the Signs: When Family Members Show No Awareness of Mental Illness

Family members have had symptoms for many years but show no awareness of their illness?

Hello, Dr.
Lin.
I apologize for the lengthy message.
My family member is a 28-year-old male who has experienced a decline in academic performance since his junior year in college and subsequently did not graduate.
Around the same time, he began to believe that he is a messenger from Earth who can communicate with aliens, and he has been sharing doomsday prophecies and predictions of disasters with the family.
After completing military service, he returned home over three years ago and has not worked or attended school since, rarely leaving the house and having no social life outside of family.
Initially, the family thought he had a special belief system or adopted an attitude of "he'll be fine eventually." However, the situation has worsened in the past six months; he has poor hygiene, rarely bathes, and has grown his hair long.
Due to his appearance, I often subconsciously avoid talking to him.

At the end of last year, he suddenly insulted and became hostile towards my friends, gathering "evidence" from information he heard to attack them and using it to point out what he believes I am doing wrong, hoping I would "make changes." When I asked him why he doesn’t go out anymore, he said, "My sensitivity is too strong; going out would overwhelm me with too much information.
I am sacrificing my small self; one day my partners and I will leave." I was shocked to hear this, but similar statements have occasionally surfaced since then.
Last night, I discussed this with him, expressing that I had been hurt by his words and hoping he could shift his perspective a bit.
I’m not sure if I triggered a "sensitive topic," but he claimed he practices clairvoyance and can see everyone’s future, and that family members speaking too loudly affects him, which made him very angry.
He also said, "They" don’t like me, that my voice is too loud, that I shouldn’t live at home, and that "this" is his studio, not a home, and we cannot disturb him.
While speaking, he seemed to start having a "conversation" with several voices in his head, mumbling things like, "I’m not talking to you right now." This deeply concerned the family present (this was my first time witnessing such behavior), but he repeatedly insisted he is not sick and has no problems, stating that many things cannot be easily disclosed because "more people will come to stalk him." I am very frightened; when I asked him, "Are you okay?" he immediately became angry.
The conversation was frequently interspersed with profanity, which left the family feeling both scared and shocked.
My concern is that he has no insight into his condition, exhibits aggressive and irritable behavior, and firmly believes he is correct.
How can we help him seek medical attention or find possible professional assistance?

A, 30~39 year old female. Ask Date: 2021/06/15

Dr. Lin Mianzhang reply Psychiatry

Hi, based on your description, it seems that your family member may be suffering from schizophrenia.
Symptoms such as negative symptoms (deterioration in hygiene, infrequent bathing), auditory hallucinations (having conversations with multiple voices in their head), and delusions (believing they have the ability to foresee the future) are indicative of this condition.
Patients with such disorders often lack insight into their illness because their brain, which they rely on to assess reality, is functioning abnormally.
As a result, they struggle to discern rationality like a typical person and are unlikely to seek medical help on their own.
I suggest that you try to persuade them to see a doctor using different reasons.
You can often appeal to their distress; for example, if they are experiencing anxiety, trouble sleeping, or physical discomfort, you could explain that visiting a doctor could help improve these issues.
If they are unwilling to seek treatment, you can visit a nearby health center and explain your family member's situation to a public health nurse, requesting a home visit.
If deemed necessary, the nurse may arrange for a psychiatrist to assess your family member at home.

Once there is an initial visit and evaluation, you will have a clearer understanding of your family member's condition, and there may be an opportunity for the nurse or doctor to persuade them to seek treatment.
However, if your family member still refuses to seek help, the last resort would be to wait until they exhibit extreme emotional distress or engage in self-harming or harmful behaviors.
In such cases, you can call 911 for assistance in getting them to a hospital, at which point you may have the opportunity to apply for involuntary hospitalization under Section 41 of the Mental Health Act.
Schizophrenia is a chronic illness, and it can be particularly challenging for family members of the patient.
I hope this information is helpful to you, and I wish for your family member's swift recovery!

Reply Date: 2021/06/15

More Info

Dealing with a family member who shows no awareness of their mental illness can be incredibly challenging and distressing. From your description, it seems that your 28-year-old male family member is exhibiting signs that may be consistent with a serious mental health condition, possibly schizophrenia or a related disorder. Symptoms such as delusions (believing he can communicate with aliens), hallucinations (hearing voices), and significant changes in behavior and hygiene are concerning indicators that warrant professional intervention.

Understanding the Signs
1. Lack of Insight: One of the hallmark features of many mental illnesses, particularly psychotic disorders, is a lack of insight or awareness of the illness. This means that individuals may not recognize that their thoughts and behaviors are abnormal or problematic. This can be particularly frustrating for family members who see the changes but cannot convince the individual to seek help.

2. Behavioral Changes: The decline in academic performance, social withdrawal, and deterioration in personal hygiene are significant red flags. These changes often indicate that the individual is struggling to cope with their reality and may be experiencing severe distress.

3. Aggression and Irritability: The episodes of anger and hostility towards family members and friends can be alarming. This behavior may stem from paranoia or a perceived threat to their beliefs or identity. It’s crucial to approach these situations with caution, as they can escalate quickly.

Steps to Take
1. Engage in Open Communication: While it may be difficult, try to maintain open lines of communication. Approach him with empathy and concern rather than confrontation. Instead of directly addressing his mental health, you might frame the conversation around his feelings or experiences. For example, you could ask how he feels about his current situation or if he’s been feeling overwhelmed.

2. Seek Professional Help: If he is resistant to seeking help, consider reaching out to a mental health professional yourself. You can describe his symptoms and behaviors to a psychiatrist or psychologist, who may provide guidance on how to approach the situation. In some cases, they may recommend a home visit or an intervention.

3. Use Indirect Approaches: If he is unwilling to see a doctor, consider suggesting a visit for non-mental health-related issues, such as a general health check-up. This can sometimes lead to a more open discussion about mental health without the stigma attached.

4. Emergency Situations: If his behavior escalates to a point where he poses a danger to himself or others, it may be necessary to contact emergency services. In many regions, mental health laws allow for involuntary hospitalization if there is a risk of harm.

5. Support for Yourself: Caring for someone with a mental illness can take a toll on your emotional well-being. Consider seeking support for yourself, whether through therapy, support groups, or talking to trusted friends or family members. It’s important to take care of your mental health as well.

Conclusion
Navigating the complexities of mental illness within a family can be overwhelming. It’s essential to approach the situation with compassion and patience while also recognizing the need for professional intervention. Remember that you are not alone in this, and there are resources and professionals available to help both you and your family member. Encourage open dialogue, seek help when necessary, and prioritize your well-being as you support your loved one through this challenging time.

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