My brother just turned 28 recently, he’s had anxiety issues for years now but just recently in the last 2 weeks states he got threatened on social media and is now in fear for his life. Our fam. believed him up until the point to where he is paranoid over anyone looking at him a certain way, he swears people hacked his phone and are tracking him, he made mom get rid of her phone due to fear of tracking her and listening to their conversations too. Now he’s talking about selling his car, went through 3 different phones, wants to move out of state or country. Every time we talked to him to calm him down and tried to tell him he was being too paranoid he would get upset to where he would almost tremble because he said we wouldn’t take him seriously and his life was in danger. We talked him into getting evaluated & says 2 Dr’s diagnosed him with schizophrenia. now he’s at a rehab center for 2 weeks to help him but states the new doctor said he is NOT schizophrenic and would do other tests. I’m concerned that he isn’t being totally honest with new Dr. & isn’t getting the help he needs since he is still being paranoid over his phone and every car he sees parked. What can I do to help since he is an adult and wont give me much information.

A. This is a challenging situation. Since he is an adult, he is able to make decisions for himself despite the fact that he is currently experiencing what seems to be psychosis.

When people are psychotic, they are not thinking clearly. He is convinced that he is being followed and it is probably making him very frightened and thus he’s reacting accordingly. Currently, in most states, people who are actively psychotic are legally able to make decisions about their care, except in cases where they have been declared incompetent by a judge or pose a danger to themselves or to others.

It’s very common for people with schizophrenia not to believe that they have the illness. It is thought to be the result of anosognosia, a neurological condition that prevents people from knowing that they are ill. It’s so common that it’s actually a symptom of schizophrenia. Approximately half of the people with schizophrenia don’t think they are ill. If an individual does not think they are ill, then they are unlikely to accept treatment. Without treatment, psychosis typically worsens.

Treatment works but when an individual does not engage in the treatment, they don’t get better. This can be very difficult for family members who are caring for a loved one with a psychotic illness. In this way, schizophrenia is a family illness. Family members often feel helpless when a loved one, who is clearly ill, refuses to participate in treatment. It’s difficult on everyone.

You should encourage him to seek treatment. You can also report your concerns to his doctors. Privacy laws prevent them from contacting you (unless he gives them permission) but you can contact them to provide them with information. It’s also best to avoiding arguing with him about his belief that he’s being followed. As you learned first-hand, it only makes the situation worse. In his mind, his being followed is very real to him. Evidence to the contrary will have no effect upon the psychotic mind. By definition, psychosis is a break with reality. It can be a very frightening experience.

One of the best books written about dealing with a psychotic family member, who is refusing treatment, is I’m Not Sick I Don’t Need Help by Xavier Amador. It’s a useful resource and can provide you with good suggestions for how to handle this problem. Please take care.

Dr. Kristina Randle