Dear Psych central, I am a recent high school graduate and will be attending college in the fall. My boyfriend and I began dating a few months ago although we were close friends all throughout high school. I love him very much and am deeply concerned for his mental wellbeing. He currently acts entirely normal and can function as any other person could, however, he has what seem to me to be undeniable signs of schizophrenia and acknowledges them but rejects the idea of taking any medication. He will be turning twenty this year, however, right before his 18th birthday during his senior year of high school he entered into some form of psychosis which he attributes to smoking marijuana and salvia and as he refers to it as “never coming down from it” his trip lasted around two months I believe during which he explains he had delusions, hallucinations and extreme paranoia. Many of these delusions were religious in nature which I attribute to his strong religious beliefs. He was taken to a hospital and diagnosed with something relating to schizophrenia. He was given medication I believe although I don’t know what exactly. He was previously a heavy marijuana smoker and has since quit entirely as he attributes the smoking to the triggering of the trip. His 25 year old half brother was also recently diagnosed with schizophrenia and was in an institution until recently although he too denies having any real problem. Today he told me that while he was at work taking a customer’s order he began hallucinating and saw the man’s face change into something horrific and then go back to normal after a few seconds. I had never before confronted him about his illness because I know it is a touchy subject for him although he frequently jokes about how he is crazy and “schizo”. I suggested he get help now because he is at the exact age that signs of schizophrenia manifest themselves and he could potentially prevent things from getting worse but he sees his trip as a one time isolated incident that wont be progressing into something more serious. Additionally I think he has kind of a macho man complex and believes he can use his own will power to fight off the delusions and does not want to be dependent on any kind of medication. We will be going to separate colleges and I will not be seeing him on an entirely regular basis to detect signs of unusual behavior. What can and should I do? How do I get him help without pushing too hard? Like I said he functions entirely normally now and only had that one episode. Thank you so much for reading, I leave for college in three weeks and would deeply appreciate if you could get back to me prior to then!
Some people only have one psychotic episode and never have another. It’s concerning that some of his symptoms have begun to reemerge. Thankfully they don’t last long but your concerns are justified. Treatment could prevent his symptoms from getting worse.
His refusal to accept treatment is obviously problematic. As you have correctly noted, it could prevent the possible development of a severe mental illness. Without treatment, he is at risk for having additional episodes of psychosis.
It’s very encouraging that he is no longer using drugs. It significantly decreases, though does not eliminate, his chances of having another psychotic episode.
The only time an individual can be forced into psychiatric treatment is when they are an imminent danger to themselves or to others. Otherwise, they are free to decide not to accept treatment. That is a difficult reality for loved ones. They know that treatment would help and could prevent future problems but they are often powerless to intervene.
Are there family members who might convince him to accept treatment? What about a friend who he likes or respects? If there is someone who you think can help, contact them immediately and discuss your concerns. You would feel better if you knew that someone was looking after him while you are away at college.
Do everything that you can to help him but realize that your power is limited. You can’t force him into treatment. You should continue to encourage him to accept treatment but ultimately the decision is his. Please take care.
Dr. Kristina Randle
Mental Health & Criminal Justice Blog