Family and Caregiver Schizophrenia Discussion Forum

Are most people with schizophrenia not bothered by filth?

My brother is 55 and lives in an apartment that my mom pays for. She cannot live with him for any reasons. He has a garbage can in his apartment but does not use it. All trash is thrown on the floor. He smokes cigars and the ashes are all over the apartment. He uses the toilet as a trash can sometimes for cups, chicken bones, plates, and then he will poop on top of those things and of course clog the toilet.
My brother has not been medicated for at least 15 years. He recently started on resperidone ( 2 months ago) I know that he has had significant cognitive decline.
But don’t you think something basic like not throwing cups and chicken bones in the toilet is something anyone with a brain disorder should be able to do?
When his toilet is full of poop it does not even seem to bother him. Although he will eventually mention it. I am not sure if this is due to psychosis or is he just manipulating my mom and me because he knows we will eventually take care of it?
What choices do I have to stop this behavior? Could it be voices that tell him to do these things? this behavior is unsustainable and no one can take care of his toilet for the rest of his life. Any advice?

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The answer is no. The disease of schizophrenia is such that when the patient is not being treated for the illness his or her brain is so completely bombarded with intrusive thoughts, voices and delusions constantly prohibiting them from ever being able to access such “common sense” practices and ideals the rest of us take for granted.

I realize many patients don’t even acknowledge their own illness and often refuse proper treatment that would likely improve their ability to function. My son was like this when he was 21. His illness was very extreme and he couldn’t perform even the most mundane daily activities. In addition to that he was a drug user. Street drugs never make mental illness better, only worse.

To help my son, I got legal full guardianship of him which allowed me to control his finances, his health, what doctors he saw, where he lived, literally everything. He didn’t like it but I didn’t care. It was absolutely what was best for him.

He’s 36 today and stable on a sound regiment of medication that he manages himself. He has regained much of his independence but he still lives with me. I still help with some things. He can still get confused sometimes and still needs reminders and redirection, but he is a million times better than he once was. We tried group homes etc and they didn’t work for him. They may be a great alternative for someone like your brother, it all depends on what is available in your area.

You may or may not be able to consider assuming guardianship of your brother, I won’t lie It is a gargantuan undertaking and not for the feint of heart. There are other options depending on your state probate laws. It’s worth investigating. You may be able to take photos of your brothers place and gather evidence of his inability to self care, household management, personal hygiene, money management, his own medical treatment or lack there of. Gather everything and go to your probate court and tell them you want the court to intervene and assign your brother a legal guardian to look after his welfare. That guardian has to report to the court regularly and follow their plan for care.
It may vary state to state. Check it out.

Sounds like your brother is floundering in the throes of his illness and my heart goes out to him, and you. Trust me when I say that in no way is he purposely “deciding” to live this way. He literally can’t help it. Even once treated he will need time to “catch up” to so called normal behavior. I know this from personal and hands on experience. My son would be exactly where your brother is had I not taken over for him so completely early on. I am grateful that the right medications were finally found for him and that I survived all the bad to eventually get to the good. I wish you and your brother better days ahead.

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Hi Catherine,
I appreciate your thorough response. I must give you a little more history though.
When my brother was in his 20’s and 30’s he did take medication but I do not know how regularly . I am only 2 years older than him. I was busy with my own life getting married and having children and I moved to another state. I did see my brother regularly when I visited my parents. He never had issues with flushing the toilet.
Yes his apartment was a mess but not like it is now. He did dress appropriately for a while. Then started wearing the same clothes a lot. I am sure he has had a significant amount of brain deterioration because of not being consistent with meds for so long. He is also much older than your son.
My parents did have issues with the toilet a few times a year, but nothing like what is going on now. My mom has dementia so after my dad died I had to get her an aide.
The aide goes to his apartment weekly and literally scoops poop out of his toilet when it is clogged . Since she started doing this and cleaning up his apartment , things have gotten worse. he comes to my moms house daily and the aide gives him medication. This has been going on for 3 months. I coordinated this effort.
I have control of everything related to him. I pay the rent, he has no access to money, and I have my moms aide basically taking care of his apartment . She also gets him to change his clothes and take his meds. So I do not know what legal guardianship would do for me.
My brother knows how to flush the toilet . he has been doing it for many years. How could he abruptly start not flushing. He should be hearing less voices now, not more.
This is why I think he is doing it on purpose. Yes medication can take a long time to kick in, but when I started being in charge of him after my dad died, he was not doing this every week and he was not on any medication…
I would like to know what you think now that I have given you this additional information.

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OMG! J9sit! I. DON’T. KNOW!!!
It’s crazy stuff right??
I’ve wondered that for YEARS… is it part of the disease? Or is the person just a downright careless absolutely filthy disgusting excuse for a human being? Right??? I mean, I have a hard time believing that the person that I love could actually BE just that gross when he’s not in crisis but MAN! If he didn’t live with me and I didn’t keep the house and remind him everyday to use the trash can and the such… I’m pretty sure he’d be right back to it… and not noticing or caring even! I do have to say he’s better about it now that he’s not in what I referred to as his ‘constant crisis’ years, but omg omg omg I DO know there are at least a few others here on the forum that know EXACTLY what you’re up against because we’ve definitely discussed it in detail in the past!
Oh boy!
Best advice I’ve heard is to actually pay somebody to go in once a week to manage the toilet (chicken bones? Yeah… I’d consider that part of psychosis) or someone mentioned actually installing a certain type of toilet that has wider capacity and a high flow volume to avoid clogging. Good luck to you with all that. It’s a tough one for sure! Drives me absolutely nuts…

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I also wonder if your father passing may have been traumatic and triggering for your brother’s psychosis. Maybe if you could some way have the prescribing doctor evaluate his current state of mind? Re-evaluate meds, even if adding in anti-anxiety meds with the AP for just a little bit? (Honestly, I’m not even sure if anti-anxiety meds or antidepressants can be taken in conjunction with APs or not, but it may be worth asking?)

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Your brother sounds like someone from the show “Hoarders”. Many of those people cant use their toilets due to plumbing problems. Instead of getting it repaired they choose to go in a bucket, etc. One lady stopped bathing and would clean herself with wipes. Which instead of throwing away she piled them up in a mountain in her bathroom. Lots of the people live in total filth. Trash to the ceiling. Spoiled food everywhere. Rats and roaches everywhere. They carve out a tiny nook in all the trash and that’s where they sleep.

Hoarding is classified as a mental illness.

Thanks for the background. Thanks for sharing. Very difficult situation for all involved. I still think that due to the illness and the likelihood that your brother is not on the medications regularly (or possibly not) that his behavior can be due to his illness.

Even though your brother is much older than my son, my son knew how to dress himself, brush teeth and bathe when he was very little but at the age of 21 it was as if he didn’t have a clue how to do those things.

After he had been stabilized on his medications for almost a year, he very slowly started to improve and regain what he once knew. I had to remind him of things especially the order in which to do things because he would and sometimes still does get the order of things confused.

In addition to that you said your father passed and your mom has dementia, by the way I am so sorry to hear this, my heart goes out to you. I wonder what kind of interactions your brother has on a daily or weekly basis. Like does anyone try to talk with him regularly? or try to watch a TV show with him or go on a walk around the block with him? I realize he is ill and maybe not presenting as clean and neat etc but he likely still has needs that even he can’t identify. I’m no therapist just throwing out ideas.

One of my son’s doctors once said that when the onset of illness occurs in a person their brain development and cognitive skills come to a standstill. It takes many years of consistent stability to catch up so to speak.

Perhaps the toilet thing is some kind of expression of anger or frustration, albeit a disgusting one but he might really need attention and has no rational way of asking for it or getting it. I think the best way to help your brother is to find a way to get him stable on medication again and maybe have a home health care aide check on him daily and make sure he is taking medications etc… There are programs that will help with that type of service and make it more all inclusive and focused.

One last thing I wanted to ask is does he see a regular family doctor yearly to get bloodwork etc make sure everything is okay with that?, and the dentist and eye doctor? Sometimes physical ailments even small ones can send a mentally ill person in a whole new direction.

I really hope you find some answers and that your brother’s situation improves. Take care.

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Hi Catherine,
I think you missed an important piece of information that I wrote. My brother comes daily to my moms house. He walks there. I is a mile from his apartment. part of his daily activities ( if you can call them that) are to walk around in the general area of his apartment. he talks to strangers and I think because he has been living in his apartment for 12 years, everyone knows him and tolerates him. Some people even buy him coffee and sandwiches. The main reason he comes to my moms house daily is to eat. We do not give him any money. He has no idea how to manage money and that will never change.
Because my mom has an aide, I use her to take care of my moms needs and my brother’s needs. She gives him medication daily. My brother refuses to see any doctor. I have a cousin who is an internist who is willing to prescribe medication for him and relies on the aide to let him know how it is going. Prior to my father’s death,
my dad was totally in charge of my brother. Unfortunately my dad relied on my brother to take his medication. He would give him the bottle of pills and hope he took it. It is the same cousin who prescribed meds for him then. Without my cousin there is no possible scenario where my brother would go to a doctor. My father tried for many years to get hime to go to one. he did see psychiatrists in his 20’s and 30’s.
I was not involved in any decision making until I inherited my mom and my brother’s issues when my dad died. So I am trying to do the best I can.
My brother has no attention span for T.V. any longer. He used to be much more high functioning. He played in a band, he had friends. He even had a small job in a florist for many years. That was about 25 years ago.
So it seems that maybe I need to wait a little longer for this medication to really prove itself. In the meantime, the aide deals with his toilet and the mess in his apartment. I am just tempted to say to him, guess what! We are not cleaning your toilet anymore. Start flushing or live with it full of crap! it makes me angry that just a year ago he could flush his toilet . Yes everything else was a mess, but the toilet is something that has to be taken care of especially if you rent an apartment.
My brother cannot under any circumstances live with my mom.

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Hi Susan,
There is nothing wrong with the plumbing in my brothers apartment. I have had a plumber there many times already to decalog the toilet because he threw a plate or a glass in there and then pooped on top of it. He does hoard things though. I have read that wording may be one of the side effects of schizophrenia.

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Hi Wisdom,
If you could remember who those people were that had exactly the same problem, that would be great! I would love to know how or if they resolved their issues.

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In the movie “A Sister’s Call” the family member with scz had a similar issue as your brother. I am so sorry that you are having to deal with this particularly unpleasant problem. In the movie they did a lot of calm reminding to help the brother.

On the NAMI forum years ago someone’s family member spat constantly - they said their walls were covered with spit. If I remember correctly they moved him down into their basement - I always wondered if they did it because they could hose down the basement walls.

Wow, good job you on finding an aide that can take care of your mom and your brother.

I do wonder about a medical check up as @Catherine suggested. Yes, yes, I know you said its not possible to get him to a doctor for an actual checkup. It is possible that your brother’s condition is degenerating for some other reason. Historically, most of our family members with scz improve over time, a small percentage stay the same, but you are saying this behavior deterioration just started one year ago?

We didn’t realize my mother-in-law (with scz) had vascular dementia until it was quite far along. Her behaviors had changed, but when people tried to tell us something was going on, we thought they were just seeing her scz.

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You might have to use tough love with him. Tell him you will drop off food to him at his apartment (so he will stop coming to your mom’s house every day). If he let’s his toilet stay clogged his landlord will get involved. These are tough choices but it sounds like you have your hands full with your mom.

Do you pay your mom’s aide extra money to do things for your brother? Also is that legal for your cousin to prescribe medication to your brother if your brother is not his patient?

To be honest it doesn’t sound like it’s a good idea for him to live alone.:sleepy:

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My brother is his patient . My father used to be able to get him to his office every few years. Now with telemedicine he could just call in to see how things are going. So yes it is legal.
Ideally he should not be living alone. But he is very disruptive at my moms house and does not listen to things that are asked of him. This was created by my parents a long time ago and it is too late to change now. Also my mom is 85, and once she passes my brother cannot be living in her house. I would never be able to get him out. He certainly cannot live in a house by himself. I also would need the money from the sale of the house to continue to take care of him.

I see. Well I guess my advice would be to try and get him into a group home. It sounds like you have accepted the situation for what it is. Like the people on Hoarders…it doesn’t sound like he cares about the filth. I know on most episodes the (forced) change comes about because the city is threatening the person with condemning their house and they will be left homeless. Could you speak to the manager at his apartments and tell them what’s going on? Are you afraid he would be evicted and try to live at your mother’s?

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Hi Hope,
My brother has been deteriorating for the past 15 years. It is only in the last year that the toilet issues has gotten much worse.

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The attitude is “I’ll clean up when I have the mental faculties to,” but that never happens, so things just pile up.

I think a good middle ground here is to get a professional cleanup with his oversight, and make his room utilitarian / minimalistic. Nothing extra beyond what he needs. This is a two-person effort at minimum.

I am in similar waters. My room is a mess, but a recent healing revelation has given me the motivation and well-being to actually clean up. I think today will be my clean-the-room day.

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I am sorry that I missed a bit of the information. I admit my eyes aren’t what they used to be and I am in need of new glasses but with the pandemic everything is on hold.

It does sound to me like you are doing the best you can under the circumstances. Our lives become so extremely complicated when we have a loved one with schizophrenia. Nothing comes easy if ever.

I hope the toilet situation gets better with time. These medications do often take quite awhile to reach full efficacy. I wish you and your family better days going forward. Thanks so much for sharing.

How are things going? How are you doing?

things are the same. They are basically ok except for the toilet issue. I have 2 choices,
just continue to let the aide deal with the toilet OR tell my brother that we are not going to continue to fix his toilet and he needs to flush it and stop putting things in that do not belong.
I do not live in the same state as my mom and brother so I do not see or speak to him on a regular basis.

My daughter, who has medication managed sz, now works at an assisted living facility. She’s been there 3 months now, over 30 hours a week, as a housekeeper, maintaining patients’ rooms twice daily. (In 2016 she was psychotic, and unmedicated, so she’s come long long way thanks to 2 years on a working anti-psychotic.)

She tells me there are several folks in the assisted living facility that have pooping problems. The aides and housekeepers have to clean it up daily. One man just stands near his toilet and poops on the floor every single day. Another man gets his business all over the toilet seat every single day. One man walks out of the bathroom naked from the waist down with runny poop going down his legs and across the floor. These are not disabled people, not super elderly people, they just cannot care for themselves and are lucky enough to have funds to live in an adult assisted living facility (not a mental health facility).

My daughter has learned to laugh about it, they cannot, are not able to, change their behavior. I think it speaks volumes that she can talk about it, laugh about it, and keep going to work and cleaning up after filthy patients.

I don’t think your brother is able to be any different than he is. It’s a shame. But the right medication may lead, in time, to a much better world for him. It is true that he may also have other things going on physically that affect his decision making ability, but the past 15 years of his being unmedicated for schizophrenia were probably very hard on his ability to look at the “real” world. I doubt he sees his apartment the same way you do.

By the way, my daughter no longer takes daily showers or even twice weekly showers, her pretty hair is usually greasy and stuck to her scalp, she wears the same clothing at home almost continually, her room hasn’t been cleaned in a year, and she doesn’t seem to notice.

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