You might be misinterpreting your brother’s behavior. It may not be PTSD but rather cognitive impairment associated with his disorder. A core feature of schizoaffective disorder, and related disorders, is cognitive impairment. These impairments can range in severity and affect virtually all areas of an individual’s life, including attention, memory, IQ, language deficits, and executive functioning. Studies consistently show that to be the case.
You mentioned that you brother doesn’t acknowledge the severity of the abuse he suffered. The majority of people with schizoaffective and related disorders have abuse histories. It’s possible that he does not remember it well because those memories have been repressed (i.e. unconsciously blocked from his mind) or he is in denial. It’s also possible that those memories are so painful that he is avoiding the topic for the sake of self-preservation.
You also said that he is living with his father, the perpetrator of the abuse. Perhaps acknowledging the severity of the abuse would mean that your brother would have to move and cut ties with your father. People with psychotic disorders often have difficulty with change. In fact, even minor changes can trigger psychotic episodes. If your brother doesn’t want to talk about the abuse, that is okay. He might talk about it when (and if) he’s ready and no one should push him to do it any sooner. People with psychotic disorders are more stable, and less prone to psychotic episodes, when they live in calm, stress-free environments, where there is structure and routine. You and your family should try to avoid anything that might trigger a psychotic episode.
If he’s willing, he should inform his treating professionals about his on-going paranoid delusions. His medication might need adjusted.
Finally, you might want to research cognitive impairment and schizoaffective disorder. It might help you to better understand your brother’s illness and explain his behavior. If you have any other questions, don’t hesitate to write again. Please take care.
Dr. Kristina Randle