Trust Issues

Submitted by jordanmaes, October 09, 2012

My younger brother is a diagnosed schizophrenic. He just turned 21. He refuses to take his medication, is a drug abuser, has delusions of grandeur, and has made threats against myself and my family (ie. he has posted on Facebook that he hopes his family "has a slow death", has told my mom that he will "cut her" and drown her in our pool, etc.). He has repeatedly tried to fight me (my father and I are the "enemies of truth"), he has threatened to stab me, and he has moments of lucidity in which we are having a normal conversation and has just snapped when I've politely asked him to move aside so I can get to the sink, trash, laundry, etc. When he snaps, he has physically attacked me.

He's convinced my father and I used to molest him when he was younger (which has never happened).

Now, he lives in an apartment that my parents pay for, and lives totally off of their support financially.

I am 23, am engaged, live at home and have a daughter who just turned a year old. I work Mon-Fri from 8-5, and my fiance goes to school from 4-10. So, my mother helps out with the babysitting for about an hour. I have told her repeatedly of my concerns of him being around her without me there to monitor the situation. It's quite a long story, and I can elaborate if necessary, but for the sake of time I will shorten it to: Am I over-reacting? I am afraid he will snap on her like he has me. That something will set him off and he will either hurt her or do something else. I have threatened to keep my mother from watching him until she understands, but I would like a doctor's opinion on the situation first.

Thank you for your time.

Hi Jordan, You are

Hi Jordan,

You are experiencing one of the toughest situations for families who have a schizophrenic family member. What makes your family's situation especially difficult is that your brother is also abusing drugs, and that really complicates things.

I can understand that your parents want to provide for him and make sure he has a place to live. Unfortunately, though, they are enabling him by doing this. (And this is a tough, tough position for any family.)

If your brother is allowed to live in this apartment with no expectations (e.g. take his medication, go to treatment sessions, stop using drugs and get into drug treatment), then he has no motivation whatsoever to make any changes. And, so things will at best likely stay the same, or his condition will get worse (especially if he continues to use drugs).

I don't think you are overreacting at all. While most individuals with schizophrenia are not violent, there are some who are - and a combination of grandiose and paranoid (or persecutory) delusions are almost always part of the picture in those cases. That being said, it's difficult to say what role his drug use is playing in this. If he is using marijuana, cocaine, or meth, for example, those drugs also cause paranoia and may be contributing to the problem you've described.

I do feel his threats of violence should be taken very seriously. If your mother believes he would never hurt her, she is being very naive. If he is having a psychotic episode or high on drugs (or both), he could become very dangerous.

My recommendation to you is to consult with his current or former treatment provider (if possible) or contact a local mental health agency regarding this situation. Very recent threats of violence (or violent behavior) can be grounds to have someone with a mental illness put on a hold (how that works varies from state to state, but 3 days / 72 hours is pretty typical). During that time the patient is usually admitted to the hospital and evaluated, which includes determining whether or not he is a danger to self or others. Someone from the courts will usually come and determine whether or not the patient should be committed or if the hold should be dropped.

You can also contact the police if he makes a threat or does anything violent.

I would document all of his threats and any history of violence (like his attack on you). That information will be very important should there be a commitment hearing. (Btw, I am not an attorney so please do not construe any of this as "legal" advice.)

Be aware that taking action may create friction with your parents, if they are not in agreement with you. However, their safety (as well as yours, your fiance's, and your daughter's) are of utmost importance here.

I'm not sure what you meant when you said you have "threatened" to keep your mother from watching him - I'm not sure how you could control what she chooses to do in that regard. I don't think threatening your mother is probably going to be wise - and will likely make her even more resistant to hearing your concerns or taking appropriate action.

I really think you need to enlist all the help you can in this. Someone with authority needs to be aware of your brother's threats, so he can be evaluated. Every state is different in terms of laws, but I would definitely contact someone (his former psychiatrist, case manager, or anyone who has treated him, or, as I said, a local mental health agency) to see what can be done, if anything, at this time to prevent him from harming anyone and get him the help he needs. Unfortunately, if the drug issue is not addressed, medications may not be very helpful. He may need "dual diagnosis" treatment if he uses frequently or is addicted.

One other thing your parents need to realize - if he is not working and just living in an apartment with idle time on his hands, and especially if he has money to spend (for drugs), that is a very bad situation for someone like him. Being isolated, using drugs, not taking his medication, and having a lot of free time is not good for anyone with a mental illness, but especially for someone with a very serious psychotic disorder like your brother.

You might also look into NAMI (they have local chapters all over the U.S.). NAMI stands for National Alliance on Mental Illness - their website is nami.org. They advocate for patients and also have support groups, etc. for families of mentally ill individuals. You and your parents might benefit from getting involved with them.

I hope this helps and again, I think your concerns are very valid. Based on everything you've described, I think the possibility of him becoming violent is quite high and should not be ignored.

Dr. Cheryl Lane

Thank you so much. That

Thank you so much. That really helps a lot. I'll be looking into NAMI and doing the things you've described.

One clarification; the "you have "threatened" to keep your mother from watching him" was actually in response to a typo on my part. I had meant to say "her" instead of "him", about my daughter.

Again, thank you. It's good to have some knowledge and some semblance of direction, as well as validation for my opinion.

schizophrenia