Smart, prickly hermit relative is delusional/psychotic and we're scared
April 29, 2016 2:25 PM   Subscribe

A family member (with a history of being psychiatrically unusual, at the very least) has an extreme, scary and violent delusion which is making her miserable and may cause harm to others. She is a smart, fiesty, aging hermit who lives alone, sees few people and resists medical care. Looking for resources about how to handle a situation like this.

My relative "Lucy" is ~65 and lives alone in a cottage in a tiny town. She tutors 1 day a week in her home and grows almost all her own food. She virtually never leaves home, although she has a car and drives to a supermarket every 2-4 weeks for certain supplies. She studies broadly, keeps up with current events via the radio (she does not use computers of any kind), creates a wide variety of (genuinely good) art, and generally has a lot to do and think about. Think old-school poet hermit. She's dedicated herself to this way of living for 20+ years.

She is extremely smart - she studies complex texts, can argue anyone into the ground, and discusses high-level subjects engagingly for hours. She is witty and charming. Despite being a hermit, she cares about her friends and family and writes letters and calls relatives.

OK, now the bad news. For decades, she has had a pattern of becoming obsessed (obsessed is not an exaggeration) with various theories, philosophies and practices, becoming totally immersed in them, only to abandon them and move on ~5 years later. This is important, see below. She has also - and this is even MORE important - had a history of sporadically lashing out at friends and family, with vicious, cutting insults. She says withering, despicable things about others, including utterly false allegations of ways in which they have hurt her. These aren't misunderstandings or misinterpretations; these are totally invented acts of cruelty that absolutely did not happen. She has burned many bridges this way. She has attacked me and at least 3 other close family members this way, and although her attacks have been painful, we have not cut off contact with her because her anger and insults are clearly not rooted in reality. More than that, she seems to forget about the horrible things she says and goes back to being normal and loving after 6 months or so, and the next outburst is aways focused on somebody else. Furthermore, 2 other family members (but not me) have seen her in what they feel strongly were psychotic states, completely disconnected from reality. Not frequently, though - just 3 times in 20 years.

Until recently we have viewed Lucy as a smart, caring, fiery woman, living a deeply principled life, who had clear psychiatric problems that we couldn't see any reasonable way of addressing. But things have suddenly taken a turn for much worse.

Lucy became involved with a group (in the realm of philosophy/spirituality) about 15 years ago, and then left it 10 years ago. Since then, she has been convinced that leaders from that group have harmed her. They are not mild accusations. She believes she was psychically raped, that certain leaders are murderers (actual murders, though we are pretty sure she believes they were committed psychically), that there is a vast cover-up operation, that leaders are systematically psychically destroying women, that the most senior leaders are perverts, and a long list of other awful things. She feels terrorized by these people, never safe in her own mind, and she is anxious for family members who are also involved with the group. When she first voiced these concerns, several family members investigated her claims quite vigorously and found them to have no basis in reality. Since then she has gotten more scared, more angry, and more insistent.

Last year, she announced that she had received sponsorship/funding from a benefactor to create an extensive piece of art (I'd rather not specify what it is) to express her concerns and warn the public. Since then, she has met with various people involved in presenting/producing/displaying her art, who come from across the country and represent various organizations. She has worked on her project daily, with a very strict personal schedule. She has produced an enormous amount of work which I have personally seen, and she has talked extensively about the minutiae of the project, from phone calls to posters to schedules of all kinds. The "big day" - which was supposed to happen in a city far away from her small town - was supposed to be tomorrow.

We just found out yesterday - by calling the "benefactor" and looking up various key personnel in the project - that the entire project was a delusion. The benefactor is a real person but has never heard of the project and some of the other people likely don't exist at all. Lucy does not have the phone numbers of any of the people involved - she claims they always called her. We do not know whether she has been sending things in the mail or not. We don't even know whether she has actually spoken to anybody else about this project.

Her perception is that her project has been cancelled, by members of the group she's against, because the group has, once again, found a way to repress and terrorize her. She is extremely distraught and fearful and views it as a personal attack.

A close family member will be visiting her tomorrow morning. What can we do? As mentioned, she is a hermit. Her delusions/hallucinations, while apparently quite severe, have not limited her ability to take care of herself and she is healthy and fit. She is distrustful of virtually all authority, but especially doctors. There is absolutely no way she would agree to psychiatric treatment, and we know better than to try to talk her out of her delusion.

On the other hand, she has incredibly violent and damning false accusations about a variety of people in the group she's against. Many of these people (some of whom I know personally and can vouch for in the strongest possible terms) could have their lives ruined if her claims were to be taken seriously. Countering Lucy's claims is risky business - as mentioned above, she can be vicious when she has a delusion of being attacked - but we are scared for her, and scared for the people she is angry with.

Have you been in a similar situation? What did you do?
posted by Cygnet to Human Relations (16 answers total) 3 users marked this as a favorite
Is there any reason for you to think she might represent a danger to others or herself? Has she mentioned wanting to hurt people in this group, or suicidal or self-harming ideas about herself?

I don't want to call this a "harmless" delusion, because it sounds awful and probably not great from a mental health standpoint. But assuming that she is still caring for herself, not stockpiling weapons or issuing death threats, and able to live her life normally-for-her, I would probably just watch and wait.

I'm not sure you should try to "do something" about the idea that she might libel someone you know. Especially if others know about her personality quirks and that she's all (insulting) bark and no bite. It's really if you think there's "bite" here that you should step in.

Are there any non-invasive psychiatric resources in her town? A therapist she would be willing to talk to? Her doctor? That's probably the place to start if you want to help and she doesn't seem to pose an immediate threat to anyone/herself.
posted by Sara C. at 2:37 PM on April 29, 2016 [1 favorite]

The book people suggest to read is I Am Not Sick I Don't Need Help: How to Help Someone with Mental Illness Accept Treatment (which, I know, she doesn't want to do this, the book is for people in your situation). Direct confrontations of delusions is not generally considered constrictive and it's unlikely from what you've said that people will not realize that her accusations are being made by someone who is mentally ill. I know her behavior sounds alarming to you but it's actually fairly within the realm of "normal" delusional behavior. Which is not to say you should just be okay with it, or that it's not a problem but the "big project" has a very typical sound to it, along with the eventual non-event for Reasons.

So I guess my question is: what are you hoping to do? It sounds like you could use support and you're trying to figure out if there's anything you should be doing for your relative? I have a partner who lives near the location in your profile who has a mentally ill family member and goes to NAMI support group meetings for friends/family members of mentally ill people that are not far away. You might find them useful. I'd call their state org and see if they can point you in a decent direction.

In the short term future I'd do a little research into how to interact with people who are delusional and especially how to tell when something needs to happen (i.e. you need to call the police) versus when they are just being delusional but not dangerous. I know for many people who deal with people with chronic mental illnesses, there is often concern about calling the cops (especially with people who have been previously marginalized for mental health or other reasons) and so some research into how the process works can be helpful and calming. For now it sounds like she has a mental illness of some kind and there are limited things you can do besides be available to her but getting some support for yourself might be useful.
posted by jessamyn at 2:39 PM on April 29, 2016 [25 favorites]

I think you are overreacting. She lashes out verbally with ridiculous accusations. This is unlikely to harm anyone.

One thing that would likely help is for you to be more validating of how she feels, regardless of whether her claims are verifiably real or not. Please note that, for example, her claim that she was psychicly raped is not disprovable. So when you say you "investigated" such claims and found them to have no basis in reality, to me that sounds very dismissive. I think it unlikely that you hired a proven psychic detective or something. Your very next sentence indicates she became more scared as a direct result of being dismissed:

When she first voiced these concerns, several family members investigated her claims quite vigorously and found them to have no basis in reality. Since then she has gotten more scared, more angry, and more insistent.

If you read articles about social injustice, the perpetrators routinely claim they didn't do anything. This winds up being part of the problem.

In the last years of Hemingway's life, he believed the FBI was hounding him. Everone treated him like he was losing his marbles. After his death, it was eventually revealed to be true.

You do not have to believe anything she says, but she will feel more supported and less scared if you stop telling her it is "untrue" and, instead, tell her "We cannot find supporting evidence, so we have to go with what we understand to be real." Be sympathetic to how frustrated and scared she is. Like "Well, we called him and your benefactor denies all knowledge. This must be so frustrating to you, to have put so much work into this."

What I am trying to say is, delusional or not, she wants some kind of support. Telling her that none of it is real isn't supportive. It just makes her more unstable and scared.

If you can stop being so dismissive of her concerns, you may be able to make some headway in terms of rebuilding trust and dialing down her anger. It may help you if you loosely interpret her stories as metaphorical -- she was involved with a cult, and now feels psychicly harmed in some way. I would try to relate to that in terms of "I regret getting involved with them. It harmed my mental health." Given what you have said here, I think that is a totally valid way for her to feel, regardless of how strangely she is expressing it.
posted by Michele in California at 3:30 PM on April 29, 2016 [16 favorites]

I note that this is April, and that bipolar people with seasonal patterns to their illness often have peaks of mania in April and May, possibly due to rapidly increasing day length; and you mention that she has 'forgotten' about some of her outbursts after six months or so.

And her delusions seem consistent to me with lots of things I've heard from people who are suffering from severe sleep deprivation. Do you or her other relatives have any sense how much sleep she's actually getting?

It might be a lot of potentially thankless work, but you could try to assess how dangerous her delusions are with a phenomenological approach, in which you would 'align' yourself with her delusions without actively confirming them, both to try to find out whether she's planning anything alarming and to nudge her toward benign and inconsequential expressions of those delusions as much as possible.

In a way, I see this project she was working on as a pretty successful attempt her part to give her delusions relatively harmless expression; if the opening date had been not tomorrow, but five years from tomorrow, she could have had a pacifying sense of doing something about the problem into the indefinite future. So you might find her more cooperative than you expect if you were to try to rechannel her more violent impulses into something more gestural and symbolic.
posted by jamjam at 3:50 PM on April 29, 2016 [5 favorites]

Thanks for the advice so far. I'd like to note that nobody has ever told her that her delusions are false. Furthermore, many of us have grappled for years with the knowledge that we can't be certain she wasn't psychically raped, and that regardless of what we believe, there are things about the world we do not understand. It is, however, the case that many of her delusions are provably false. We have treated Lucy with respect at all times and I have absolutely never dismissed her in any way. The worry here is that she is terrified and miserable and believes the world is against her.
posted by Cygnet at 4:15 PM on April 29, 2016 [6 favorites]

I've always found the best approach is to be kind, and validate someone's experience. You never know what she has been through, real or imagined, and imagination is sometimes worse than a real experience. Artists travel through realms that the rest of us cannot imagine, and sometimes, yes, it does lead to weird thoughts.

I don't think you can dictate her life, only check in as you have, and be concerned as you have, and maybe interact with her more? Because interacting with friends and relatives is a huge part of life, and I know she has been difficult, but maybe you could tag-team it?

No easy answer here. I have had free-thinking relatives in my family, but they've always had a spouse attached to keep them from going off the rails, as society only permits people to go so far without clamping down on them.

The best you can do is a wellness check: and if she is hale and hearty and feeding herself, that's it. We are all born and die, and some people choose to live the way they want, despite society's approval. And if after that, and she is quirky, you might just have to let her be quirky. Then it's up to you and the rest if you want to continue to associate with her and her diatribes.
posted by Marie Mon Dieu at 4:26 PM on April 29, 2016 [3 favorites]

Are you talking about the School/Study or SES or something similar? If so, Lucy may well have been triggered by being part of it. (without the larger accusations being true.) Particularly if she's mentally ill, groups like that have cult-like practices and leaving can be really painful and difficult.

(This may be a strange question, but I was triggered by your description of the group and your location. I know someone who had a fairly nasty brush with School in Cambridge.)
posted by frumiousb at 5:20 PM on April 29, 2016

Your post concludes with the statement that you are scared for the people she is angry with, and I think that point hasn't been addressed. You said some of these people are even your friends. If a person was obsessively terrified and angry with me, I would want to know about it. So that I could be sure to stay away from that person. Your family needs to consider the likelihood of Lucy confronting any of these people. If there's any possibility of that happening - say, if she is confrontational to others and these are people she might encounter - then I think you have an obligation to mention this to the people who may be a target of her verbal attacks.
I'm sorry. I know that would be a difficult decision. But I would hope your friends would be sympathetic and I think you're obligated to warn your friends, even if it potentially harms Lucy.
posted by areaperson at 5:28 PM on April 29, 2016 [1 favorite]

frumiosb, no - not School/Study or SES. It's a secular, explicitly-non-culty, open group with well-established ethical guidelines and publically available procedures for making complaints about the conduct of leaders. I can't possibly overemphasize how harmless and non-creepy these people are. I speak from experience, and I am more wary and less willing to consider myself a part groups than anybody I know except Lucy. Another wrinkle to this whole thing is that Lucy has claimed for years that she has been writing about her complaints to these various committees/publications/boards, and that they have been ignoring her. When she first said this, I immediately looked into it, speaking with a variety of different people - an unrelated family friend who works in communications, a leader I happen to have worked with and know personally, and just by making some office inquiries. Unless folks are not being truthful, she has never ACTUALLY made these complaints.
posted by Cygnet at 5:31 PM on April 29, 2016 [1 favorite]

Thanks-- I just hear "philosophy group" and because of my friend's experience, this is what comes to mind.

I wonder-- you say she hasn't made any of the actual complaints about these people. So maybe it's worth doing nothing for a while and seeing if this passes on its own. If she was really calling and filing complaints then there would be something which could be done. I agree with areaperson that you might want to warn them that she's not well, and focused on them.

I have a good friend who is severely bipolar and unfortunately has delusions/hallucinations on a yearly base. Her family has been trying for years to help her-- but, as in your case, she's smart and otherwise healthy so they can't do much about her refusal to get help.
posted by frumiousb at 5:49 PM on April 29, 2016

This could be me in 30 years. I am not sure about her family members, but artists fucking her over and then denying it sounds pretty par for the course. She sounds like she may be getting involved in some pretty toxic environments that have otherwise messed with her head. I agree that the best step is to make her feel validated even if you think her claims have no basis in reality.

I'd also wonder if she is autistic and perhaps her anger comes from constant rumination/confusion over people's motivations. She may be lashing out over minute transgressions that deeply hurt her without anyone knowing...years or decades ago even! You say she seems otherwise healthy and self-sufficient so I'd rule out psychosis, but perhaps some comorbid disorders. Meltdowns and other presentations of autism can seem like schizophrenia or psychosis but are completely based in just happens that most people don't see or react to that reality the same WAY, thus making the person's reaction or behavior very distressing or confusing.

Again, validate her.
posted by Young Kullervo at 8:50 PM on April 29, 2016 [1 favorite]

Yes, I have been in a similar situation - your story sounds very familiar. I had the person involuntarily committed for a mental evaluation, whereupon they were diagnosed as paranoid schizophrenic.

I second the book "I am not sick, I don't need help."
posted by MexicanYenta at 10:49 PM on April 29, 2016 [2 favorites]

If you really care about her, instead of digging your heels in and insisting that everything she believes is false, you should look for the validity in what she says she feels--guaranteed it's there. The facts you think you've accumulated to refute her claims don't refute her emotions. I know you say you have been respectful to her, but when I read the long post and the follow-ups, I get a very strong sense of your dismissing and invalidating her emotions. If you really want to help, that's not helpful! What might be helpful is looking for the emotional truth she's living in, and sympathizing with it. Also keeping an open mind about the possibility that some of it is factually true as well. Right now you seem to have closed the book on her, and that stance will probably come through loud and clear in any interactions with her.
posted by mysterious_stranger at 5:27 AM on April 30, 2016 [2 favorites]

It is, however, the case that many of her delusions are provably false.
she has never ACTUALLY made these complaints.

Again, this is in keeping with the apparent fact that she is delusional and seems to be surprising to you but seems really standard/normal in the world of dealing with people with mental illness. I'd suggest a bit of a step back and just removing yourself from any sort of fact-checking with regards to assertions she has made as a non-productive way to spend the time you spend with her or assisting her.

As you've said, she's able to live independently and even though some of these interactions are causing her some agitation (whether because of real life things that are happening, or concerns that she has manufactured) it's not going to make sense for you to act as any sort of intermediary short of trying to keep her safe and/or possibly run some interference if there's an actual altercation that occurs. I know it's sort of stressful just sort of hanging around and feeling like you're waiting for things to get worse and something to "really" go wrong, but that's sort of the deal.

If some of the people she is interacting with are friends/colleagues it's totally appropriate to let them know, if they have expressed concern, that you are aware of her erratic behavior (that is, you don't have to pretend that the way she might interact with them is totally normal-seeming to you) and have been keeping an eye on her but that it's outside of your control. It's tempting to want to really run interference for neurotypical folks who deal with your mentally ill family members, but there's really a diminishing return short of being supportive and providing a listening ear. You'll have to assure yourself that no one is going to have their lives ruined because of her allegations.

Until recently we have viewed Lucy as a smart, caring, fiery woman, living a deeply principled life, who had clear psychiatric problems that we couldn't see any reasonable way of addressing.

You said this in your initial question and I think it's basically still true except you know more about her inner dialogue and have tested more of the assertions she's been making about what is happening in the world. She's still smart, caring and fiery but her mental illness may be progressing or you may just know more about it at this point.
posted by jessamyn at 6:26 AM on April 30, 2016

Thank you for the input. We've purchased the book jessamyn and MexicanYenta recommended. Personally, I have had a fair bit of experience/training with people who schizophrenia-related crises and other severe mental illness issues, but this is my first encounter with somebody who is simultaneously dealing with severe delusions, yet also very functional and healthy in other ways. It's helpful and reassuring to hear that this is not an uncommon pattern. Furthermore, it's helpful to be reminded that this latest delusion (which, by the way, has been going for at least 18 months) may not be worse than previous ones - we might just be more aware of it.

The relative who is visiting her today will, as always, be validating her emotions (which we all understand are indisputably real, regardless of cause) and empathizing with her pain, as we have done for more than a decade. I have also periodically reassured her that "the group" has not harmed me in any way, and that I am safe and healthy, because she finds this reassuring. We have been receiving/appreciating the art she makes about this issue for more than 5 years now and we have always taken it seriously. The relative will also be checking on how well she is caring for herself. All of us dearly wish we could we could help her, but she is extremely independent and proud and does not want to depend on others. I have looked up to her in many ways throughout my life - I admire her conviction and principles, including now, and I wish she wasn't suffering this way.
posted by Cygnet at 7:13 AM on April 30, 2016 [2 favorites]

Michelle, disassociation disorders and delusional s are very seperate things, and both are very rough.

I would be concerned about her feelings and about her vulnerability because people who are already delusional there are people who will take advantage of that. They already have a hard time explaining things and outlandish behaviors get muddled in with things that aren't true.

So yes, someone could be asking for art, stealing pieces for sale on the Internet or for their own collection and youwouldn't know because the person doing it isn't going to tell you !

Sometimes the best thing to do is hold someone's hands and listen. Themes are important.

Good luck.
posted by AlexiaSky at 11:56 AM on April 30, 2016

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