Delusions? My Brother Has Two Invisible Friends

Reader’s Question

I have a brother who recently revealed that once he started to hang around on his own he met two people, which became his ‘best’ friends. For a year or more he was in the belief that they existed, and he would talk to them and listen to their advice. He says they actually helped him and fixed his life, and made him what he is today. He says physically he sees them, and talks to them. It wasn’t until he was on a balcony talking to one of them, and somebody walked in and said, “what’s going on?” and the ‘friend’ was gone, that he realised it wasn’t real.

However, he continued to see these two people. Apparently now, they aren’t talking because of something that happened. What bothers me is that these people are so real to him, one of the ‘friends’ had breast cancer, and that friend had a boyfriend who left her for it and things. He says he still sees them sometimes across the road, but if he was to look away and look again they’d still be standing there. I told him his mind can destroy it, but he said he kind of likes it.

I’m worried that this is harming him but he says no, it’s rather benefiting him. Does this illness have a name?

Psychologist’s Reply

With your question about delusions, you’re on the right track. A delusion is a false belief that far exceeds the normal boundaries of a person’s reality or culture. Your brother’s belief in not only the presence of these two “friends” but his discussions and fantasies about their life are beyond his actual reality. Sadly, what you are describing is actually more than a delusion. Your brother is also experiencing visual and auditory hallucinations — the ability to see his friends and the ability to conduct conversations.

The symptoms you are describing are typically found in Schizophrenia. When you mention that his “friends” appeared when he was old enough for independent socialization, that also fits with the clinical pattern of Schizophrenia as a disorder that surfaces in young adulthood. If Schizophrenia is present, your brother would have had a gradual development of the disorder, becoming more socially withdrawn, odd in his behavior, and even less motivated over the last 1-2 years. It’s as though they gradually slip into a fantasy world and leave the reality of family and community. Early symptoms of Schizophrenia are often tolerated by the family and interpreted as “growing pains” or a reaction to school or social pressures. As in this case, eventually more dramatic signs of the disorder emerge.

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You are also seeing a pattern we often find in clinical experience. The gradual onset of the delusions and hallucinations is often accepted by the individual. Over time however, the delusions become more negative and eventually begin to torment the individual. The fact that the “friends” are present but not talking, basically pouting, tells us they will soon become “voices” that torment him and make derogatory comments.

Your brother should seek psychiatric treatment as soon as possible. We have a variety of effective treatments available that can address both the hallucinations and the delusions that are found in this disorder. While treatment can make his “friends” disappear and the voices stop, medications will not erase his previous experience with his “friends”. To understand this experience, I would recommend therapy by a clinician experienced in psychotic disorders.

Without intervention, it is likely your brother will sink deeper into this fantasy world. It may be helpful to enlist the help and support of the local mental health agency or a community mental health specialist. You might be able to arrange a family meeting with the professional to develop a treatment plan for your brother. Prior to such an intervention or meeting, I would recommend reading information on Schizophrenia. You can review items on this website, including other ‘Ask the Psychologist’ questions related to Schizophrenia. You might also read my article on Chemical Imbalance on my website at www.drjoecarver.com. This may require a major effort by the family, and the sooner the better. Once his paranoia increases, he will begin feeling the family is trying to harm him rather than help him. Those paranoid feelings, in combination with increased hallucinations and delusions, typically prompt an emergency hospitalization.

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