gnargtharst

Mentally ill family member

10 posts in this topic

I have a brother, who has been acting stranger and stranger over a period of many years. At first, I thought all his problems were cognitive (blaming others for his problems, avoiding solutions, exteme defensiveness, etc.), and that he could solve them by simply committing to and working at them.

His various traits were self destructive, leading to: no professional life of any kind (still lives with parents), no lasting romance, etc. It was frustrating to me to see all the wasted potential -- he is very smart, graduated medical school, likes to invent and build, etc. Especially notable is his unhappiness: happiness seems transient at best, with interspersed periods of dread and depression.

Recently, a couple of things occurred which indicated to me that his problems weren't simply bad habits and bad ideas (at least I think so -- I don't know if these issues could evolve from bad ideas...): on 2 occasions he lapsed into a moment of very odd gibberish -- not nonsense words or syntax, but just very strange non sequitirs (to give a sense: we were watching a show with animal videos, and he said something like "...but just imagine Dad, with his friends from the war, and they never see the planes but they still talk about them." [note: our dad was never in a war or anything similar].

The other big event that signals to me a flat-out break with reality: delusions of grandeur. He has latched onto a theory, devised by him, which is absolute nonsense. I won't go into it -- I think this account could still qualify as anonymous if I skip the details of this theory? -- but it is akin, epistemologically, to phrenology or time travel or something similar -- just utterly at odds with so much evidence (thinking about it, it is even less plausible than phrenology or time travel, etc.). The theory is replete with conspiratorial-sounding ideas about how he'll never succeed with these ideas because the world will persecute him for going against the staus quo, etc. but that his ideas shake the very core of science iteslef, etc. To my untrained mind, his rantings sound like a vast rationalisation about why he never succeeded at any career ("..because *they* couldn't handle this monumental truth...")

So, it is evident to me that he has gone 'round the bend.

I would very much like to help him. In a way, it's almost a relief to think that he has an actual mental illness, because it seems like it may be "curable", as opposed to such a heap of volitional bad ideas which seemed almost insurmountable.

But, what to do? I barely trust the psychiatric industry -- it seems many of them are nuttier than their patients, and the theories I hear sound horrific. And even if I could trust someone in particular, the largest obstacle seems to be convincing my brother that he should "solve" his problems (how do you convince a paranoid person that *they* are the one that needs to fix their mind?).

Should I politely challenge him on his nutty theory? Would going into details, and calmly identifying the irrational components bring him back to earth?

I dont' even know what he "has". A cursory reading of wikipedia articles on schizophrenia and bipolar disorder reveal some familiar "symptoms", but I'm not a doctor and can't reasonably make that jump.

Finally, my motivation in this is: I love my brother and I think he has true potential to be happy, and to make something of himself. It would make me happy, if he could emerge from this fog. If some sort of choice arose, which pitted this issue against my own family (wife and kids), I would not hesitate to choose my wife and kids, who are my first love and loyalty. But no such choice is evident yet. So, I'm not conflicted about a potentially altruistic action; it's not. Also, it appears that if anybody is going to address this, it will have to be me -- he has alienated friends, and my parents are, at least so far, clueless as to his condition (in particular, they are not scientifically literate enough to infer mental illness from his "theory").

If anybody has any ideas, please mention whether you speak from experience, esp. any expertise in mental health profession. Thanks.

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I think you are going to have to trust the professionals on this one. It sounds like a medical problem.

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I think you are going to have to trust the professionals on this one. It sounds like a medical problem.

I agree, but look for a psychiatrist (an MD) who practices Cognitive Therapy as formulated by Dr. Aaron Beck. Most Objectivist therapists respect Beck's work and underlying theory. You may find some leads to a doctor in your area by contacting the Beck Institute (link).

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But, what to do? I barely trust the psychiatric industry -- it seems many of them are nuttier than their patients, and the theories I hear sound horrific. And even if I could trust someone in particular, the largest obstacle seems to be convincing my brother that he should "solve" his problems (how do you convince a paranoid person that *they* are the one that needs to fix their mind?).

If your brother is truly paranoid (which I couldn't say based on what you've written), it will be very difficult to get him into treatment. On the positive side, many paranoid people have at least one person they trust to some degree, usually a family member or close friend. If you have that kind of relationship with him, you can slowly, gently talk with him about his situation and, at the appropriate time, suggest he get some help. And that's true whether he is paranoid or not.

Regarding the right professional, Betsy offers good advice. Also, psychiatrists are medical doctors, and their training requires significant rationality and intelligence. This doesn't mean that all are good, and many will be primarily focused on medication treatment as opposed to psychotherapy. However, there is nothing wrong with taking a psychotropic medication when needed, as it can be extremely helpful in reducing symptoms. Symptom reduction puts someone in a far better place to address any underlying problems and/or engage in produtive actions. Thus, adding psychotherapy to a medication treatment often yields the best, longest lasting effect.

By the way, does he have any friends from medical school who he might feel comfortable talking to?

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Thanks for the replies so long ago in this post. I have, since originally posting this, done a lot of reading (particularly Beck), and a lot of observing of my brother's situation (we live in different cities and our interaction is infrequent). (My amateur diagnosis is: delusions of grandeur and persecution delusions, associated with clinical depression). (Note: I dont' give any weight to this "disgnosis"; I am not a professional, I realize that I could have a lot of things wrong, etc. -- don't worry, I am not going to play mental doctor with my brother as guinea pig. But the details I describe are accurate.)

I have not heard any further examples of "gibberish" or weird-syntax or non-sequitir speaking. But the delusional aspects continue.

My brother has closely flirted with the idea that he himself is mentally ill. Sometimes by implication by things he says, sometimes as explicit if rhetorical self-questions. The only reason I haven't jumped on the bandwagon and run with his musings is due to lack of appropriate situations (for example: don't really want to delve into that topic at the dinner table, or with only a minute or two available to discuss, etc.)

But it does seem clear to me that 1. He is as open as I can imagine to considering his own metnal health, and 2. I am the one who must broach the subject with him, or at least, advance the conversation.

I believe that as a precondition to any progress, he will have to admit that he is delusional.

So, a question, hopefully to anybody who knows by example -- i.e., a mental health professional: what's the best way to go about telling somebody they're delusional? The common sense way would seem to me to simply respectfully tell the person such-and-such, with sympathy to the inevitable defensiveness, etc. BUT... with absolutely no experience in such a thing, I don't pretend to know if my "common sense" is really that sensible. Do most delusional people respond well to such attempts? Are "interventions" useful? (rhetorical, as there's only one of me to "intervene"). Should delusional people be "tricked", for example, asked to expand on their delusional ideas, until they must certainly eventually come face-to-face with the contradictory aspects of it?

I'll bet some psychologists deal with this all the time; anybody with any experience to share would be helpful. Essentially, I know what I have to do, but I have virtually no idea how to do it. An "Idiot's Guide to Convincing Delusional People That They Are" would be helpful.

Thanks in advance for any help.

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But it does seem clear to me that 1. He is as open as I can imagine to considering his own metnal health, and 2. I am the one who must broach the subject with him, or at least, advance the conversation.

So, a question, hopefully to anybody who knows by example -- i.e., a mental health professional: what's the best way to go about telling somebody they're delusional?

I'll bet some psychologists deal with this all the time; anybody with any experience to share would be helpful. Essentially, I know what I have to do, but I have virtually no idea how to do it. An "Idiot's Guide to Convincing Delusional People That They Are" would be helpful.

Thanks in advance for any help.

I've got some experience in the mental health care, not especially the delusional or paranoia sector. It is very good possible it's different in America (I live in the Netherlands), but I've experienced in several cases that psychologists and psychiatrists can offer very good help. My advice would be: try to get your brother, one way or another (it would be better if he goes there by free will, then he already acknowledges his problem, that is a big step. If that doesn't work, it's maybe better to trick him in, I would anyway first go to the psychologist yourself, or with your parents, to ask his advice. Maybe he can help you to convince your brother to seek help, or maybe could he even go to your home for the first meeting.), there is a chance you brother can get the help he needs, I think it's important to do something now, it probably only gets worse.

I hope you'll come to a solution. All the best.

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So, a question, hopefully to anybody who knows by example -- i.e., a mental health professional: what's the best way to go about telling somebody they're delusional?

If someone is truly delusional, you won't be able to convince him that he is. A delusion is an extremely "fixed," by which I mean set or entrenched, belief. The research and other literature I'm familiar with, as well as my experience, indicates that delusions are exceptionally difficult to treat.

However, what we must be clear on is whether your brother's beliefs are actually delusions. Delusions are symptoms of psychosis, which is usually a brain-based disorder, such as with Schizophrenia. If your brother is psychotic, it would mean he has extreme difficulty in multiple areas of life, such as holding down a job, romantic and other relationships, and sometimes even basic self-care.

If these things are not true about him, then he more likely has extremely irrational beliefs based perhaps on personality factors and his experiences. Such beliefs can have a delusional quality in that they are resistant to change and not reality-based. However, they are easier to change than a truly delusional belief based on a psychotic process. There are non-psychotic disorders that involve grandiosity, a sense of being persecuted, and depression.

As to how to approach him, the moments when he is reflecting on his mental health and voicing concern about it are good openings. If the situation isn't right to get into a longer discussion of it, then maybe you could just say something to the effect that, "It takes a lot of guts to admit and overcome a problem. If you think you have one can and could use some help with it, then go for it."

Personally, I always try to speak to the best in people. Let them know that they deserve a better life; that they have the ability to overcome the problem, even if they need help with it; and that you admire people who face reality and improve their lives. In other words, don't try to convince him he's delusional--try to help him see the value of using his rationality to make his life better.

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I believe that as a precondition to any progress, he will have to admit that he is delusional.

So, a question, hopefully to anybody who knows by example -- i.e., a mental health professional: what's the best way to go about telling somebody they're delusional? The common sense way would seem to me to simply respectfully tell the person such-and-such, with sympathy to the inevitable defensiveness, etc. BUT... with absolutely no experience in such a thing, I don't pretend to know if my "common sense" is really that sensible. Do most delusional people respond well to such attempts? Are "interventions" useful? (rhetorical, as there's only one of me to "intervene"). Should delusional people be "tricked", for example, asked to expand on their delusional ideas, until they must certainly eventually come face-to-face with the contradictory aspects of it?

I'll bet some psychologists deal with this all the time; anybody with any experience to share would be helpful. Essentially, I know what I have to do, but I have virtually no idea how to do it. An "Idiot's Guide to Convincing Delusional People That They Are" would be helpful.

Thanks in advance for any help.

At the risk of changing the subject, I would like to relate my experience with a psychiatrist who once attempted to convince me that I was mentally ill. I believe that this will help to show why it is a bad idea for a psychiatrist to attempt to "push too hard" when trying to explain to a patient that he is mentally ill.

When I was 15 I was hosptalized after my second suicide attempt. I was severely depressed, but in my own opinion I was not psychotic (I do not take depression, even a suicidal depression, as being coextensive with psychosis). The psychiatrist who treated me apparently thought that it was important that I come to realize that I was ill. He probably thought that such a realization would constitute a major step on my road to recovery. So he tried to convince me that it was wrong per se to commit suicide. Since I valued my independence, I argued back that I had a right to make the decision for myself, whether to live or to die. I knew, implicitly, that I owned my own life, that life is not an *intrinsic* value and that nobody has a *duty* to live.

The psychiatrist also tried to convince me that I was mentally ill. That outraged me. My perception was that he was assaulting my self-esteem, since he was denying the efficacy of my mind!

That psychiatrist and I would argue for half-hours at a time (we never had more than a half-hour together, since he had many other patients). I remember that in the very last argument we had, just minutes before my parents came to fetch me and take me home, the psychiatrist told me still another time -"But you are mentally ill, Henrik!". I answered him by asking him the question - "But if I can be mentally ill without knowing it, so can you! So how do you know that *you* are not mentally ill right now?" The psychiatrist became so exasperated that he slammed the flat of his hand onto the desk and exclaimed (and these were his exact words) - "You are the most stubborn patient I have ever had!" I felt immensely proud of myself when he said those words. I had demonstrated my independence by standing my ground when under pressure! I had refused to knuckle under and renounce my convictions!

Ever since that negative experience with a psychiatrist, I have had generalized negative emotions about psychiatry. I know on a conscious level that psychiatrists, at least most of them most of the time, help their patients. But since that psychiatrist I had when I was 15 had attempted to *pressure* me into conceding that I was mentally ill - I was left with the emotional impression that psychiatrists in general tend to be power-lusters. Because my perception was that that psychiatrist had attempted to *force my consciousness*. And as Ayn Rand pointed out, the attempt to force a man´s consciousness is the essence of power-lust. I know on a conscious level that the idea that psychiatrists in general tend to be power-lusters is ludicrous. For one thing, the many psychiatrists who I have interacted with after the age of 15 were all nice, gentle people. But my experience with that psychiatrist, at the age of 15, was so jarring that I have not been able to shake the thought completely. It keeps jumping into my mind every now and then, even though I do not *seriously* believe that psychiatrists in general tend to be power-lusters. (And I have no trouble whatsoever in getting along with the psychiatrists who I meet from time to time, in order to get new prescriptions for my anti-psychotic medicines. For I know on a conscious level that they are helping me and I feel no animosity whatsoever towards them personally, my feelings of hostility are only directed at the idea of psychiatry in the abstract).

The general lesson to be learned from all this is - Sure, it is important for a mentally ill person to understand that he *is* mentally ill - for otherwise how is he going to be able to solve his problems? The mentally ill individual needs self-awareness. But - if a psychiatrist "pushes too hard" when trying to explain to the patient that he *is* in fact mentally ill - that is likely to backfire. Because a mental illness is by definition an impairment of a man´s mind. So if a psychiatrist promotes the idea that the patient is mentally ill too agressively, the patient is likely to take that as being an assault on his self-esteem. Because the foundation of a man´s self-esteem is the premise that his mind is valid. And if it is *impaired* - then it is not, at least not for the time being, completely valid, is it?

Incidentally, to this day I hate that psychiatrist who treated me at the age of 15, more than I hate any other person in the world, except for my parents. I absolutely *loathe* that psychiatrist!

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It just occurred to me that my post above, about my feelings about that psychiatrist who treated me when I was 15, could easily be misunderstood. I was *not* trying to imply that the hostility which many mental patients display towards the psychiatrists who treat them is in fact *justified*. I know that psychiatrists are trying to help people who need help. They are doing their patients a service. I am not one of the anti-psychiatry crowd.

The point of my post was that there is a very logical explanation for the hostility many mental patients display towards their psychiatrists. That hostility may in many cases just be a result of the generalized feelings of frustration which an individual with grave psychological problems must have. But in some cases, I believe, the hostility is a manifestation of the patient reacting in a negative fashion when his psychiatrist "pushes too hard" while trying to explain to the patient that he (the patient) *is* ill. Psychiatrists do, of course, need to make their patients aware that they have a problem. Because otherwise, how are the patients going to be able to deal with their problems and get better? But the problem is, a mental health problem is by definition an impairment of the functioning of the patient´s mind. And most patients know this. So it is, in a sense, natural that when a psychiatrist tries to tell a patient - "You are mentally ill." - or - "You are psychotic." - the patient will take that as meaning that the psychiatrist is denying the efficacy of the patient´s mind (which he is). And, of course, if the patient has a shred of self-esteem, he will perceive the message that his mind is not perceiving reality correctly as being an assault on his self-esteem, and he will be enraged.

That is what happened to me when I was 15. And I have not been able to de-automatize my generalized feelings of hostility towards psychiatry in the abstract - which I have had ever since then - although I have tried.

The philosophical premise at work here is intrincisism. I perceived that psychiatrist I had at the age of 15 as being an intrinsicist. For one thing, he evidently was on the premise that life is an intrinsic value, and that people have a *duty* to keep themselves alive. And also, I perceived his epistemology as being intrinsicistic, since he was pressuring me to agree with him.

And, to top it off, I saw that he was, obviously, committing the fallacy of self-exclusion. For he said to me - "You are wrong because you are mentally ill without being aware of it." So he was saying that I could not be certain of my knowledge because I was insane without knowing it. But then - by the same logic - how could he be certain of his knowledge? Why was it not just as possible, in principle, for him to be wrong because *he* was insane without knowing it? Why the epistemological double standard? When a psychiatrist says to a patient - "Believe me - you are wrong because you are insane without yourself being aware of it." - that is exactly analogous to the philosopher who in Dr. Peikoff´s essay "Maybe You´re Wrong" argues - "You might just be wrong without knowing it."

Of course, a psychiatrist is *not* being arbitrary if he explains to his patient, with evidence, why he (the psychiatrist) believes the patient is insane. But in order to get a chance to explain things, a psychiatrist must be careful not to "push too hard". Because that can easily be counter-productive. I think that, often, a psychiatrist who is treating a psychotic must find himself in a difficult position. How is he to explain to the patient that the patient *is* insane, without the patient perceiving the psychiatrist as being a threat to his self-esteem, with hostility as a result?

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Of course, a psychiatrist is *not* being arbitrary if he explains to his patient, with evidence, why he (the psychiatrist) believes the patient is insane. But in order to get a chance to explain things, a psychiatrist must be careful not to "push too hard". Because that can easily be counter-productive. I think that, often, a psychiatrist who is treating a psychotic must find himself in a difficult position. How is he to explain to the patient that the patient *is* insane, without the patient perceiving the psychiatrist as being a threat to his self-esteem, with hostility as a result?

My guess is that most psychiatrists who have treated psychotics have had the experience of meeting with hostility from their patients. I would like to hear from whichever practicing psychiatrists read this post what their experiences in this respect are. And I wonder how they deal with the difficult problem of explaining to a psychotic that he is mentally ill, without giving rise to hostility which makes it more dfficult to help that patient.

Scott A. - do you have any experience of the treatment of psychotics? How common, in your experience, is the phenomenon of mental patients displaying hostility towards the psychiatrist who is trying to help them? How major a problem does this phenomenon constitute in the treatment of psychotics? And how do you deal with this problem when it arises?

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