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Within the last 10 years, my mother has developed severe paranoia. It started when she and my father first separated. She began to accuse him of damaging parts of the house, and took pictures of every small spot of perceived damage. These ‘damages’ included natural black knots in the wood grain of paneling, wear on furniture that had been there for years (she insisted it was new), and creaky floorboards where, according to her, he had pried up the nails and damaged the hardwood. She would have hysterical fits where she was crying and calling my dad ‘crazy.’

This seemed to blow over after a while, and for a year she seemed back to ‘normal.’ By now I was the only child left at home, and I began to make tentative plans to move out. My mother went on my computer one night and read my emails. She found a response from an apartment I had applied at, and became totally hysterical. She was screaming and crying, telling me I couldn’t move out. I tried to explain that it was only something I was considering, which is why I hadn’t brought it up before then. She refused to listen, and called the entire family telling them something was ‘very wrong’ with me. My father panicked thinking I was physically hurt, and came over to the house right away. Her level of hysteria at this point was frightening, and as we tried to calm her down, she began to tell us about the danger she was in, and feared I was in. She told us that a friend of hers, a retired librarian, had a husband caught up in drug dealing. The two of them had ‘learned too much’ and were being followed and terrorized. Two housewifes in their 60s.

She talked fervently about these stalkers, and said people all over the country were being stalked as well. She began pulling up websites and videos on her computer, as well as a 30-something page document she herself had written on the subject. My father asked her why she hadn’t called the police if there were people threatening her life. She couldn’t give him a straight answer.
After that night, my mother was so unstable I was forced to move out to protect my own state of mind, which was already fragile due to other personal problems I was having.

Since this incident, my mother has had no further outbursts. However, she is always making references to people trying to harm her, always noticing things that she perceives have been moved around or changed and will wonder aloud ‘who was in here?’ While at her house a month or so ago, I saw poorly concealed marks where she had cut the drywall and pulled it down. Immediately I thought of her paranoia, and the fears she had previously expressed about having surveillance on her.

No amount of talking will convince her she is sick or needs help. She honestly believes this stuff, and she tries to convince me of things, too, like that my husband is poisoning my food.
Everyone in the family, including me, believes Mom is schizophrenic and has no idea how to handle her. Please, in your professional opinion, does she sound schizophrenic, and if so what are the treatment options for someone who refuses to accept treatment.

It is difficult to provide a reliable diagnosis over the Internet. I would need to interview your mother in person to verify a schizophrenia diagnosis. Having her evaluated by a psychiatrist would be the most reliable way to know if she has schizophrenia or another disorder. Having said that, she is exhibiting some of the symptoms of schizophrenia. It is also possible that she has a delusional disorder. Both are psychotic disorders in which paranoia is a main symptom. In addition to paranoia, typically individuals with schizophrenia would exhibit other symptoms including hallucinations, problems with social interaction, disorganized behavior, and hearing voices, among others. There are various types of schizophrenia and each diagnosis would depend on the specific symptoms.

At least 50 percent of individuals with schizophrenia have an inability to recognize that they are ill. This symptom is called anosognosia (pronounced anna-sig-nose-ea). It is also sometimes referred to as lack of insight. Approximately one hundred studies have evaluated this phenomenon and have consistently found that approximately forty to fifty percent of individuals with schizophrenia cannot recognize that they are ill.

People who do not have insight into their illness classically do not admit that they have schizophrenia. They will refuse to believe they have schizophrenia, refuse treatments and will usually generate alternative reasons to explain away their condition. For instance, one schizophrenic client who was hospitalized close to 40 times, each time for not taking prescribed medications and subsequently relapsing, staunchly refused to believe that she had schizophrenia. When asked why she believed she was hospitalized so many times, she replied that her kidneys were infected.

There is no simple way to deal with an individual who refuses to believe they are ill and subsequently refuses treatment. Generally speaking, if an individual is a danger to themselves or to others they can be hospitalized or treated against their will. An individual who is experiencing symptoms of psychosis but does not pose a danger to themselves or others generally cannot be forced into seeking treatment.

As a family member, it is difficult to witness your loved one in a state of psychosis yet be unable to convince them to accept treatment because they lack the ability to know that they are ill. Strict involuntary commitment laws throughout the United States prevent many individuals from receiving the help they desperately need. The tragedy is that many individuals needlessly suffer when medications or other interventions would benefit them greatly.

I would encourage you to contact your local Community Mental Health Center or hospital and speak to them about her situation and her symptoms. They may be able to assist you in helping her to receive treatment. There may also be a local mental health crisis team in your community that can further assist you.

The commitment laws throughout the United States tend to be very strict, though state laws do very. Here’s a website to help you learn more about the laws in your state. The National Alliance For Mental Illness (NAMI) is another resource you should consult. Here’s a link to their website. NAMI is a large national group who advocates on behalf of individuals with mental illness and their family members. The website contains a great deal of psychoeducational information.

Another great resource is a book written by Xavier Amador called I’m Not Sick I Don’t Need Help. The book provides a number of strategies that may assist you in convincing your mother to seek help.

You should try to convince your mother to see a physician for an evaluation. Even if she will not be seen by a psychiatrist, she may be willing to see her family care physician. The family care physician could help to rule out any possible medical problems that may be contributing to her symptoms. If she were to agree to this, it would give you an opportunity to speak to the doctor about your concerns.

I understand this is a difficult situation. The bottom line is that there is no easy solution. Paranoia is a sign that your mother is most likely experiencing some type of psychotic disorder that needs to be treated. As I mentioned above, it will not be easy to convince her that something is wrong and that she needs treatment. This is where you and your family need to be creative in attempting to get her to see a doctor. If she poses a threat to herself or to anyone else, then I would highly recommend calling the hospital, local mental health crisis team or 911 to report your concerns. If she becomes a threat to herself or to others, she would most likely be admitted to a psychiatric hospital.

If you have any additional questions please don’t hesitate to write again. I will be glad to help you in any way that I can. Please take care.

Dr. Kristina Randle