Reader’s Question

I need some information about psychiatric illnesses. I am 29 and have gone through substance abuse treatment and have been clean and sober for over 2 years now. I have a brother who is 33 who I thought was also alcoholic, but now I’m coming to believe he is schizophrenic.

My brother claims people are “spying on” him. He claims that “everyone knows things” about him. He started saying these kinds of things a couple years ago when we were both drinking. At the time, I really didn’t think too much about it. Now that I’m clean and sober, I realize that it is pretty serious. My brother also used to overreact when he drank, talking about things that happened to him when he was around 5-10 years old, and once he even got violent with me and other family members.

My brother has always been fairly prone to avoiding social interactions, has seemed very unmotivated, and has been unkempt in his appearance and in the way he keeps the house. Now he is so isolated that he doesn’t hang out with anyone he knows but only drinks and goes to a casino. He claims the people spying on him want to change who he is and his beliefs. When I ask him about his drinking, he claims he is not drinking a lot. I try to let him know I care, but he thinks of it as “spying”.

I’m getting more convinced this is schizophrenia. How do I get him to agree to see a doctor when he doesn’t think he is sick and that someone is “spying on him”? Do I have to worry about violence?

He said he would rather die than live with the torment of someone spying on him. Does that mean he is rather deep in his sickness?

My family and I are really concerned, but we really don’t know what to do. Any suggestions would be great.

Our Clinical Psychologist’s Reply

Paranoid delusions can arise out of conditions other than schizophrenia, including the effects of some psychoactive substances like alcohol and/or other drugs. However, some individuals can develop an Alcohol Use Disorder (AUD) in response to or co-occurring with a more serious mental illness such as schizophrenia.

Substance abuse is the most common disorder that co-occurs with schizophrenia. Although the reasons for this are not fully understood, a wide variety of biological, psychological, and environmental factors is thought to play a role.

It’s critical that individuals suffering from brain dysfunction complicated by substance abuse get treatment. However, it’s also often common for individuals so afflicted to resist efforts to secure them help. Involuntary commitment is not possible unless the individual presents a clear and immediate danger of significant harm to themselves or others (e.g., is suicidal or homicidal). Individuals who successfully get help and overcome their difficulties generally pass through four stages:

1. developing a trusting relationship in which real “engagement” is possible,
2. allowing oneself to be persuaded to accept guidance and therefore slowly developing motivation to change,
3. engaging in active treatment efforts to develop new coping skills, and
4. abiding by a plan of relapse prevention.

So the first step is the most critical, and you can play a very key role in helping your brother. Do your best to build trust and confidence. When you challenge his distorted thinking, do it as benignly as possible, and make it clear how much care and concern is behind it. Make it clear how much help and support is available. Most of all, be prepared for the fact that it will likely take some considerable time and effort, with no guarantee of success, to get your brother the help he needs.