by smithywise » Wed Feb 19, 2014 1:38 am
I think he is suffering from something much more severe than delusional disorder.
And no matter what his diagnosis is, it's likely he's going to have periods of time when he's 'better' or 'worse', because that's simply how these diseases affect people - the symptoms usually fluctuate. And quite often, there is no actual 'reason' why symptoms are 'worse' or 'better' at any given moment.
Symptom levels change. People can have a good minute, a good hour, a good week, a good month, I've seen people's symptoms 'go away' for long periods of time - everyone gets so hopeful that it won't come back.
Here's the bottom line. Once symptoms have been present for six months, they are likely to persist. One way or another.
What I am saying is that it's nice that his symptoms seem less right now, but it's fairly likely that his symptoms will continue to gradually worsen - with or without the usual little blips and ups and downs. Because he's been sick for a long time, he's likely to continue to be sick.
A few people have an incredibly up-and-down course, and seem 'perfectly ok' sometimes and scary as he** at others. But in general, you see ups and downs that go for a month or two.
People have various patterns. Some people are very psychotic for a few days or a week, and then are just lethargic and disinterested and disorganized between 'bad episodes'. Others are more constantly psychotic.
MOST people think that symptoms are very constant and consistent, with these illnesses. And for most people, that just isn't how it is.
What I'm trying to say is this. Don't get lulled by a temporary change in symptom level.
Also, he may be very resistant to treatment, but sometimes the most resistant people, will eventually agree to treatment. That isn't usually because a family member or spouse talks them into it - usually it's because a social worker or counselor convinces them, very slowly, usually, over a long period of time, that they agree to take medication.
Counseling isn't going to do anything for his symptoms. It just doesn't work. In fact, psychotic people tend to grossly misinterpret what counselors say to them. A psychotic person can't understand a counselor very well - counseling is entirely predicated on the person not being psychotic and being able to understand what the counselor says.
Further, except for a group of incredibly underpaid and highly skilled social workers, often those who work at the county mental health office - for peanuts - very few counselors have the slightest idea how to communicate with a psychotic person off medication. Most counselors, therapists and the like, I hate to tell you, do more harm than good.
One eagerly explained to a friend of mine, that his illness was rooted in childhood events and the patient took a gun and went over to his parent's house to kill them both.
In other words, be careful who you involve in this situation. You're going to get an awful lot more realistic and practical help from the 'ordinary' social workers and doctors who work at your county mental health office, in most cases. Beware grand promises and quacks.
Psychiatrists are trained very skilled doctors who receive specialized training in these illnesses, and in dealing with psychotic people. I've seen good ones get very very psychotic people to take medication. That is an art, and many of them are very good at it. It can take months, years.
here's the hard part.
He's going to get worse again.
Yes, he is. I can't say when, but he will. These illnesses don't 'get better' unless they take medication, consistently, every day, at the recommended dose. No matter how much you love him, comfort him, no matter how hard you try, or what you do, he isn't going to get well.
This disease isn't about love. This is a biological disease of the brain. No one ever thought their way into one of these illnesses, and no one ever loved their way out of 'em. These are brain diseases. You can see them on am MRI, on an EEG, on an - autopsy. People act the way they do because the illness affects their brain.
That's not to say that kindness is bad. It's not bad. You can sometimes temporarily calm a person. Sure you can. But this is a disease, not a choice. He needs treatment.
it may seem impossible, but there are things you can try - to get him help.
It's not easy. He may agree to treatment and then a few months later, quit and you'd be right back where you started. Your life could be a never-ending cycle of 'oh my god, what's going to happen now'.
And you have children in your home. One child has said if dad comes back, she's gone.
That means things have already gotten pretty bad. I doubt the child is just 'being selfish' or 'demanding'.
How do you get an unwilling person to agree to that? That's an art, and you need help. There are different methods you can try. These are well written up and can be discussed with a psychiatrist or social worker at your county office.
It takes quite a shift of perspective, a lot of knowledge about these illnesses, and the ability to NOT ARGUE about the person's delusions. It is, without any doubt, an art, but you succeed by completely shifting your perspective and how you react to things.
One thing that may work is getting the person to go TALK to the people at the county mental health office. Not to agree to take medication but just to TALK. Sometimes that works, it's a very long slow process, and you have to be patient.
Another thing that may work, is to make his staying there, predicated on him taking medication. Yes, that can get pretty nasty. You will find people can get very, very nasty when they are pushed to take medication, or their housing is predicated on it. And sometimes, that can get pretty ugly.
But people can and have, pulled that off.
What some people will do, is give the person 2-3 months to THINK ABOUT IT and DISCUSS it with their case worker (no, not with their spouse or family, with their case worker, it often works far better if someone who is LESS close to the person). They may wait til symptoms worsen again, to discuss it. This often means being willing to call the police on the person, to have them hospitalized against their will, and I'm not going to lie to you - things can get dangerous. A very ill person simply isn't fully in control of their own behavior.
They don't get nasty deliberately or intentionally. When a psychotic person behaves in disruptive ways, he isn't doing so for the reasons non-psychotic people are mean.
Time is, in fact, of the essence. The quicker they start treatment, the better their response to treatment, the less complicated their medications will need to be, the easier it will be to arrive at a dose and a form of antipsychotic that works well for them. And the quicker they get on treatment, the less the illness damages their brain.
Many people, after some years - after multiple hospitalizations, give up and say goodbye - they tell the person they can't take it any more.
Sometimes, when a person's back is really up against the wall, they'll finally accept treatment.
Sometimes when the person is more obvious to social services and not housed, social services will get more involved, and the person will finally be willing to take medication. And sometimes not.
Some never accept treatment.
And some do.