Q. My wife is suffering from paranoia. It continues to get worse. I am very concerned for her and our small children. There is no talking to her about getting help, because she is convinced everything she feels , hears, and sees is the absolute unequivical truth. She, nor I have never seen a mental health professional. I have spoken to a few psychologists, and the said I should have her see a psychiatrist. I have talked to her about talking to a therapist, and she says she will never, never, never see a shrink. Our relationship has been hurt very badly by the financial stress we have had the past couple of years, now for the past couple of months she has become paranoid and delusional. Is it possible to have her forced to go to therapy? Can she be ordered by the court? She will not go willingly, and this is not getting better, it’s getting worse.
A. I am sorry to hear about your difficult situation. This situation is all too common-an individual who is delusional and paranoid refuses help and the family is left feeling helpless and with few options. It is difficult to force someone into treatment even when they are clearly in need of treatment. This is because of the very strict mental health laws that exist throughout the country. A person can be delusional and paranoid but when taken to a doctor or a hospital, may be turned down for not being sick enough. Most laws state that a person has to be a danger to themselves (suicidal) or to someone else (homicidal) to be forced into treatment. Other laws also state a person who is gravely ill (i.e. not eating, not bathing, etc.) may also be considered for help or forced into treatment. So in essence, the laws have individuals wait until he or she is almost at the point of suicide or homicide before he or she would be eligible for help at a hospital. This is the current state of affairs in many states. New Jersey may have different laws on the books and I would encourage you to become familiar with those state laws.
Having said that, my advice would still be to try and take your wife to a hospital if she continues to be delusional or paranoid and things get worse. Even though it is difficult to receive help sometimes at the hospital, there are few other options. You did not mention that your wife suffers from any specific diagnosis but you should be aware of some of the symptoms that are characteristic of psychotic disorders that are relevant to this discussion.
With bipolar disorder and schizophrenia, a common symptom of these illnesses is lack of insight. Lack of insight is thought to be prevalent in close to 50 percent of these illness populations. Those who lack insight into their disorder are not denying they are ill but rather do not know they are ill. With individuals who lack insight into their illness, no matter what you say or how much you try to convince them that they are sick and need treatment they will not be convinced that they are ill. Arguing with them only makes the situation worse. It is not because they are trying to be difficult or cause problems; not knowing their ill is thought to be a symptom of the illness. I am not saying that your wife has either of these diagnoses mentioned above, or even that she lacks insight into her illness. The situation that you described and her refusal to receive help reminded me of the many bipolar and schizophrenic individuals that I have worked with who are unable to recognize that they are sick.
I will reiterate my advice again. If you are concerned about your wife and her psychotic behavior (delusions and paranoia signify psychosis) it would be wise to take her to the hospital and have her evaluated. Be prepared and aware that the mental health system is difficult to navigate but it is the only option for getting your wife any help. I hope this is not your experience but anecdotally, it has been for many individuals and families that I have worked with. Please write again if you have any questions. Take care.