right now. He swears up and down he didn’t take any drugs, but we’re very convinced there is something in his system. However, it’s been going on for 3 days now, and the effects of drugs normally don’t last this long. My other thought is that he is having a psychotic issue. This has never happened before and I am afraid. Please help.

Your concerns about your brother are valid. As you suspect, it could be drug use or psychosis (or drug use that led to psychosis). Another possibility, is an organic brain disease but the only way to know with certainty is for him to be evaluated. If you can convince him to go voluntarily, that would be ideal.

He may be telling you the truth, about his not taking drugs, as he knows it to be. He may not remember taking a drug or he may have taken a drug without knowing it.

If he’s unwilling to seek treatment, then consider calling the local mental health crisis team. Many communities have them. You can call them to ask for their advice and to request that they come to your home to evaluate your brother in person. These are exactly the types of situations they are trained for and they can assist you.

You can also consult your local community mental health center, the National Alliance on Mental Illness (NAMI) group (most communities have them) or the Treatment Advocacy Center in Arlington, Virginia, who can be reached at 1–703–294–6001. Here is a link to their website for resources in your state.

In the meantime, do whatever is necessary to keep your brother safe. His rational thinking processes are compromised and he might do something that he would not normally do, as demonstrated by his leaving the house inappropriately dressed. He needs treatment as soon as possible. Psychosis (if that is what the problem is) generally does not get better on its own.

I hope that you and your family are able to find help for your brother. Please consider writing back to let me know how things have turned out. Please take care.

Dr. Kristina Randle

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Should I Disclose Depression?

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

When I was 21 years old I started having visions and hearing things that others did not. I thought and still do think, I am special because of it. However, I started to feel like I did not want to be special any more. I went to the doctor and was treated for depression…

I am now 35 years old. I am college educated, I had a great career…children and now everything is falling apart. I used to be able to drown out the voices when they became overwhelming. I am having trouble dealing with it. They call me names and scream at me. They used to be friendly and even helpful. I am also extremely worried that someone will hurt me and my children.

I started seeing a therapist in October but I could not tell him everything. I did not really trust him. I felt by the way he was speaking to me that he was trying to judge me. I was also very afraid that he would have me arrested and take away my children. I was taking medication, but the voices told me that if I continued to take them I would die…I thought it would be in my best interest to listen….

I have an appointment with a new doctor next month…what should I do? Should I tell the doctor everything? Is this normal? Am I suffering from a depression?

Yes, you should tell your doctor about the symptoms that you are having. Withholding information from your doctor makes it difficult for him or her to properly treat your problem. The fact the you withheld this information from previous mental health professionals means that they may have misdiagnosed you with depression. Nothing in your letter suggests that you have depression. Your primary symptoms seem to be delusions and hallucinations, neither of which are symptoms of depression. They are in fact symptoms of a possible psychotic disorder such as bipolar disorder or schizophrenia. I cannot say with certainty whether or not you have a psychotic disorder but it is a possibility. That is why it is imperative that you report all symptoms to your doctor so that he or she can treat your symptoms accordingly.

There’s no reason to believe that you will be arrested or that your children will be taken away from you. Your children are not in danger. The authorities only remove children from their parents in cases of imminent danger. You’ve done nothing to suggest that you might harm your children. Simply having symptoms of a mental health disorder does not make you a danger to your children.

I would encourage you to read the New York Times article by Elyn Saks entitled “Successful and Schizophrenic.” Elyn Saks is a university professor, a successful researcher and the recipient of the MacArthur Foundation genius grant. She has schizophrenia and has been wildly successful in her life. In the article, she describes some of the ways in which highly successful individuals with schizophrenia manage their delusions and hallucinations. Some utilize cognitive techniques. In one instance, one particular individual would ask the following questions of himself when he began to experience hallucinations: “what’s the evidence for that? Or is it just a perception problem?”

She describes another individual who would simply “blow off” their derogatory voices. Another individual identified their triggers for the purpose of preventing a “full blown experience of symptoms.” Others used techniques such as minimizing sensory outputs, exercising, focusing on work, getting proper sleep, healthy diet, avoiding alcohol, and prayer.

There are very effective treatments and strategies that you can employ to significantly decrease or eliminate your symptoms. The sooner that you report these symptoms to your doctor, the sooner your symptoms can be properly dealt with. Please take care.

Dr. Kristina Randle

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Am I Crazy?

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

When I was younger (middle school aged), I had what I think were hallucinations. I tried to tell my grandmother about them but she told me it ‘was the devil’ and that I should never tell people about it. So I didn’t. It happened three times and never again. Last year, I started believing crazy things such as thinking I was the Second Coming and could move things with my mind. I actually stared at objects trying to make them move and had a conversation with the sky (God?) asking why my powers weren’t activated yet. I sometimes think people can read my mind. I’m depressed, and have major anxiety issues… To the point that its hard for me to leave the house long enough just to get the mail.

I also lost all my friends and most of my family because I had an episode where I was overly happy and made horrible impulse decisions. I couldn’t understand why they didn’t think the way I did and why they were so upset… Long story short, I ended up in a cop car and moved in with a distant relative that I barely knew.

I sometimes have thoughts where I want to hurt people/things like my Nana’s dog. I tried to smother her last month just to see what it felt like. I’m confused about myself and am going to see a therapist in a few weeks about this but I’m nervous and wanted to get an opinion before I go. What could possibly be wrong with me? Even if it could be more than one thing, I’d just really like an opinion on the possibilities.

It is good that you have decided to seek professional help. Having an in-person evaluation by a mental health professional is typically how a diagnosis is determined. Diagnosis via the Internet is difficult, given the lack of personal details and psychosocial history. Based on the information provided, there are several possible explanations for what might be wrong but please remember that I have limited information.

Hallucinations and delusions are associated with psychotic disorders. Psychotic disorders include schizophrenia, schizoaffective disorder, psychotic disorder not otherwise specified (NOS), bipolar disorder, and several others. You stated that you had hallucinations but have never had them again. With regard to delusions, it is unclear if you currently have them or if they were something that only occurred years ago.

Having a history of hallucinations and delusions does not mean that you have a psychotic disorder but it does increase the likelihood. Whether or not you have a psychotic disorder depends on if you currently are experiencing symptoms of psychosis, how often those symptoms occur and their level of severity. Bipolar disorder may be the most likely possibility given your current symptoms which include (as you described them): being overly happy and making impulsive decisions which led to your involvement with law enforcement. Again, given the fact that I have limited psychosocial and personal information, a potential diagnosis of bipolar disorder can only be considered speculative.

Seeking professional mental health treatment is the wisest approach to addressing your psychological problems. When meeting with the mental health professional, inquire about the possibility of medication. Medication could significantly reduce your symptoms and improve your overall mood and emotional stability. I wish you the best of luck. Please take care.

Dr. Kristina Randle

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Delusional Mother Turning Against Her Family

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

Just over a year ago my mother started talking to me about things that didn’t make too much sense.

She believed her neighbors often would yell things threw the walls at her. She moved to a different province shortly after (as my parents retired.) She claimed the neighbors wrote letters to the police about her because she occasionally smoked weed.

Since moving she has been having constant delusions that a neighbor is stalking her. To the point where she won’t talk to me on the phone in the house. She has to go outside to talk “about the stalker” he has wired her house so he knows everything she is doing. He knows where she keeps things. He takes pictures of her. She hears his voice everywhere. She seems weird when she talks like she is watching what she says because of who can hear.

We got her to see a doctor but they only did blood work and everything came back okay. She truly believes these things are happening to her and now will only talk to my sister about it (because she told my mom she believed her) she refuses that she needs help.

Things have only been getting worst. She called the cops on “him” when they arrived at the house she had the cops listen to the tea kettle and she claimed she could hear his voice.

She is turning against my father. She believes he is planting drugs with her fingerprints around the property to have her taken away. Also that he is divorcing her (in secret)

she tried running away the other night with a bag of clothing. My father went out looking for her and found her.

I want to help them. I feel horrible for my family. But he refuses she’s sick, and is slowly turning against us.

What can we do to help her get help? My father is all alone and says he’s okay but I know how hard it has to be.

She could be experiencing psychosis. Psychosis is a break with reality. She seems to be paranoid and delusional. That’s evidenced by her fear of the neighbors and now members of your family. Psychosis is associated with disorders such as schizophrenia and bipolar disorder. Typically, people with schizophrenia and bipolar disorder-type conditions begin experiencing symptoms in their late teens or early 20s. For your mother to develop these conditions later in life, would not be the norm but it also would not be rare.

She could be experiencing an organic brain condition. For example brain tumors, cysts, dementia, certain types of epilepsy, and strokes can all cause psychosis. She was evaluated by a doctor but only blood was drawn. A more thorough evaluation with a specialist is necessary.

You mentioned that your mother occasionally smokes marijuana. Marijuana is a hallucinogenic drug. In the United States, it’s classified as a schedule 1 drug which means that it has a high potential for abuse and no medical value. Studies show that people who use marijuana are at an increased risk for developing psychosis when compared to people who do not use marijuana. It’s possible that your mother’s symptoms are the result of her marijuana use.

Your mother should consult a psychiatrist. A psychiatrist is a medical doctor with specialized training in mental illnesses. He or she would be in the best position to determine what’s wrong. Depending on his or her evaluation, the psychiatrist might recommend that she be evaluated by a neurologist. A neurologist is a specialist in brain diseases.

It’s imperative that your mother be evaluated immediately. Go to the emergency room if necessary. Generally speaking, psychosis does not go away on its own. It requires intervention. The sooner the better. She needs help now. Please take care.

Dr. Kristina Randle

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How Do We Help Delusional Relative Who Is in Another Country?

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

From Australia: My sister in law, who currently lives in Canada, has been diagnosed with a psychological disorder. She seems to have been tipped into delusional thinking 12 months ago when her ex husband filed divorce proceedings. She has always had OCD and paranoid tendencies but never delusional as she is now.

She has no family and possibly only a couple of new friends around her as she only just 2.5 years ago moved to the city for his work. She has no work and though a resident she is not a citizen.

She was committed to a mental health unit a few months back after she called police about her safety and security – she believed the house is being watched, phones bugged, computer hacked and was unable to go out without fearing she was followed or conversations overheard. She has been prescribed medication and group therapy however all conversations with her from her Australian family indicate she is unable to function.

She needs to finalise the divorce proceedings to be financially supported but is unable to accept that her ex wants to divorce her. He is planning to sell the house she is living in and the divorce papers are being processed. She refuses to accept any of this and pack to leave the house, believing that he is being coerced and eventually will come back to her and we are lying when we say the house is on the market etc, even though she has the paperwork saying otherwise. Her ex has been gently trying to get her to understand that he is divorcing her for 2 years now.

How do we communicate with her so that we can support her to at least come back to Australia for a time. Her conversations are totally irrational and her mood swings from dispare to elation within moments -with a delusional positive or negative thought and she gets very agitated and irrational as soon as we mention anything related to her leaving. What do we say or do to help her?

Family have stayed for 3 weeks with her on 2 occasions but as she is manipulative, delusional and paranoid she is unable to take the steps she needs to. She will not seek therapy support. She started group therapy but we are not sure she is continuing as she says she doesn’t need it. Help — how do we managed this!?

Sadly, this may have to get worse before it gets better. You’ve already done what I would suggest. As you already discovered, this can’t be handled long distance by phone and email. It needs people’s presence and persistence. But you did that with your visits. She also may need more time in a hospital to stabilize her medications and to establish the value of therapy. But she has already had one such stay.

It may require another crisis — and another hospitalization — to give you some leverage with her. In this sense, it might be more helpful for her husband to move ahead with his plans than to continue to try to reason with her. His gentle approach has inadvertently helped her remain convinced that he doesn’t mean it.

While she is in hospital, you could request a family meeting to learn more about her state of mind and to ask for advice about how best to support her. My hope is that such a meeting would persuade her to return to your country where she has on-going support. But she may not agree to do that.

I don’t know enough about Canadian law to advise you about whether there is anything you can do to compel her to accept treatment and go where she is loved and cared for. In your shoes, I would check with a lawyer to see.

Meanwhille, you are in the very difficult position of having to watch someone you love self-destruct. There’s nothing I can say to make that any easier. If there is a support group in your area for relatives of people who are mentally ill, I do urge you to attend. Such groups often provide both information and emotional support that are helpful.

I wish you well.
Dr. Marie

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I Think I’m Delusional

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

I don’t know where to start. About a week ago I had a realization that I have been straying from reality for a long time. These “Episodes” have been happening more frequently and they’re getting worse.

About a year ago I spent two-three months thinking people were watching me. I thought that two guys (to be exact) could open this portal and see me while I changed and when I was bathing. It freaked me out. I turned to self harm, and they watched me do it. It sounds crazy, it really does.

I spent a few months before that thinking that my “mind” was in fact three people. Three people that would switch around and use my body. I remember thinking “okay so this one uses the body on Tuesday cause she’s the smart one and this one is Monday cause she’s good at sports.”

A few months ago I spent a whole night awake because I thought people were in my room. I’d turn my eyes and I’d see a dark shape. It doesn’t only happen during the night, sometimes in the corner of my eyes I’ll see dark shapes. I’ve read that they might be ghosts. It scares me to think that I actually believe in it.

Two nights ago I was talking to myself about how I thought this certain guy was cute. I got so caught up with it that the “voice” inside of my head that is usually mine became him. It freaked me out, his voice wouldn’t leave. I actually believed he was in my head, I told him to say a “safe” word to me at school so I would know if this was real or not. It wasn’t real of course.

I think the biggest one of all was when I realized that all the times I thought my parents were the worst, (typical teenage rebellious stereo-type I know) that I thought they would never let me do anything. It was me. My parents don’t mind me going to parties, I was the one convincing myself that they wouldn’t let me go. They don’t mind drinking, I convinced myself that they did.

As I am running out of words to explain everything, I’m reaching out for help. I don’t know what’s going on. I don’t trust the psychologist at school as she screwed me over once. Please help me.

It’s unclear what might be wrong. It’s unusual to have the thoughts you have described but your symptoms don’t necessarily suggest any one mental illness.

I’m most curious about your sleeping patterns. Sleep deprivation could be contributing to your symptoms. In fact, some studies suggest that 24 hours of sleep deprivation could cause schizophrenia-like symptoms among otherwise healthy people.

It’s important that you speak to your parents about these issues. You should not keep this information from them. They need to know what’s wrong so they can help. You should tell them what you wrote in this letter and ask them to take you to see a mental health professional. A mental health professional will gather information about this problem, determine what might be wrong and design a treatment to correct your symptoms. Please take care.

Dr. Kristina Randle

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I Think I Have The “Truman” Disorder, Feel I’m Being Watched As An Experiment

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

Q. I seem detached from some things, while being too deep into other things. Also, i sometimes feel like people and even tv are giving me “signals”. i know how stupid and crazy this all sounds so i’m hoping that’s a good thing, but i have lived with this all my life and can’t imagine it any different. it has been mostly comforting, feeling like i am not alone and people might know everything i have been through and understand me. But i don’t want to be crazy and i want to put a stop to this once and for all. I’m getting ashamed at some of the thoughts i am having now and it’s making me feel really stupid and crazy. it’s very distressing feeling like people are watching you even on the toilet, then realising that you’re insignificant so it can’t possibly be happening. People on tv i think like me and say certain things for me, then i remember that i’m stupid and crazy and weird looking and get embarrassed because i had that thought. my mind is switched on all the time so i can’t even sleep, i am just running imaginary conversations in my head where i can be myself and people can see that i am a nice person but i even get embarrassed by my behaviour in a fantasy scenario! i don’t want to be crazy any more, i want this to go so i can live my life normally. i would appreciate some advice or some kind of feedback, anything please. it sounds so much more stupid seeing all my thoughts written down, i’m worried. thank you for taking the time to read this.

Some people have referred to the type of delusion that you are describing as the “Truman Show” delusion. The name stems from a famous movie starring Jim Carrey in which he discovers that he is living in a fictional world in which his every move is being broadcast. The “Truman Show” delusion is not listed in the Diagnostic and Statistical Manual for Mental Health Disorders, the official guide used to diagnose psychiatric conditions. Its closest classification might be delusional disorder, persecutory type.

Two researchers documented five cases of patients who described experiencing the “Truman show” delusion. It was their belief that the patient’s were experiencing persecutory and grandiose delusions. They speculated that the “Truman show” delusion may be a “product…of the contemporary popularity in our culture of reality television.”

It’s very encouraging that you’re able to recognize your symptoms. Many people who experience psychosis are unable to recognize their symptoms and even deny them. You also seem to want help. Being able to recognize your symptoms and being open to treatment positively influences your prognosis. My recommendation is to undergo a mental health evaluation. The evaluator can make an official determination regarding a diagnosis and recommend a course of treatment. These symptoms can likely be eliminated with medication. I wish you the best of luck. Please take care.

Dr. Kristina Randle

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Mother Has Schizophrenia

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

Hello, I am 19 years old, and my mother has been suffering from schizophrenia since I was 2 years old. She was initially diagnosed as schizo-effective, and for most of my life it has stayed that way, up until about 4-5 years ago she was fully diagnosed with Paranoid Schizophrenia. It breaks my heart to see my mother slipping away from reality. She never leaves the house, is terrified of the “conspiracies” in her head, and has verbally violent conversations with the voices in her head. She is nothing like the person she used to be, and it’s devastating. Another hard factor is that I am the baby of the family, and she is very attached to me since I am the only child she has been a stay-at-home mom with (she was able to work before I was born), and my biggest concern is never being able to leave the house and live on my own because I don’t want her to feel even more scared and alone than she already does. My father is very loving and understanding towards her, and they’ve been married for 29 years, but he works a lot, leaving my mom home alone most of the day, every day, and I’m afraid that when I get out on my own she is going to lose it. How can I lead a normal healthy life without feeling guilty and worrying about if my mom is alright at home by herself. She has a history of being suicidal, and being alone all day seems to increase her paranoia symptoms, hallucinations, and delusions, and I don’t want her to suffer even more than she already is. I feel stuck here and that I have to take care of her and miss out on my own life, and I feel selfish feeling that way, because I should take care of my mother, I just always thought it wouldn’t be until she was in her 80’s and I already had raised a family of my own. How can I cope with this and keep my mother at ease as well?

Your mother is fortunate to have a loving family who cares so much about her well-being. Many people with schizophrenia have “burned bridges” with their families, often to the point where their families have had to part ways. In some cases, families have no choice. In the book “Angelhead,” for instance, Greg Bottoms writes about his brother Michael. Michael staunchly believed that his father was the source of all of his problems. He believed that the only way to stop his father was to burn him alive “before the demons completely overtook his soul.” In an effort to “save” his family, Michael lit the house on fire, convinced that killing his family meant that he was setting them free.

That example was meant to illustrate circumstances in which some families are forced to separate from their loved one with schizophrenia, for their own safety. Fortunately, that is not the case with your mother.

It is not selfish to want to live your own life. It is both normal and healthy. The desire to do what is normal and healthy should not produce feelings of guilt. Love often involves sacrifice, but you cannot sacrifice your entire life, chance of happiness and your future for the sake of your mother. You have the right and the obligation to care for yourself.

I would encourage you and your family to explore what social programs are available for your mother. There may be programs, staffed by mental health care workers, that could help care for your mother. Many counties have such programs and they may be free to your mother, depending on her health insurance. She may be eligible for intensive case management or a program in which doctors and nurses visit the home every day (if needed) to assist with medication management or to assess (and to subsequently attempt to improve upon) her daily mental health status.

What about medication? You mentioned that she is experiencing many psychiatric symptoms. The fact that she is experiencing significant psychiatric symptoms means that her quality of life is being compromised. Does her medication need to be adjusted? Check with her doctor about a possible medication change. Medication typically does not eliminate all symptoms but one can expect a significant reduction in symptoms.

You love your mother. That is clear but love cannot cure mental illness nor is it enough for her or for your family to have a high quality of life. Outside professional help is likely necessary in this situation and it may help to resolve this problem. You’d feel much better if you knew that, in your absence, your mother was being appropriately cared for by trained mental health professionals. It would also make you feel good to know that you helped to facilitate that care.

Check with your mother’s doctor, her treatment team or the local community mental health center to assess what programs or services are available. You should also contact the local National Alliance on Mental Illness (NAMI). They may suggest programs that could assist your family. Please don’t hesitate to write again if you have additional questions. Please take care.

Dr. Kristina Randle

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Why Is Son’s Wife Saying He Abused Her?

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

From the U.S. My son is getting a divorce. Only married a year. Wife pregnant. Telling everyone he is abusing her. Went to church and started crying saying she can’t believe he is there and she can’t deal with him because of his abuse and she is scared. This is my son’s church. Been there over 11 years. Rarely misses a service. She just started going when they got married. He had told her 2 days before to stop coming because she was harassing him.

Later that day my friend who son’s wife doesn’t know said wife just contacted her and was telling her all the abuse she had to go through from son and me and she had to leave for her safety and her sons. I get off the phone and message my son. He is on phone with wife. Wife is living with parents and she says her brother just abused her and she wants my son to take her boys if she doesn’t make it through the night. He told her he will call the police for her. She said no. Her parents will only tell them she is crazy. Told her to leave and go to shelter. She said no. She started yelling at him that she didn’t call for help and she is tired of dealing with him. Afterwards she post on Facebook that now she is being abused by 2 and “oh the pain. No understanding.”

Is this the behavior of someone being abused or what? Does someone being abused constantly call their abuser dumb and stupid? She harasses him at work so much that his boss says he is calling the police on her if she steps foot on his property. She got into his phone while he slept and read all his messages from everyone he knows. That is why she is mad at me because I gave him legal advice because she said he will never see their unborn child. She went off on me and told me how dare I disrespect her after she read my private messages.

Can you tell me what is happening here? I am completely stunned and not sure what we are dealing with. Also, she pawned her wedding band that son is still paying on. Said it was hers. Few days later, demanded his wedding band because she paid for it. It is hers. Please help.

Sadly, I can’t tell you what is going on with your daughter-in-law without interviewing her. From your description, it is possible that she is suffering from a psychosis related to her pregnancy. It’s rare but it does sometimes happen. The fact that she is accusing multiple people and distrusting people around her who you think are trustworthy suggests that the “abuse” is in her head, but I won’t rule it out. Just because someone is acting symptomatic doesn’t mean that there isn’t also something serious going on.

She needs to be evaluated by a mental health professional, not blamed or shamed or arrested. Since she has other children, it is especially important that she get an evaluation — for their protection as well as hers. Since she reached out to your son to take her other children when she was in such distress (despite the fact that she is accusing him of abusing her), I’m concerned. It may be necessary for him to contact child protective services to ensure the children’s safety. Although I don’t like the term “crazy”, her parents may be correct that there is something seriously wrong.

Since she is attending the church, is it possible that the pastor can influence her to see her obstetrician for a referral to a psychiatrist or psychologist? The pastor may be in a unique position to encourage her to get the help and support she needs. Since psychosis related to pregnancy is rare, the evaluator should be alerted that there is some concern by those close to her that it is a possibility.

As for the wedding bands. Once a gift is given, a receiver can do with it what they wish. Although unfortunate, she does have the right to pawn her own ring. But she doesn’t have the right to demand that your son return the ring she gave him.

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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Paranoid Partner

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

Hi, I have been knowing my SO for a year now, I like to believe that we have a great connection. He has told me in the beginning that he has trust issues and have a hard time letting people into his life. He doesn’t have many friends and he prefers to be home on his own which at first I had no problem with because I am a homebody myself. However, after a while, I noticed he had intimacy issues which then rose quite a few problems within our relationship. He distances himself quite often, becomes very cold. He also shared with me that he was sexually abused when he was young but he didn’t go into detail and I did not ask questions because I felt like he didn’t want to talk about it so I comforted him and we have not spoken about it since. I also know he did not come from a good background. He has also gone through my phone and found some messages from social media. The trust was fully broken then but after a couple months of separation, we decided to work out the relationship. A couple of days ago, he became very distant and I began to worry what was on his mind. He finally opened up and told me he suspects his roommates are plotting to get him. I reassured him that that was all in his head and to stay positive. He also bought a knife for protection which I didn’t think much of. However last night, he smoked a little bit of marijuana (he has before and has never acted weird) and after an hour, he began to shake uncontrollably. I had asked him what was going on but he told me he was just cold and told me to go to bed. As I am laying next to him, I couldn’t help but notice his behavior. He was still shaking, his heart was pounding and he was looking straight at the door and noticed he was holding a knife in his hand as he looked like he was prepared for whatever was going to happen. I began to worry even more and he suggested we leave his place.. it was 2am. While we were in the car, he began to suspect I was hiding something from him. He kept saying “What’s going on” and began interrogating me and went through my phone again believing I was out to set him up. I was afraid for my safety and I told him to get out of my car, he got a lyft and just left. I have not heard from him since and I am still worried about his mental state. What should I do? I deeply care for him but he doesn’t trust me and believes I am out to get him. I believe he has paranoia disorder but he doesn’t have medical insurance and I am afraid it is going to get worse. I don’t want him to hurt himself and I want to help but I don’t know if he wants help from me.

It is very difficult when the people we love and want a relationship decompensate, and I admire your tenderness and compassion. However, a paranoid delusion is nothing to try and deal with on your own. There is potential for him to hurt you, someone else, or himself during these states and justify it with these irrational thoughts. This is a situation that requires professional assistance with an evaluation from a psychiatrist or psychiatric nurse practitioner.

Set a clear boundary with the primary goal of protecting yourself physically and emotionally. This is not an opportunity for you to reason with or convince him. This is a situation you must view as a self-care priority with your well-being coming first and foremost. Individuals can recover from these episodes, but it will require professional guidance and (most likely) medication. An evaluation for him is imperative.

It is not uncommon for intimacy to be the trigger for such episodes and you may not be able to offer more than your compassion from a distance. If he is sleeping with a knife he intends to use it if he feels it is necessary—and that necessity may be determined by a delusion. Worse—the use of drugs may exacerbate his anxiety and disordered thoughts.

Set clear boundaries for yourself. Explain that his actions and behavior are such that you are concerned and cannot be with him until he finds some help. I know this seems difficult, but your well-intentioned acts can easily be misinterpreted and used to justify his paranoia. Don’t put yourself in harms way.

Wishing you patience and peace,
Dr. Dan

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