I understand and appreciate your hesitancy to report her, but I would advise you to throw caution to the wind. Helen seems to be experiencing significant symptoms of psychosis that now involve her daughter. The fact that Jan is highly sensitive to anything negative being said about her mother means that she is not likely to reveal much about what’s going on in the home. There may be many other things that you don’t know about that are equally worrisome or perhaps worse.
Generally speaking, people with psychotic disorders, engaged in treatment, are not dangerous. That’s because their symptoms are being treated and managed. People willing to undergo treatment also recognize that they have an illness. In the clinical world, people who recognize their disorder and are willing to accept treatment are described as having insight into their illness.
Insight is an important element in the treatment of psychosis. People who lack insight into their illness typically won’t accept treatment and therefore are more apt to have psychotic episodes. People who are psychotic can inadvertently be dangerous to themselves or to others. That’s because their mind is being ravaged by the psychosis. It’s tricking their mind into thinking something is true when in fact it is not true.
As you also noted, she’s not receiving treatment and is refusing to do so. That would suggest that she lacks insight into her illness. It further increases the possibility that she may act out dangerously in an effort to protect herself and her daughter against perceived threats.
Actively psychotic individuals are at their most dangerous when they are refusing treatment and believe that are at risk of being harmed. That seems to be the situation you have presented here. There are occasions when they preemptively strike first in an effort to protect themselves against perceived dangers.
Think about it. If you thought that you or your daughter were being drugged and tracked, wouldn’t you attempt to protect yourself? Most people would. To the people experiencing them, delusions and hallucinations feel very real. Their inability to discern truth from delusion is the essence of psychosis.
Helen’s family should encourage her to seek treatment. If she is unwilling and there is evidence that her daughter may be in danger, then it is incumbent upon people with knowledge of the situation to report their concerns either to the authorities or to child protective services. Child protective services will take the report and will make a decision about whether or not further investigation is necessary. They are trained to make these types of decisions and you should feel confident in their ability to do so.
There may also be a local mental health crisis center in the community. You can call and ask them for advice. Report your concerns. They can go to the home and investigate the situation. Their goal will be ensuring that everyone in the home is safe.
This is a complicated situation. Part of what makes psychosis so difficult to treat is the insight factor that I described above. Approximately half of people with psychotic disorders don’t recognize they are ill and thus refuse treatment. Their inability to recognize their illness is actually a symptom of their illness. It’s called anosognosia. This condition prevents people from recognizing that they are ill and thus inhibits their ability to benefit from treatment. Sometimes, people with severe psychotic disorders are subjected to forced treatment in an effort to help them recover but also to protect themselves and others. This may or may not be one of those occasions.
I would encourage you to make the report to child protective services and or the mental health crisis team. Helen will likely never know that it was you who made the call.
It may also be necessary for you to limit your interactions with their family until this problem has been resolved. The fact that Helen has incorporated you in her delusions could put you are at risk of being harmed. You may think that sounds alarmist but I’ve studied cases in which individuals, in the midst of psychosis, harm the people they are convinced are a threat to them. It happens more than you might realize.
Untreated psychosis, coupled with paranoia, and a belief that others are out to get you, is a recipe for serious potential danger. You must protect your family and young Jan. She loves and want to protect her mother but may also be at risk of inadvertently being harmed by her mother.
I hope this helps you know how to proceed. Write again if you have additional questions. Please take care and stay safe.
Dr. Kristina Randle