How should I respond to a delusional email from my mother who is suffering from paranoia?

December 12, 2009 8:34 AM

How should I respond to a delusional email from my mother who is suffering from paranoia?

A few moths ago, I posted this askme, and shared the helpful suggestions with my siblings.

Since then, my mother’s paranoia has continued to scale upwards. She’s been living with my brother and he has tried to help her and to get this looked at by her doctor, but she’s been very resistant to this. During this time, my mother has not mentioned any of this to me, although I’ve been getting updates from my sister in-law via email.

Things came to a head a few weeks ago after a couple of middle of the night 911 calls by my mom with claims she was being gassed by my brother and his family. I can’t imagine the stress their household has been under, but this at least seems to have had the effect of getting my mom’s condition looked at seriously, and hopefully will result in treatment in the long run that will help clear up her delusions.

However, last night I received an email from my Momtelling me that she was expecting my brother and his wife to kill her that evening and that she'd email me again if she survived the night.

And this morning I did indeed get an email from her letting me know she’s still there and to expect further such reports.

She had shared a little bit of such delusions with me in the past, but at that time, they were not nearly so full blown and she also only mentioned them in passing. I was able to be supportive and direct the subject to other things.

So, my question is for those of you who’ve had to deal directly with delusional and paranoid loved ones. What is the best (or least worst) way to respond to this? Should I (as my brother has tried constantly to do – clearly with no good result) try to reason with her? Should I ignore it? What? I suppose I could just try to generally supportive and loving and elide all of this, but that doesn’t seem terribly realistic either.

I’ll be checking in soon with my SIL about all of this to give her and my brother a heads up and to see what I might be able to offer them.

Email account: [e-mail] is still active. Thanks.

posted by anonymous to health & fitness (23 answers total)

You can't reason with crazy. You just can't. This is something that needs to be seriously addressed by doctors. Somebody needs to make sure it's taken seriously by doctors. Your mom is resistant because she thinks she's perfectly sane. She needs to have a serious mental evaluation. The people talking to the doctors need to be very clear on that point.
posted by fluffy battle kitten at 8:58 AM on December 12, 2009

If I were you, especially if your brother has children, I would do my utmost to get her out of that house and into a secure facility. Why? Because if she thinks that they're trying to kill her, which she very clearly does, what is to say she won't take proactive action and try to hurt or kill his family? If I was positive someone was trying to kill me, this would be my first reaction. Take a hostage.

I have no experience with mentally impaired family or friends, but she needs to get looked at by a doctor, stat. I don't know any of the legality surrounding this. For instance, can you drag her to a hospital against her will? I don't know, but hopefully someone else.

I'm really sorry if this seems alarmist, but you can't try to anticipate crazy, you need to take preventative steps.
posted by InsanePenguin at 9:02 AM on December 12, 2009 [4 favorites]

Hopefully someone else will.

I am an idiot.
posted by InsanePenguin at 9:03 AM on December 12, 2009

Reading your other post, I see that your mother is in her 70's so maybe you needn't worry so much about her trying to hurt his family.

But she still needs to be seen by someone, whether she likes it or not.
posted by InsanePenguin at 9:05 AM on December 12, 2009

We've tried reasoning with our schizophrenic relative but it doesn't work. I just respond noncommittally in a way that tells them I'm listening to them but neither confirms nor denies their paranoia. "Thank you for telling me." "Oh." "I see."

This might not be the best thing for them, but it's a hell of a lot less stressful for me. I don't constantly feel like I need to either convince them that their completely irrational delusions are completely irrational or play along with them.

My feeling is that constantly trying to deny the delusions gets you written into them, because they start to see you as the enemy. Supporting them drags you into the drama that they create. Just not responding to the truth or falseness of them either way seems to be the middle road.

If your mother sincerely believes your brother is trying to kill her, she may also feel forced to retaliate in some way, injuring him or her or everyone. I assume your line about getting the condition looked at seriously means she has mental health professionals involved. They should be able to offer more specific and medically valid advice on how to handle your mom, and whether she might be a danger to herself or others. Her son's home may simply not be the best place for her.
posted by jacquilynne at 9:05 AM on December 12, 2009

Somebody needs to make sure it's taken seriously by doctors. Your mom is resistant because she thinks she's perfectly sane.

A good friend of mine went through something like this with his wife (also a good friend) a few years ago. She grew increasingly paranoid over a period of time to the point where she actually started assaulted him for imagined transgressions. But, of course, there was no reasoning with her; certainly no hope of getting her to voluntarily visit even the family doctor, let alone seek psychiatric help.

Finally, one evening, he told her he was having chest pains and asked her to drive him to the hospital (she was still functional in that regard). Upon arriving at the hospital, the family doctor was waiting and quickly got her to the psyche ward. And so on. She was more or less out commission for about a month until they got her meds figured and now, a few years later, she (and the whole family) are doing fine.
posted by philip-random at 9:13 AM on December 12, 2009 [2 favorites]

I am not a mental health professional, but I do work with people with serious psych disabilities. I have always been told by professionals not to challenge delusions. You are not going to reason her out of this. I have had some success with saying something like, "That sounds very difficult. Maybe it would help to see a therapist and talk about how stressful this is." It might not work, but it is a supportive and non challenging way to suggest treatment.
posted by Mavri at 9:14 AM on December 12, 2009

You've been dealing with this at least since April and you've not been able to get her to a doctor? Did you ask a doctor for advice on how to get recalcitrant people into the office for evaluation?

What is the best (or least worst) way to respond to this?

Get her to a doctor immediately. This is not going to "go away."
posted by TWinbrook8 at 9:19 AM on December 12, 2009

Yes, doctor please. My grandfather had Alzheimer's disease and my grandmother had to lock away the knives, put his hunting rifles in my parent's garage and put locks on the inside of the doors to keep him from running away because he thought someone was out to get him.

This was over 15 years ago, so there wasn't much to be done other than to wait for it to get worse, but lots of progress has been made in the treatment of the disease and waiting to treat it will make treatment less effective, if this is indeed what is going on with your mother.
posted by chiababe at 9:31 AM on December 12, 2009

follow-up from the OP: "She's getting regular visits from a social worker, has been evaluated psychologically and medically and a treatment plan is in the process of being put together for the long term."
posted by jessamyn at 9:38 AM on December 12, 2009

I think several people are trying to be helpful but are misunderstanding or missing the OP's phrase "this at least seems to have had the effect of getting my mom’s condition looked at seriously, and hopefully will result in treatment in the long run that will help clear up her delusions." I am pretty sure this means that the mom HAS been to a doctor and some kind of psychiatric treatment is being considered currently. I don't think repeating the advice to go to a doctor is useful to the OP, who is asking specifically for advice about how to respond to this e-mail from his or her mom.

(I don't have any advice there because I haven't dealt with this kind of thing, but I wanted to point out that detail that I think is being overlooked.)
posted by wintersweet at 9:42 AM on December 12, 2009

Whoops, preview is my friend (posted at same time just as jessamyn posted clarification). Carry on. :P
posted by wintersweet at 9:43 AM on December 12, 2009

I think it is time to consider moving mom into a long term care facility. Facilities than handle patients with Alzheimer's should be able to manage her condition. At her age, seriously consider that your mother may never get better, even with medication and intervention. In the meantime, have your brother look into respite care and have your brother take a vacation. Good luck.
posted by crazycanuck at 9:53 AM on December 12, 2009 [1 favorite]

"I see that your mother is in her 70's so maybe you needn't worry so much about her trying to hurt his family."

Disagree. It doesn't take much to pick up a knife, or matches, or some standard household chemicals.

Don't take the risk. No one here wants to hear about this family on the news. Speak to a doctor yourself and ask about her being committed against her will, for everyone's safety. Yes, bring this up with other relatives first, but remain firm that safety of everyone, including Mom, is your primary concern.
posted by swimming naked when the tide goes out at 10:13 AM on December 12, 2009

So, my question is for those of you who’ve had to deal directly with delusional and paranoid loved ones. What is the best (or least worst) way to respond to this?

Be kind, to your mom and to yourself. As other people said above, crazy people are not reached by logic. When I have similar experiences to yours, I find all I can do is be reassuring, without accepting the paranoia as true. I tell my relative they are wrong, and try to redirect their thoughts and attention to something else, rather than getting into an argument about how or why they're wrong. Of course, that's difficult via email.

Really, there isn't anything much you can do apart from get anti-psychotic meds into the sick person, which can be very difficult without professional help (e.g. psych ward temporary stay, to get the situation stabilized.) If your mother appears to be a danger to herself or to others, see that as an opportunity for professional intervention.

Good luck. Mental illness can be very painful for everyone, not only the sick person.
posted by anadem at 10:18 AM on December 12, 2009

Care Home. She'll be happier, your brother will be happier, you will be happier.
posted by A189Nut at 10:25 AM on December 12, 2009 [1 favorite]

Mavri (& others) have it. However, I feel compelled to chime in with concerns about safety. Although people struggling with severe mental illness are not necessarily more dangerous than your average person, if she fears for her life, she may feel compelled to take desperate measures. (Wouldn't you?) Also, although I'm encouraged that she is getting ongoing treatment by MH professionals, I would be wary about being lulled into a false sense of security. In my state (MA), MH professionals have a duty to warn if they believe their client may be planning to harm an individual, but someone with paranoid delusions may be more frightened/delusional/sleepless/isolated at night and impulsively act out violently. Again, I don't intend to perpetuate untrue stereotypes about people with mental illnesses, just want to be sure that your brother's family has considered the possibilty and has a safety plan in place. Also, my experience working with people with persistent mental illness and their families has taught me that the stresses of caring for a delusional family member can be very, very confusing and difficult, and quite often is a good reason for the supporting family members to seek supportive therapy themselves. Please MeMail if you'd like to.
posted by dreamphone at 10:36 AM on December 12, 2009

The reason it's important not to try to challenge the delusions is that she could then wrap you up into the group of people she can't trust. Right now, it's helpful that she feels she can trust you/your motivations, and she will stay somewhat connected to you because of that. If she feels you are "in" on the plots to kill her, she may be at an even greater risk for leaving the home or taking more drastic actions. You need her to still think of you as an ally, so that she might communicate more with you that she won't communicate to your brother and sister-in-law at this time. Things may change once the assessment process is completed, and it may be recommended that she stay somewhere inpatient, but for now, you kind of have to work with her and not against her.

Best wishes. I know this is an incredibly difficult and painful experience for a family.
posted by so_gracefully at 10:36 AM on December 12, 2009

Please have your brother and sister in law get her out of the house. These types of delusions worry me. We had a tragedy here in my hometown last month-the father of the home started having delusional thinking-his friends made him promise to get help but that very same day he took a gun and killed his entire family and then himself.

Yes, I know most mentally ill people are not a danger to others, but I really don't see it worth the risk in this case.
posted by St. Alia of the Bunnies at 11:26 AM on December 12, 2009

My mother was paranoid schizophrenic and I went through this kind of shit for years. I generally just ignored her bizarre missives.

Your mother should not be living with family members! She should be living in some sort fo supervised setting. Your brother should contact the social worker and tell him or her what's going on. Your mother needs help that she's not getting. I feel for you.
posted by mareli at 6:17 PM on December 12, 2009

When I said that your mother needs a mental evaluation - I did not mean she needs to be looked in on by a social worker once a week and that there is a treatment plan in process. Your mother is being delusional NOW - not when it's convenient for the social worker OR the plan to be ready.

If your mother is delusional/crazy/paranoid none of those things help IMMEDIATELY. When I said she needed to be evaluated - I meant she needs to go off to a facility for at least three days AWAY FROM THE FAMILY. The ER cannot accurately gauge what a delusional person is capable of particularly not when a delusional person can get it together for short periods of time.

My father is a schizophrenic. I've dealt with this shit before.
posted by fluffy battle kitten at 8:32 PM on December 12, 2009

Check your gmail.
posted by foxy_hedgehog at 5:22 AM on December 13, 2009

If the OP is in the U.S., his family can't just drop mom off at the hospital for three days unless she consents or is assessed to be dangerous to herself or others. (And no, being paranoid and delusional, even to the point of thinking someone is going to kill you, does not necessarily rise to the level of dangerous.) Given what he said in his update, I would suggest his family let the SW know about her latest delusion and maybe even specifically ask for a dangerousness assessment. In my experience, assessing for dangerousness and homicidal/suicidal ideations are standard operating procedure, so the SW is probably already doing that. Still, the SW might not know that mom thinks her son is going to kill her, and that's valuable information for a treatment provider to have.

Depending on the privacy laws in place and what releases may or may not have been signed, the SW might not be able to tell your family what her assessment is. But if she thinks she needs to be hospitalized, she can call EMT's to take her there. (Again, my experience is in the US--New York specifically.) If your family is has immediate concerns about dangerousness, they can call 911 or your local equivalent. It's certainly possible your mother is dangerous, but strangers on the internet can't tell you that (and I realize you didn't ask that question, but you're getting a lot of stuff about it anyway).

Your mother is seeing a mental health professional regularly, which is good news. If her SW can't spend the time to talk to your family about how to deal with the paranoia and delusions (and she may genuinely not have the resources for that sort of thing), then I suggest you contact NAMI (again, US-specific) or ask your own doctors for referrals to SW/therapists/etc. who can help you deal with this. Aside from your own stress, it would be useful to have a professional help you understand how to respond to her. If your brother is trying to reason with her about her delusions, that's just going to upset her and frustrate him. I'm not blaming him for taking that approach (it's perfectly natural), but it would probably be better for everyone involved if he stopped doing that. So_gracefully offered a very good explanation for why you shouldn't challenge delusions.

Good luck.
posted by Mavri at 8:13 AM on December 14, 2009