Examples of "listening" to delusions

My son’s delusions are that his neighbors want to kill him and are recording him, talking about him, etc. He also thinks they follow him under the apartment and play alarms as he moves from one spot to another to get back at him. Today he told me that he might have to go downstairs and address it with them and that “one of us may end up being killed.” I understand we are not supposed to argue with delusions - we are supposed to listen empathetically. How do you all do that?? What exact phrases can be used?

Hi Caringforhim,

You need to place a call to your Crisis Intervention team, mental health officer or regular police right away. Tell them what your son said. This is a threat to the safety of your son’s neighbor’s life.

If your son will talk with you, go and get him - is that possible? Use LEAP to suggest he go with you to the hospital and tell them his concern about his neighbor. Or have him call the police and tell the police himself and ask the police to come talk to his neighbor and check out his concerns.

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He’s had these delusions for years. He doesn’t ever harm neighbors but instead makes noise to bother them (music, games, yelling) and smashes up his own apartment. I’ve called the police over this in the past and since he hasn’t threatened imminent harm to neighbors (he thinks they will harm him and he has taped pointy objects on himself in case they try and get him in his sleep for example). He’s had 4 hosptilzations and the longest was 18 days. It’s very traumatic to go through the police as each time it makes him more fearful and paranoid.

Does moving him help?

My son “resets” after a move and usually has several good years before needing to move again.

It used to help when he moved for about 6 months each time. But now he’s been at his new studio for only 3 weeks and paranoia happened immediately so things are definitley getting worse. So many considerations - if I call police and he gets admitted for another short stay he might refuse to return to his apt because now the neighbors will know he’s “crazy.” He will end up homeless because although we’ve always paid the rent he’s got so many complaints by other tenets. It seems like problem with no solution except completely giving up and letting the world give him consequences and maybe he would start taking medication.

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Just a few thoughts…

  1. encourage him to go out for long walks, or jog, anything to take his mind off the neighbour
  2. someone to spend time with him in the apartment, a sleepover from time to time maybe, eat a meal together, if that person is one he feels safer because of the presence
  3. adjustment in the medication perhaps

I am usually at a loss to explain to my daughter regarding her delusion. She can recognize hearing voices, but is unable to differentiate less obvious ones like people stalking her. It is probably because those conditions have developed over a longer time and it’s not something that I can pinpoint and explain away. Most of the time, I just have to settle for agreeing to differ and do what I can to alleviate her situation.

It’s hard, and I wish you the very best in your endeavour.

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Another long shot that came to mind is to have a pet. It distracts the focus away from the neighbour and provides companionship that enhances the feeling of safety. Apartments may not allow pets, and also there may be a risk that a pet may not work out. To mitigate, I am wondering if there are organizations out there that lend pets to aged care and disability settings that there may be something similar to explore for your son.

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@Chong is really giving excellent suggestions. Having a pet has helped my son immensely. Agreeing to differ and trying to figure out how to alleviate the situation works as well.

In this circumstance, with my son, I would have used the opportunity to “partner” together with him and get him to report the neighbor to our mental health officer. Our circumstances are different, I waited for years for my son to say such a thing to have a chance to try forced meds on him.

My son is quite attached to his current apartment. The landlord threatened to non-renew him if he didn’t stop yelling and banging on the walls at his neighbors. He likes the current apartment so much he stopped the behaviors. He does take walks or long bike rides as @Chong mentioned.

When I visit I have not noticed any damage to the apartment - he really likes the space.

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This (a pet) can be really helpful. My son has Guinea pigs in a cage near his bed and he finds them comforting.

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Thanks for all these ideas! The one that might work best for us is taking a walk when the weather warms up. I wouldn’t trust him at this point to have a pet because he doesn’t empty trash (to avoid the neighbors). He likes going for a drive with me far from his neighborhood.

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Could you build an accessory dwelling unit (ADU) on your property? If you add up rent costs over many years it might not be much more expensive.

You could then constantly use LEAP techniques to get him into psychiatric care and on an AP medication like clozapine or olanzapine, which is the only solution.

You son’s delusions are similar to those I had while florid, but in my case I thought I was being surveilled by the FBI. Per going on walks and car rides, these are good distractions. Car rides have often been mentioned on the forum as a uniquely suitable venue for dialogue— my theory is it’s hard to imagine how conversations might be overheard while driving.

Paranoia is a form of hyper vigilance and too much time cooped-up in the same place tends to make the mind wander to possible threats. I liken the experience to waking up in the middle of the night to a noise and your imagination running wild that it might be a burglar, or some other form of predator— human or otherwise. I found my paranoia lessened while I was on walks or at work or school.

Not that I was symptom-free outside the home, but each place had its own paranoiac milieu where delusions were accordant to context. So fixations were diluted by not staying in the same place too much and allowing them to fester.

Companionship or occupation of all kinds can distract from paranoid thoughts, if keeping an animal isn’t feasible, then visitors— perhaps who might bring their animals might help. For example, my parents didn’t have any animals when I first became ill, but I’d trained a neighbor’s cat to cross the street and come visit me on the porch. Later, when I had an apartment of my own that didn’t allow pets, I’d visit my hairdresser’s house to visit the family cat and accompanied her and her mother on visits to cat shows, etc.

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Per “listening” to delusions, I want to make a distinction which can be missed when attempting LEAP. You are listening and empathizing with your son who HAS delusions. You’re empathizing with his experience and trying to understand how they work and what they mean to him. When you approach your son as a bag of delusions to be dealt with rather than a person first, you may unintentionally frame the situation negatively.

You ask reporter type questions about the “factual” part of his experience (who, what, where, why, how) without drawing conclusions or making judgments about his “facts”— that’s the listening part. You empathize by making conjectures as to how these might make him feel, and ask if he agrees with these assessments.

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MB, so glad you mentioned this sort of questioning. I have found it to be really helpful with my son. I do have a question for you about something they taught us at Family to Family.

Example: My son once told me about a man talking to him while he was putting on a green at the golf course. He said the man had surprised him. My son readily answered my questions. He was unable to describe the man’s features or clothing. He didn’t know where the man had come from and he didn’t know which way the man went when he left. I didn’t respond as though any of that was unusual. In Family to Family they told us that one way to tell if our family members were describing an hallucination would be a lack of details. Do you think that is true MB?

From accounts of visual hallucinations I’ve heard, this may be true to some extent, but I’m unsure I’ve experienced visual hallucinations aside from migraine auras and imagery in dark rooms before and after sleep (I believe there’s a word for this phenomenon that escapes me now). I’ve heard accounts of “shadow people” on the edge of vision or faceless figures, and the most cogent I recall are from Elyn Saks’ memoir The Center Can Not Hold

My personal experience is largely with auditory hallucinations and delusions. Here I find the opposite appears more common. Excessive detail and elaboration seem more of a tip-off of symptoms, rather than too little. I think this may speak to differences in the nature of perception and interpretation of thoughts and sensory data.

We’re accustomed to filling in the blanks in narratives (internal or external) or missed or misheard words or phrases in conversations. This happens frequently even among the “well”. I feel we’re less disposed to this in visual media because these perceptions seem more concrete. Given ambiguity in a visual situation, I think we’re more likely to question ourselves and either not commit to seeing anything at all or asking for consensus from others instead of elaborating. (Clarification: this is speaking from a general perspective— diagnosed or not)

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Thanks for the response, I should have specified that the Family to Family statement is in regard to visual hallucinations.

I know from past observation that my son does see, and speaks, with visual hallucinations of people. Those moments he has not mentioned to me at all.

Another time he called upset because someone had tried to enter his car at a stop sign. He wanted to know if he should report it to the police. I questioned him and there wasn’t a single detail to describe the person or their clothing. He was satisfied when we concluded that “he hadn’t gotten a good enough look at the person” to make a report.

Sometimes, thanks to our LEAP process, I think he uses me as his cognitive questioning bounce board.

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I try to ask questions to see why he thinks that…and if possible direct the thoughts to more likely scenarios. I would probably get DNA test and try to get on a medication that helps this if possible. As it could get dangerous. When my son was hallucinating things like this or other I didnt know exactly what he thought, but he would lash out, and think I said really mean things to him and put up his fist to fight me. He then tried to kill me 3 times. So, he hasnt been thinking like that since we changed and were consistant on medicines.

This is something I’ve thought of! I don’t own any property and am close to retirement age but have thought of buying a super cheap place in the middle of nowhere with a separate area for him. I’m so tired of worrying about landlords, eviction threats, police … .

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I think that is a great idea @Caringforhim . I am my daughter’s landlord and it has worked out well. Originally she had her own separate studio apartment in the back of our house, attached to our home but split off with a locking door between our areas. We built a back door from her room to the outside, a mini kitchen in her room and a locking hallway door to close off her bathroom and room from our home. It was built mainly to cut down the screaming noise at night and to help stop the police from needing to come to our home so often as she was paranoid about my husband (her step father) and they used to call the police often on each other.

But after going on medication 3 years ago, the hallway door is always unlocked now and she is a joy to live with. Either way, the separate living space in my home saved our relationship.

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How do you listen empathetically? Of course, you don’t want to agree with the delusion but you could relate to him as far as how it makes him feel. “That must be scary.” OR “How does that make you feel?” Dr. Amador doesn’t ask a person to agree with the delusion but focus on what you could agree with the person. Maybe say “Does this sounds like a good idea?” about going downstairs and confronting the neighbor OR “What can we do that would be make you feel safer?” My daughter needs to know she is safe and that she has someone who is there for her. It is so important that you son has a therapist that he can talk with and feel safe. May you be wise and caring as you come alongside your son.

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