Can he stop doing what voices tell him?

Family
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Hi everyone,

My boyfriend of 14 months has confessed to me tonight that the reason he says hurtful things to me during arguments, and does things he knows hurt my feelings is because the voices tell him to. He’s said out of the blue he should leave me, that he doesn’t have strong feelings about me (followed by laughter), that I don’t understand how he feels (I’m not capable) and that being alone is more important to him than me.

He says they tell him if he moves in with me or progresses the relationship then something bad will happen and he will die, he has to be alone because he’s disgusting and evil, and that I will never understand him or his illness.

He says at times he isn’t sure if the voices are real or if what they say is right. He’s been on clozapine for over 10 years with no hospitalisation so I am unsure if he’ll ever get any better.

Obviously this is a tiny part of what’s going on day to day. I have another post but think it was too long so got few replies. Things have got worse since I posted.

Is he stable enough to be in a relationship?

Should my safety concern me?

Liz

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Hi, so very sorry for what you are going through right now.

I answer your questions based on my many years of experience as a full time caretaker for my own adult son (now 34) and my interactions with other mentally ill family members in my family.

I would say that although you say he has reported to you that he has been on clozapine for 10 years now, I would question the truth in that for several reasons, #1) is he accurately reporting how he feels and the voices and other self beliefs to his psychiatrist (many patients do not)? I would guess not because if he was his psychiatrist (if he is worth his salt) would have made med adjustments accordingly.

While his voices are active he is truly out of control of what he thinks and how he behaves because of what he thinks. This is the nature of the illness.

Typically, clozapine is a drug choice of last resort-prescribed when all others have failed and often (but not always ) has the best outcome for reducing voices and delusions over time. It has worked well in that regard for my own son.

Either your boyfriend is not on the right dosage or it simply isn’t working for him anymore or he says he takes it as prescribed and he actually doesn’t.

Clozapine legally requires monthly CBC blood draws to check the white blood cell count so there’s that. Perhaps he has mentioned that?

2/ If he is not stable and by your descriptions of what he has said and what he believes and the presence of active voices -He is not stable right now. That fact leads me to say that this is not a good time for a relationship (or moving in together) where he is concerned. I am basing this only on what you have reported about him and what I know of those things personally in my own life.

Maybe he has “muddled by” okay before he met you -before he was in a relationship at all or maybe it was just a case of there not being anybody present daily to observe his illness up close and personal, no checks and balances so to speak.

Now you are in the picture and you can see things clearly and for him regardless of how sweet or kind or loving you are toward him …being in any relationship for a mentally ill person is full of stress, stress can come from both and good and bad events in life…many people with mental illness do not and may never possess the tools to deal with or cope with added responsibilities that come with adult relationships. There are the rare few that have the insight and cognitive ability to conquer that with the right treatment and support but it is not the “norm”.

Do you know his family?-does he have any and if so can you talk to them about you’ve learned so far from him? Perhaps even they don’t know the things you have discovered about him. Maybe they can help him get on the right path?

My best advice based on what you’ve said so far is no he is not ready to be in a serious relationship while he is still unstable and maybe you can remain friends in some capacity, maybe encourage him to tell these fears to his psychiatrist, maybe even consider writing a “letter of concern” to his psychiatrist if you know who he or she is.

Of course the psychiatrist cannot share any personal details of his or her treatment protocol with you but it may alert him or her to ask your boyfriend more probing questions at his next visit and perhaps monitor him closer.

I would reduce your boyfriend’s stress by saying (if you choose to) that you have heard what he has said and thought about it and it is fine to remain just friends if that is better for him, and that you can hear the stress and anxiety in what he saying and that you only want the best for him which I am sure you do. I am only making a suggestion here.

If you decide to take the friendship route and you don’t even have to do that if you don’t really want to. But if you do I would highly recommend contacting a local NAMI chapter if you have one. They are a wealth of knowledge, referrals and free peer support classes that help tremendously for someone new to all of this. Here is a link: Family Members and Caregivers | NAMI: National Alliance on Mental Illness

What ever you decide will require careful thought and consideration, pushing for a seriously relationship right now as things stand will undoubtedly throw you squarely into a “caretaker” role which if it can be avoided I would before you are married or with children. Even the most enthusiastic person ends up drained, depressed and depleted throughout the process and there is no guarantee of a successful end to the care taking, sad to say. There are also some studies that point to mental illness being in some cases a genetic disease although there are many other factors that play a role in becoming active in anyone’s life.

I wish I had happier answers but I am all about being honest because anything less is not helpful. I wish you and your boyfriend the best going forward. Take care of yourself, and yes take his threatening fears seriously, he may not be able to control any of it in his state of mind. Try to remember his words are not really personal even though they feel very personal, they are yet another symptom of a very serious mental illness.

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He told you what he is experiencing and what he needs and wants.

The more ill a person becomes, the less they can tell the difference between reality and hallucinations. A psychotic break is when they cannot tell the difference at all. At that point, they don’t know what is happening in reality and the voices might be in charge. When a person is more stable, the voices can be managed, coped with, and disregarded.

I think your biggest concern right now should be for yourself, not for your safety necessarily since people with effectively treated serious mental illness are as dangerous as the general population, but for your own happiness (knowing that men in general are the largest danger to women in general). He is communicating very clearly with you that he doesn’t want a relationship.

My advice would be to accept and respect his choice. When you feel ready, take your caring, wonderful self into the world again to find a romantic partner who is ready to relate in a way that enhances your life.

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You might want to recommend that your boyfriend check out the other side of this forum, for those diagnosed with schizophrenia.

If he reads up there, he will learn that doing what the voices tell him to only makes hallucinations more debilitating.
That interacting with hallucinations makes them more present, not less.
He may also read up on how much of a profoundly good impact having a primary care psychiatrist, medication and a treatment plan makes.

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Thanks so much for all of your responses - in particular Catherine, your wise words have made such a difference, you’ve really reassured me about what I am going through. It was the truth that I wanted and I thank you so much for giving that to me. Your insight was just what I needed. I very much needed someone to be clear about how serious mental illness affects functioning in a relationship. I seriously didn’t know if he was deliberately letting me down or not at times, but that’s partly because of things I didn’t know about his symptoms.

After basically 2 days discussing his voices and delusions, we split up tonight & went separate ways. He left an hour ago. The loss of someone that I had so much affection for has devastated me. The choice was based mainly on him obeying voices plus the fact he isn’t willing/isn’t able to to maintain the relationship, plus partly on friends & family input. I had a conversation I had with the outreach team in our area earlier today. As he is a service user they obviously had to be impartial, but they did indicate to me that he wasn’t stable and I had reason to be concerned.

I have decided to stay friends with him. I am genuinely concerned about his welfare. Time will tell if we can maintain a friendship, I don’t know how I will feel about this in time. I know much of what’s happened isn’t his fault but it has caused me a lot of emotional distress.

I have recommended the forum to him so thank you Wreklus for posting the link.

Re: medication and treatment - he is on clozapine and does have regular ECGs and blood tests. I do believe he takes as prescribed, but - I know he hasn’t been discussing the voices with his therapist. He tells me that the voices have been controlling him for a long time and that he hasn’t been honest about it. He says it’s because he feels he needs to deal with it alone. He also says he believes his diagnosis isn’t correct and that it must be “something more”.

I believe the outreach team may have made a clinical error with his clozapine dosage based on his outward presentation… He does not self harm physically. He does not behave impulsively to any obvious level. He is high social functioning. He does not generally verbally express anything of a disturbing nature. Therefore he presents as much more stable than he is and I don’t believe the therapist would know otherwise unless told. He has managed to get me to believe for over a year (whilst living together 24/7) that his symptoms are manageable and he knew that the voices weren’t real.

I know his family quite well. I don’t think he speaks to them about his symptoms at all. I have known him since I was 17 years old although we only started a relationship recently. I didn’t know prior to the relationship any details about his mental health history. I knew he was troubled in some way but not about schizophrenia. I will be speaking to his mum at some point about the situation.

I have a 12 year old child who doesn’t know about his illness and now never will - the fact I am a mum has also had a big impact on my decision. He has never behaved in a way where I had to explain his mental health issues to my son. I am grateful for this.

Thanks so much for all your help,

Liz

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There are goose bumps running down my body, in relief for you, that you have decided to break up. I am soooo sorry for your loss of someone you care about, you will always care about him, especially if you were childhood friends who connected in a relationship as adults years later. But you cannot save him from his delusions, hallucinations and persecution.

It is simply that he told you he should leave you, doesn’t have strong feelings toward you, and that something bad will happen if you move in together, that you must respect how he feels and end the relationship. I wouldn’t even pursue active friendship unless he calls you. As you stated, “being alone is more important to him than me”. Give him his space and leave him alone, until, unless, if maybe he reaches to you for a friendship.

It is very, very good that your 12 year old will never be living with a man as ill as your ex-boyfriend. My sons had a hard enough time adjusting to a step-father, let alone to someone on medication who is still unstable.

I do understand how someone can present to others that they are well. My daughter can do that at times, and did it for years until her voices basically took her over and she can’t control them anymore. (She refuses treatment and medication.)

Unfortunately for you, your boyfriend, as an adult, has the right to be mentally unstable if he/she wants to be mentally unstable. He has chosen for years to not be honest with his therapist/doctor. To me, that is the biggest red flag, and the reason why as a total stranger, I feel that this breakup is good. Dishonesty is never going to be a good basis for a long relationship.

It is a problem for many of us on this forum, if not all of us, we want so badly for our loved one to see their illness and get treated successfully, and our hearts are broken over and over by delusions/hallucinations aimed at us or other loved ones.

You and your son deserve much better, I can tell how big your heart is by how much you care despite the hurts you’ve borne from him. Leave him be, perhaps he will realize that he is lonely for you and become honest with his therapist, perhaps not… but you must make a new better life for yourself and your son.

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That’s a really hard decision.

But I agree that you made the right one.
You deserve someone who is focused on providing good times, security, a hopeful future and fun. Not chaos and negativity.

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Thanks everyone. It’s one day since the break up now and I’m still left feeling very disturbed. I have spoken to him via text today and spoken to his mother on the phone. He has apparently told her that he knows he needs to be more honest with his therapist. He has said the same to me.

I’ve had a friend tell me today (contrary to all advice on this forum) that that his therapist wouldn’t think that obeying voices was a problem, if he’s not doing anything strange. She said that ending a relationship isn’t strange behaviour and so that wouldn’t be a concern. Surely it is strange behaviour purely on the basis it’s been brought about by psychotic symptoms? Isn’t she getting this backwards? Surely it’s the fact someone is obeying the commands that’s the issue from a clinical POV?

I have tried my best to concentrate on myself but I’m worried because I’ve been drawn into text communication with him already about his mental health. He says it’s helpful and he needs my help. But if he needs my help then why has he treated me so badly? I’m worried he’s not as helpless in all of this as he claims to be. Every time he hurts me he gives guilt ridden apologies almost immediately.

I’m thinking this means he knows what he is doing.

I’m wondering if what someone said about “he is free to choose to be unstable if he wants to be” is completely correct. At this point I’d feel so much better to think that he was - it would actually make it less painful and I’d feel less inclined to want to help.

Is he choosing to do what the voices are telling him, because if he is he’s still responsible right?

Liz

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@lizzy1984 Liz, WE cannot choose our parents, many have been brought up by parents with mental illnesses that caused them anxieties, trauma and diseases… WE cannot choose our siblings, many have brothers/sisters with mental illnesses and we love them very dearly and it’s one of the most difficult things some of us are going through to see our parents, siblings and many people here have their sons/daughters go through pain of mental illnesses… WE cannot choose our families and many of us try to help them as much as we possibly can although the journey for some of us is the most difficult ever… The journey of mental illness is length of our afflicted ones lifetime, can’t you see that? Read about its duration please, do you want to sign up for that willingly? It’s a sad journey for some families/caregivers and some of us need therapy to be able to do that…

What I am trying to say is, now please realize that you DO have a choice here, don’t be in a relationship with him, leave him in a very kind respectful manner and live a full joyful life and focus on your happiness and your own child’s! Your child doesn’t have a choice to live a life with this and all what it entails of hardships if you insist on having this relationship. I do believe that afflicted people with this illness wish to love and be loved but it goes back to their personalities and the level of their illness and if they are medication-compliant and are functioning then yes, maybe they could be in a loving HarmLess relationship? You already have you and your own child to take care of your mental and physical health and maybe find one who enhances it… it is up to you.

That’s my view with my LIMITED knowledge.

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I already have left the relationship if you see my earlier post - I’m just looking for closure which is natural.

Liz

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@lizzy1984
Sounds like you have a friend who isn’t being very supportive at the moment.
It’s strange for a friend to suggest you get back together with someone you -just- left. Especially by excusing the behavior that led to a breakup.
Remind yourself that your happiness, security, comfort and fulfillment are extremely important and anyone that discounts those things isn’t a good influence.

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Many (roughly 60%) of our family members with scz suffer from the symptom anosognosia. Anosognosia is frequently called “lack of insight”. Anosognosia prevents these family members from realizing they are suffering from a brain disorder.

The simples way to think about it is that they are too sick to realize they are sick.

Some do gain “insight” when they are taking meds. This insight can be lost again as the disorder progresses or if they decrease or stop taking their meds.

Scz is a disorder that cycles, anosognosia can cycle as well.

Can a person possibly be “choosing” when they believe the voices are telling them the truth?

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I have some more input on the two points @hope was mentioning.

There are many good examples in the “I’m not Sick, I Don’t Need Help” book that show what it is like to suffer from a delusion or hallucinations. One example would be walking into the wrong home, thinking it is YOUR home, the person in the home is trying to tell you you are in the wrong home, and you just are positive this is YOUR home, and you don’t understand why your mother is telling you to leave (it isn’t your mother, and it isn’t your home). No one can talk you out of the fact that it IS your home, even though it isn’t. Eventually, the police are called to take you out of the home… So, a person can’t really choose to obey or not obey a delusion, they might be able to NOT do what a voice says, if they disagree with the voice, but they will still hear the voice making demands. Unless, until medicine might turn off the hallucinations (voices), and even then delusions (strange beliefs) might remain despite medication.

Per several doctors I’ve talked to, usually a person with sz will not take destructive actions just because a voice says so IF they can disagree with the voice. I hear my daughter arguing with her voices on a regular basis since she talks out loud. It is weird to me, but I am happy that she can argue with her voices, and try to resist what they say. She has been offered many times the opportunity to see a doctor and to be medicated, but she chooses to be un-medicated. Since she is an adult, and Florida does not have laws to force a non-dangerous person onto medication long-term, she has the legal right to be un-medicated.

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Hi Liz
I am so sorry to hear of your experience and all the questions you have. The replies yuo have received are great. Like Catherine, I have a son (now 32) with schizophrenia. I was so hopeful for long term recovery at first, but he has slowly become more and more ill and now adds to the difficulties by using marijuana. It’s not clear whether once effective medications still work or whether the problem is the marijuana, but he is back in hospital now, taken there by the police due to his public behavior. He may face charges - again. It’s terribly sad. He completed his engineering degree when the medication worked and he was supervised, but all that is now just a memory.
Marriage is often a tough road even with a regular man. I could never suggest that you should take such a risk with someone who tells you that does not want a relationship and especially if he is mentally ill.
I do hope you find happiness. I can only say that I have learned that mental illness is a very terrible thing and I hope that science will one day find an answer to free all those who suffer so much.

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Thanks everyone for your replies.

Firstly I’m still adjusting to this break up and being left feeling like I didn’t really know the person I was with, has added another dimension to the grieving process. I didn’t truly understand how much this illness affects the personality until it was too late. Also my ex cannot process what impact this has had on me & my son I don’t think.

My ex has taken steps to contact his therapist and to try and get more help for himself post split. He has expressed regret for what’s happened. I do think he understands that his dishonesty about his symptoms is damaging. That has to be good.

I appreciate the clarity people have given me in how “insight” into the illness can come and go over time for various reasons and also how achievements/progress can quickly be undone with a relapse or breakdown.

Re: my friend who said ending a relationship wasn’t odd behaviour, I meant she thought it wasn’t a concern to a mental health professional. Not that it wasn’t a concern to me.

My life has progressed in the year I was with my ex & I thought it was joint progress. I’ve now realised that it was just my own, in that he had no grasp on what any of it meant as he was so deep in psychosis. What I was excited about he just found stressful. He participated but wasn’t truly present. He’s now returned to his life exactly as it was before we met. There has been no change ultimately for him. I find this tragic but if that’s what he truly needs so be it.

At so many stages I’ve felt guilty for loving someone with a mental health issue - many have implied it was irresponsible of me and that my pain is my own fault in the end. Maybe it is.

Liz

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What?? Love is a special thing, and it is not irresponsible to love someone. It is always painful when a relationship doesn’t work: as the song said long ago, “Breaking up is hard to do.” I’m sorry for your pain.