the Signs: When to Seek Psychiatric Help for a Loved One

excuse me?

Hello Doctor,
I am 25 years old, and my mother is 52.
She has always been quite superstitious, but this year it seems to have worsened.
Initially, she installed a bagua mirror on the third floor of our house, which led to complaints from our neighbors about the reflection.
It took a lot of effort from our family to convince her to remove it.
After that, she frequently felt that the neighbors had installed many mirrors in our house that reflected back to her, and she could point out specific locations, but no one else could see them.
My father even went to check with the neighbors, but found nothing.
Despite our explanations, she refuses to believe us, and when we get frustrated, her reactions become quite intense.
In April of this year, my father was diagnosed with nasopharyngeal cancer.
We thought this would make my mother more understanding and less extreme, but I don't know if it's the stress of caring for my father, but recently her behavior has escalated again.
She has placed stones and brooms on the front balcony and taped red paper on my brother's desk, leading to conflicts between them.
She believes that the neighbors are trying to harm us, but from what my father and siblings understand, the neighbors are not like that.
My mother even suspects that the son of the neighbor's aunt is playing tricks on us and has spoken ill of him.
I can sense that when I try to reason with my mother, she superficially agrees, but deep down she is steadfast in her beliefs.
She thinks she is doing what is best for the family, and that we are siding with outsiders.
My mother is usually a good sleeper, but recently she has needed sleeping pills to fall asleep, yet she enjoys watching feng shui programs and has arranged our home in very unusual ways.
During my father's treatment, he should be focusing on his recovery, but my mother's behaviors severely interfere with him, including her firm belief that certain foods are forbidden, even after consulting professionals who said they are harmless.
My father may agree to certain things verbally, but when it comes to execution, she follows her own ideas.
We are starting to question my mother's mental state and whether she needs to see a psychiatrist, as our family opinions no longer seem to influence her.
I kindly ask for your guidance on this matter.

Ban, 20~29 year old female. Ask Date: 2005/09/25

Dr. Chen Wenyu reply Psychiatry

Hello, based on the content of your letter, your mother's paranoid thoughts seem to have reached the level of "delusions" (meaning that even strong evidence to the contrary does not change her beliefs).
Furthermore, her thoughts lean towards bizarre and irrational ideas, which are indeed affecting her interpersonal, occupational, and social functioning, necessitating psychiatric intervention.
However, given her current situation, she is unlikely to accept that she has a mental illness and take medication.

You might consider the following approach: contact a physician in advance to explain the situation, and then encourage her to seek treatment specifically for her insomnia symptoms.
You can ask the physician to prescribe a "liquid formulation" (the psychiatrist will understand what you mean by "liquid formulation").
Currently, there are two types of liquid formulations available: one is traditional with significant side effects that may cause the patient to feel uncomfortable and suspect that food is poisoned, while the other is a newer formulation (Risperdal) with lower side effects.
After a period of treatment, you can reassess the situation and consider switching to oral medication.
Thank you for your letter!

Reply Date: 2005/09/25

More Info

It sounds like you are in a very challenging situation with your mother, and it's commendable that you are seeking help for her. Based on the behaviors you've described, it does seem that your mother may be exhibiting signs of a mental health issue that could benefit from professional evaluation and intervention.

Signs to Consider
1. Paranoia and Delusions: Your mother’s belief that neighbors are conspiring against her and her insistence on seeing reflections from mirrors that do not exist are concerning. These types of delusions can indicate a serious mental health condition, such as a delusional disorder or even schizophrenia.

2. Increased Obsession with Superstitions: The installation of the Ba Gua mirror and her fixation on feng shui to the point of conflict with family members suggest an escalation in her beliefs that may not be grounded in reality. This can be a sign of obsessive-compulsive tendencies or other anxiety-related disorders.

3. Sleep Disturbances: The fact that she now requires sleeping pills to rest is another red flag. Sleep disturbances can be both a symptom and a contributing factor to mental health issues, exacerbating existing conditions.

4. Impact on Family Dynamics: The conflicts between your mother and other family members, particularly during a time when your father is undergoing cancer treatment, indicate that her behavior is not only affecting her but also the well-being of the entire family. This is a significant concern, as it can lead to increased stress and anxiety for everyone involved.

5. Resistance to Reason: You mentioned that she appears to agree with you on the surface but remains steadfast in her beliefs. This kind of cognitive rigidity can be indicative of a deeper psychological issue where the individual is unable to process information that contradicts their beliefs.

When to Seek Help
Given these signs, it would be advisable to seek psychiatric help for your mother. Here are some steps you can take:
1. Consult a Mental Health Professional: A psychiatrist or clinical psychologist can conduct a thorough assessment to determine if there is an underlying mental health disorder. They can also provide a diagnosis and recommend appropriate treatment options.

2. Family Intervention: Sometimes, family members can facilitate a conversation about seeking help. It may be beneficial to approach her with compassion and concern rather than confrontation. Express how her behaviors are affecting the family and her own well-being.

3. Educate Yourself: Understanding mental health issues can help you communicate more effectively with your mother and the professionals involved. It can also help you manage your own stress during this challenging time.

4. Consider Support Groups: Look for support groups for families dealing with mental health issues. These can provide you with resources and emotional support as you navigate this difficult situation.

5. Emergency Situations: If her behavior escalates to the point where she poses a danger to herself or others, it may be necessary to seek emergency psychiatric help. This could involve contacting a crisis hotline or taking her to an emergency room.

Conclusion
Your mother’s situation is complex, especially given the stress of your father’s illness. It’s important to approach this with sensitivity and care. Seeking professional help is a crucial step in ensuring that she receives the support she needs. Remember, mental health issues are medical conditions that require appropriate treatment, just like any physical ailment. Your proactive approach in seeking help for her is a vital first step toward her recovery and the restoration of harmony within your family.

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