Persuading Your Mother to be Evaluated — She May Have Schizophrenia

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Reader’s Question

I think my mother is displaying some symptoms that could be related to schizophrenia. This started a few years ago, and the symptoms have gotten worse over time. She has a feeling that the superintendent from our building is going to kill her. She hears his voice in her head, threatening her, and she panics. It seems she also hears other voices, because she very often laughs to herself and says random things to no one in particular. Sometimes she feels that her body is vibrating, which she insists is being caused by the superintendent. She also feels like she is being watched; she swears there are cameras all over our apartment, monitoring her every move.

I am very concerned, and have told her that it’s all in her head and that she should go to counseling, but she gets really mad, and tells me that I am unaware of the situation, and that what is happening to her is true.

She obviously has a psychological disorder, but which one? And how do I convince her to seek counseling? I have tried many times over the course of the past year but she always refuses.

Psychologist’s Reply

Psychotic disorders are defined by the presence of hallucinations and delusions. Hallucinations are simply sensory experiences not shared by others (because they’re occurring inside the brain, rather than as a result of stimulation from the exterior world). The most common form of hallucination is hearing voices. For some, the voice sounds like it’s coming from within, whereas for others the voice sounds like it is coming from outside, just as it does when any of us hear another person’s voice.

Delusions are fixed, false beliefs, and often they revolve around being targeted or persecuted. Such paranoid delusions might include beliefs that someone is trying to control or kill the individual. Often the hallucinations are incorporated into the delusions, and are experienced as simply evidence for the accuracy of the delusional beliefs. The ‘fixed’ nature of the delusions means they are entrenched; there’s no talking someone out of his or her delusional beliefs.

As you suspect, your mother’s symptoms are cause for concern, and a likely indication of some form of neurological dysfunction. Although the symptoms of schizophrenia most commonly show in early adulthood, they are possible at any age. There are also other possibilities. For example, a brain tumor, dementia, and severe depression may cause psychotic symptoms. Only medical examination can rule out such possibilities.

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It sounds like the difficult part is convincing your mother to be evaluated. One tactic is to appeal to her torment over being controlled by the superintendent. For example, you could present the possibility that a thorough evaluation might result in a way to get the superintendent out of her head (which is true), or reveal how he is able to control her. In other words, rather than trying to convince your mother that she is ill, focus on your concern for her wellbeing, and your desire to help her get back to the way she was before the superintendent began wreaking havoc.

As a last resort, there are legal steps a concerned family member can undertake to have a loved one involuntarily committed for evaluation and treatment. Of course this solution often strains the relationship between the family members, and your mother may be uncooperative, making it that much more difficult to determine the cause of her symptoms. The criteria for involuntary commitment revolve around whether the individual is a threat to anyone, including herself (perhaps by neglecting self-care). As you work on a supportive approach to eliciting cooperation, also document specific examples that demonstrate that your mother (or others) are at risk by her continuing to live untreated. Hopefully it won’t come to that, but it’s best to be prepared for that possibility.

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