Help me understand a particular mental illness

January 25, 2013 11:07 AM

The short version: chronic paraphrenia.

The long version, then, thanks for reading. So there's someone in the family that had a serious breakdown including (ineffectual, pretty much ridiculous) attempted suicide, female, single, late 30s, living alone by herself and with a decent job, first time with any such issues. Spent a month in a psychiatric facility under observation but among the general patients of the place, as seems is the legal requirement here after such an attempt. After release, proper medication and a lot of talk with psychologists she was diagnosed with chronic paraphrenia. Her delusions seem of the "political victim" type, as in "the government and multinational companies' executives are after me for my facebook opinions", or "they hired the neighbours downstairs to keep tabs on me", not to mention thinking they actually installed a microphone in her cell phone to hear all she said or the unending tales of woe about hackers with magical powers of snooping chasing her through internet. Before the breakdown and medication, visual and auditory hallucinations most likely happened to her. There is no apparent neurological cause, just psychological, and they haven't yet been able to determine the origin of the delusions, which probably started 6 to 9 months before the breakdown. They also haven't had much luck in making her see she has a condition or that she imagined most of what she imagined happen to her last year. So I'm pretty much at a loss here, never having been in contact with anyone in those conditions, much less a family member that might need permanent assistance in the future. I'm looking for online reading material to learn and understand this condition, and practical advice about what to expect as development of the condition, how to help (or at least not make things worse), what are the ways one should interact with such a person when she starts complaining or getting agitated about her "persecutors", what the actual risk of a new breakdown is, how this will affect her ability to hold and keep a job, etc.

posted by Iosephus to health & fitness (6 answers total)

A great book to read is I Am Not Sick, I Don't Need Help!. Among other things, it tackles the issue of how to interact with such a person, and gives great specific advice on what to say (e.g., "let's just agree to disagree on this, ok?").
posted by Melismata at 11:14 AM on January 25 [4 favorites]

I am not a psychologist or psychiatrist, nor do I know you or your relative.

What she is experiencing does sound a bit like schizophrenia. To grab a bit from the first paragraph from Wikipedia's article on schizophrenia: "Common symptoms include auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social or occupational dysfunction. The onset of symptoms typically occurs in young adulthood[...]"

Now: I am not saying she has schizophrenia, but you might find useful reading if you search for writings of people with close friends/family who suddenly start experiencing the symptoms associated with schizophrenia.
posted by bjrn at 11:17 AM on January 25

So "paraphrenia" isn't used as a diagnostic in the US currently. To get more results, you might want to broaden your search terms to include "atypical psychosis" + "paranoid", and "delusional disorder" + "paranoid"---those should get you some case studies and essays by US psychiatrists and psychologists.
posted by Sidhedevil at 11:18 AM on January 25 [4 favorites]

And seconding Melismata's recommendation of Xavier Amador's work! He is one of the people doing the most insightful work with, and on, people experiencing delusions.

Delusional Disorder: Paranoia and Related Illnesses by Alastair Munro is, I think, meant for students of clinical psychology, but I found it very readable as a lay person.
posted by Sidhedevil at 11:23 AM on January 25 [1 favorite]

Hey Iosephus,

Like some folks mention here, I am not a doctor, but I did some searches on pubmed and google scholar on paraphrenia (not a lot available open access). I did find a few that might help you and 2 are by this guy Robert J Howard, who has a book called Late Onset Schizophrenia which has a chapter on paraphrenia.

Chronic hallucinatory psychosis. A case report
Late Onset Schizophrenia and very late onset Schizophrenia by RJ Howard
Late-Onset Schizophrenia and Very-Late-Onset Schizophrenia-Like Psychosis: An International Consensus by RJ Howard (This one has some references at the bottom that you might want to pursue).

Hope this helps.
posted by Mrs_Who at 3:21 PM on January 25

The Center Cannot Hold" is a good book written by a woman diagnosed with schizophrenia who manages it via medication, social support, and therapy.

In order to challenge the delusions of someone with a psychotic disorder, you need to be trusted by them - and given paranoia that can (and does) take years. A lot depends on what you are willing to do, however, and what relationship you want to have with the person. An easy base behavior for you is to stop challenging any delusions, and when you want to challenge, stomp on it. On the aquaintance level, try to figure out the emotional content behind the delusion and address that in a paraphrase (e.g. "the government and multinational companies' executives are after me for my facebook opinions" can gardner a response of, "Sounds like you're feeling really vulnerable for what you believe," or "Wow, it must be hard to have beliefs and feel persecuted for them" - the validity of the belief is not at issue, the emotional content of feeling vulnerable and persecuted is more centralized). Then change the subject; look on it as an opportunity to practice your nonoffensive smalltalk.

If you want to have an ongoing relationship, do everything in your power to be scrupulously honest with her. Even sarcasm and irony can be detrimental, though that's more of an individual case judgement (and sometimes sarcasm with one topic works, where it doesn't work with a more emotionally triggering one). If you decive her or are wrong, admit it as soon as possible and as straightforwardly as possible. If you feel like you have to disagree with her on something, make exstensive use of "I" statements. (e.g. "I haven't heard of that, and it seems pretty unbelievable to me, but I've been wrong before.") Asking questions can often give you information abotu what's going on - but again you're listening both for the factual content and the emotional content; often delusions reflect emotional experiences of isolation, hatred, insecurity, jealousy, regret, anger, etc... which are too threatening to address directly. If you find yourself becoming emotionally riled by the delusions, seek out your own counseling and work it through there.

The prognosis is difficult to determine from the information gathered; if she has put you on her information disclosure list, you can ask whatever doctors and caseworkers she has. Some people manage full lives with jobs, with the proper supports and medications. I'm far more used to people unable to maintain successful employment who needs regular case management, but that's the population I work with and not necessarily representative (and even if it is representative, your family member could be an exception).

Usually, people who are able to maintain their family relationships and remain in their communities do better than people who are isolated with other people with mental illnesses; a lot of my clients are legacies of the old pattern of locking people in mental institutions for the rest of their lives, and in my personal opinion I think a chunk of their symptoms are actually in response to that, rather than due to their mental illness per se. The more regular, positive, enjoyable interactions she can have with people the better, and even with people who have had really awful histories I've seen a lot of improvement when they and the people around them are able to work together. A focus on skills, skill building, and non-judgemental feedback seems to work best in my opinion, along with setting firm boundaries of behavior (e.g. if she becomes verbally abusive, set the boundary that when she does you will leave immediately).
posted by Deoridhe at 4:25 PM on January 25