and Addressing Paranoia in Aging Parents: A Family's Struggle

Q: and Addressing Paranoia in Aging Parents: A Family's Struggle

Hello Kila： From your description, it seems that your father may have a mental disorder and needs medical treatment. <br>To confirm the diagnosis, he must be evaluated by a physician in person. <br>However, the challenge you are facing is how to get your father to seek medical ca

The father is suspected to have a delusional disorder?

Hello, Doctor.
My father is about 60 years old and has been experiencing delusional mental health issues for the past ten years (possibly even longer).
Initially, he believed that someone wanted to kill him, and later he developed a belief that toxins could infect him and others, which he thought could lead to severe illness.
He believes that not only could he transmit these toxins, but that my mother could as well.
They both work in the scrap metal business, and during interactions with clients, my father would assess the clients' facial or skin conditions to determine the potential risk of infection to my mother.
He often raises his voice at her and is constantly taking medication and receiving injections for his skin issues, consuming four to five packets of medication daily.
Whenever he perceives redness or itching on his skin, he seeks injections.
He insists that we, the children, take medication if our skin condition is poor and believes that my mother is being indiscreet and having affairs with others, even suspecting his own niece and neighbors.
He has physically assaulted my mother and restricted her behavior.
We, the children, have tried to persuade him to see a psychiatrist due to his insomnia and physical discomfort, and he has visited two hospitals, but he later became very resistant.
In the past year or two, his concerns about my mother's alleged indiscretions and toxins have intensified, and he has even mentioned that my mother needs to be hit for her behavior.
We are truly distressed by this situation.
I believe that the psychiatric departments at hospitals cannot help because my father appears very normal and coherent in front of others, and he can manage daily life independently.
Some doctors believe he has no issues, but the pain he causes us is unknown to outsiders.

Doctor, since my father does not engage in self-harm and his domestic violence towards my mother is limited to slapping or kicking, which does not happen frequently, I have inquired at the local health center, but he does not meet the criteria for mandatory hospitalization.
However, his behavior has severely impacted us.
Recently, my mother even mentioned wanting to kill him and said she would lock herself away so that she and we could have peace.
We hope he can be mandated to seek treatment.
Would recording his episodes be helpful? Are there other methods we could consider? Would hourly psychological counseling be more beneficial for him than just prescribing medication? I apologize for the lengthy description, and I appreciate your patience in reading it!

kila, 30~39 year old female. Ask Date: 2010/06/03

Dr. Fan Tingwei reply Psychiatry

Hello Kila: From your description, it seems that your father may have a mental disorder and needs medical treatment.
To confirm the diagnosis, he must be evaluated by a physician in person.
However, the challenge you are facing is how to get your father to seek medical care, which can indeed be quite difficult.
I found some provisions from the Mental Health Act regarding the regulations for patients seeking medical treatment, which you should understand at this point.

From your description, your father has exhibited behaviors at home such as shouting, physically assaulting your mother, threatening to harm her, and restricting her movements, which meet the criteria outlined in Article 32 of the Mental Health Act: Article 32 states that when police or fire authorities, in the course of their duties, discover a patient or a person exhibiting the conditions defined in Article 3, Clause 1, who poses a danger to themselves or others, they should notify the local competent authority and, if necessary, request assistance in handling the situation or jointly manage it; unless otherwise provided by law, they should escort the individual to the nearest appropriate medical facility for treatment.
If the public encounters such individuals, they should immediately notify the local police or fire authorities.

You can request assistance from the police or fire authorities and the local competent authority (health center) to help your father seek medical care.
If you encounter difficulties, you can present this legal provision to remind the authorities, which also provides them with a legal basis to assist you.
The above provisions need to meet the conditions of the patient, and based on what you described, your father may qualify as a patient: Article 3 defines the terms used in this law as follows: 1.
Mental illness refers to abnormal manifestations of mental states such as thinking, emotions, perception, cognition, and behavior, leading to impaired functioning in adapting to life, requiring medical care and support; this includes psychosis, neurosis, alcohol dependence, drug dependence, and other mental illnesses recognized by the central competent authority, but does not include individuals with antisocial personality disorder.
3.
Patient: refers to a person suffering from mental illness.
4.
Severe patient: refers to a patient exhibiting bizarre thoughts and peculiar behaviors disconnected from reality, rendering them unable to manage their affairs, as diagnosed by a specialist physician.
Whether your father meets the criteria for a severe patient requiring involuntary treatment needs to be determined by a physician after an in-person evaluation.
Some patients with mental disorders can indeed appear normal in front of others, and without information provided by family members, it can be challenging for psychiatrists to grasp the true condition of the patient.
Therefore, it is advisable for family members to accompany the patient during medical visits to provide useful information beyond the patient's subjective expressions for the physician's reference.

In addition to seeking medical care, your father's verbal or physical violent behavior and threats towards family members or your mother can be reported through domestic violence reporting channels.
You can call 113 for more detailed information on the process and what materials and evidence you should prepare.
Your father's condition may require medication, psychological counseling, or even hospitalization, and it would be more appropriate for a physician to explain this after evaluating him in person.
I hope this response can provide you with some assistance.

Dr.
Fan Ting-wei from Chia Nan Psychiatric Hospital has attached relevant provisions of the Mental Health Act for your reference: Article 3 defines the terms used in this law as follows: 1.
Mental illness refers to abnormal manifestations of mental states such as thinking, emotions, perception, cognition, and behavior, leading to impaired functioning in adapting to life, requiring medical care and support; this includes psychosis, neurosis, alcohol dependence, drug dependence, and other mental illnesses recognized by the central competent authority, but does not include individuals with antisocial personality disorder.
3.
Patient: refers to a person suffering from mental illness.
4.
Severe patient: refers to a patient exhibiting bizarre thoughts and peculiar behaviors disconnected from reality, rendering them unable to manage their affairs, as diagnosed by a specialist physician.
Article 32 states that when police or fire authorities, in the course of their duties, discover a patient or a person exhibiting the conditions defined in Article 3, Clause 1, who poses a danger to themselves or others, they should notify the local competent authority and, if necessary, request assistance in handling the situation or jointly manage it; unless otherwise provided by law, they should escort the individual to the nearest appropriate medical facility for treatment.
After the medical facility has appropriately handled the patient, they should transfer them to a designated mental health facility as specified by the municipal or county (city) competent authority for continued treatment.
If the identity of the individual sent for treatment is confirmed as a patient, the local competent authority should immediately notify their family and assist them in seeking medical care.
The designated mental health facility's designation method, qualification conditions, management, specialist physician designation, and other compliance matters shall be determined by the central competent authority.
Article 41 states that if a severe patient poses a danger to themselves or others, and a specialist physician diagnoses that full-day hospitalization is necessary, their guardian should assist the severe patient in going to a mental health facility for hospitalization.
If the severe patient refuses full-day hospitalization, the municipal or county (city) competent authority may designate a mental health facility for emergency placement and have two or more specialist physicians designated by the municipal or county (city) competent authority conduct a compulsory assessment.
However, in outlying islands, the compulsory assessment may be conducted by only one specialist physician.
If the results of the compulsory assessment indicate that full-day hospitalization is still necessary, and after consulting the severe patient's opinion, if they refuse or are unable to express their opinion, a basic data form for compulsory hospitalization and a notification form should be filled out, along with the opinions of the severe patient and their guardian and relevant diagnostic documents, to apply for permission for compulsory hospitalization to the review committee; the decision on whether compulsory hospitalization is permitted should be communicated to the severe patient and their guardian.
The emergency placement and application for compulsory hospitalization permission mentioned in the second paragraph shall be handled by the designated mental health facility commissioned by the municipal or county (city) competent authority; the procedures for emergency placement, application for compulsory hospitalization, required documents, and other compliance matters shall be determined by the central competent authority.

Reply Date: 2010/06/03

More Info

Dealing with paranoia and delusional behavior in aging parents can be an incredibly challenging and distressing situation for families. It sounds like your father has been experiencing significant mental health issues for quite some time, which have escalated to the point where they are affecting not only his well-being but also the safety and mental health of your mother and the rest of the family.
Paranoia, particularly in older adults, can stem from various underlying causes, including but not limited to neurodegenerative diseases, severe anxiety, depression, or even substance abuse. In your father's case, it appears that his paranoia manifests as a fear of contamination and a belief that others are trying to harm him or his loved ones. This can lead to aggressive behavior, as you've described, and can create a toxic environment at home.

It's important to recognize that while your father may appear normal in public and can manage daily tasks, this does not negate the severity of his mental health issues. The fact that he is resistant to seeking help is also a common barrier in mental health treatment, especially among individuals who may not recognize their condition as problematic.

Here are some steps you can consider taking to address this situation:
1. Document Behavior: Keeping a detailed record of your father's behavior, including specific incidents of paranoia, aggression, and any threats he makes, can be crucial. This documentation can provide valuable insights into the severity and frequency of his symptoms, which may be helpful if you pursue further medical intervention.

2. Engage a Professional: While you mentioned that previous visits to mental health professionals did not yield results, it may be beneficial to seek a different psychiatrist or psychologist who specializes in geriatric mental health. Sometimes, a fresh perspective can lead to a more accurate diagnosis and effective treatment plan.

3. Family Intervention: Consider organizing a family meeting with a mental health professional present. This can help facilitate a conversation about your father's behavior in a non-confrontational way. Sometimes, hearing concerns from multiple family members can help the individual recognize the need for help.

4. Explore Community Resources: Many communities offer resources for families dealing with mental health crises, including support groups and counseling services. These can provide you and your family with emotional support and practical advice on how to cope with the situation.

5. Legal Options: If your father's behavior poses a direct threat to your mother or others, you may need to explore legal options for involuntary commitment. This process varies by location, but it typically requires demonstrating that the individual poses a danger to themselves or others due to their mental illness.

6. Safety First: Ensure that your mother is safe. If your father becomes violent, it may be necessary for her to stay with family or friends until the situation stabilizes. Her safety is paramount, and it's crucial to have a plan in place for emergencies.

7. Therapeutic Support: If your father is open to it, individual therapy could be beneficial. Cognitive-behavioral therapy (CBT) has been shown to help individuals with paranoia by addressing distorted thinking patterns. However, this requires his willingness to engage in the process.

8. Medication Management: If your father is resistant to seeing a psychiatrist, consider discussing the possibility of medication management with a family doctor. Sometimes, a general practitioner can prescribe medications that may help alleviate some symptoms of paranoia.

9. Self-Care for Family Members: Finally, it's essential for you and your family to take care of your mental health during this challenging time. Consider seeking counseling for yourselves to process the emotional toll this situation is taking on you.

In conclusion, addressing paranoia in aging parents requires a multifaceted approach that includes documentation, professional intervention, family support, and legal considerations if necessary. It's a difficult journey, but with the right resources and support, there is hope for improvement. Remember that you are not alone in this struggle, and seeking help is a vital step toward finding a resolution.

Similar Q&A

Understanding Paranoia: Coping with a Parent's Suspicion and Anxiety

Dr. Chen: Hello! I previously raised some questions but did not provide detailed explanations. I would like to offer some additional context. My mother is 51 years old. In recent years, she has frequently suspected my father of having an affair, particularly with more outgoing wo...

Dr. Chen Wenke reply Psychiatry
Hello: This letter provides a more specific description of the mother, and I believe the likelihood of a delusional disorder has significantly increased. The letter does not specifically mention any emotional changes, which makes it less indicative of menopausal symptoms. Cases o...

Understanding Paranoia: Is It a Mental Illness in Family Dynamics?

I'm the eldest son in my family. Since kindergarten, my family has been torn apart due to my father's infidelity. Despite this, my parents have not divorced, and now that I've graduated from college, one thing that hasn't changed is that my mother has constant...

Dr. Huang Xiaoxian reply Psychiatry
Dear Mr. Lin, It seems that your mother has been experiencing a lot of emotions due to years of marital dissatisfaction, which may also affect you. While there may not be visible psychiatric symptoms, it appears that your mother's emotional state is indeed significantly im...

Dealing with a Parent's Paranoia: Seeking Help for Delusional Disorders

Hello, doctor: I have researched a lot about paranoid delusions and have scoured the internet for information, but I feel like I'm going crazy. I can't think of any way to get my mom to willingly (or trick her into) see a psychiatrist (or a psychosomatic specialist). To...

Dr. Lin Mianzhang reply Psychiatry
Hello, Your mother's condition is indeed very serious, and it can be quite challenging to live under the same roof with her. Although it seems difficult, there are solutions available. You can start by visiting the local health center and informing the public health nurse ...

Coping with Paranoia: Managing a Father's Delusions in Family Care

My older brother passed away early, and my sister-in-law has been living with my parents ever since. My mother had long-term health issues, and my father is heavily in debt. After my mother passed away five years ago, my father became suspicious that my sister-in-law was bringing...

Dr. Qiu Junda reply Psychiatry
Hello. Your father's condition requires further evaluation. If he is unable to cooperate with medical treatment, you may first consult with your sister-in-law at a psychiatric facility (or with the physician he previously visited) to discuss how to address your father's...