Hiding symptoms

One thing that blew my mind during my son’s first visit with his pDoc was his ability hide almost all of his symptoms. He was able to carry an conversation that was not only lucid, but also highly intelligent. When he is alone or with us, he acts in a very different matter.

Is that common and how it is possible?


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My son does that all the time. I don’t know how common it is - I do know that a county agency by Galveston, TX has a psych evaluation that takes 3 hours, supposedly for this very reason. I know my son would be hard pressed to pull it off for 3 hours. He can suppress his symptoms, but, it’s very tiring for him. He refused to do the testing in Galveston when his job referred him years ago.

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Yes. Unfortunately it is VERY common.

Unless they are decompensated and or actively avoiding treatment and medication, anosognosia which is a symptom characteristic of Schizophrenia, means a patients inability to perceive their own illness, also includes wanting to hide that illness.

I will play devil’s advocate for a moment. Being sick and finding out that your delusions both positive and negative, are not safe nor as helpful as you thought they were is a horrible let down for the patients that some never come to accept. (i.e your paranoia and job loss was your own fault. Your boss didn’t hate you and they weren’t working for the government. That was the patients delusion that eventually got them fired. I.e they never expressed or disclosed those feelings and simply walked off/ stopped coming to work of their own volition.) The highs can feel great and the lows and conspiracy can be bad enough they truly feel if they let other people know it will be dangerous to themselves or others.

The most responsive patients are usually ones who are so afraid of the negative parts of their delusions that they will take any meds in order to make them stop. A family member is in the latter category. She valued being present for her children and NOT being afraid of the devil raping her children to death enough (her own description of her fears/hallucinations) that she sought help right away. Patients who are resistive to communicating those ideas or feelings are difficult to deal with. Acknowledging you are sick in this way means there can be significant short falls in how, when, and where you live life. Being on medications and needing to see a doctor regularly is hardly fun.

Taking care of themselves (or perceiving they haven’t been) is a mortifying and sometimes disgusting thing to come around to, in some of the lucid moments. They may or may not be able to live by themselves because their delusions are so pervasive. They may or may not have the ability to communicate with others they are so terrified of what they see or feel. They may feel justified in keeping their own beliefs and delusional systems because they believe they are true, not that there is any basis in that reality. Not when everyone else can reason or see that they are wrong. No one likes being wrong, least of all someone convinced of their own ideas, sane or not.

If your family member will verbalize what they think/feel/ or hear, it’s worth reality testing, which is not going with their delusion, but proving that whatever they are thinking is going on or feeling, (like that there is a man in the corner or something) is not true. On this end, animals can be helpful, so long as the patient can discern that the creature is calm. One of the rare but few times my brother acknowledged our cat (aside from trying to imbue him with psychic powers) was that he would do nothing while the delusion was supposedly hopping around the corners or waiting in spaces that the cat currently occupied. Unfortunately this doesn’t always work. My brother hurt our cat thinking he was saving it and we ended up having to give her away (to a good family who let us visit, at least). But sometimes it’s worth a shot. It depends on how communicative your family member is about their symptoms.

My brother’s were varied and somewhat changing. (although his delusional states always came, no doubt about it.) The biggest issue was making him talk. More often than not, his voices would tell him to stop talking to anyone either to the point of completely ignoring us or any people sent to help, or he would run away. He basically vacillates between seeming like a child to becoming and overgrown, ill-kempt, and terrifying bully. That isn’t ALL of his personality or most of it, but it is the largest concerning characteristic which meant he could not and truthfully should not, have been living with us for nearly as long as he did. Most of what you will be doing at visits is trying to establish a patients trust. He was obviously, or hopefully, referred via ER or from some other outside source who could claim he had altered mental status. As an outside family member, the care provider’s will believe you, but they also have an ethical obligation to respect patient wishes as often as they can engage with their own treatment and care plans. Anosognosia makes this VERY difficult.

I’m not adding this to suggest your situation is like this or will even become like this, but it is worthwhile to think about. An irrational mind can rarely come to rational conclusions unless pushed to the point of death. This is why I’ve met homeless, obvious MI patients, that are so hungry they eat paper. They dig through garbage cans and steal plastic bags to make shelters, they throw “Changes to the winds and signs” whatever that means, they’ll wear no clothes or clothes that are too hot for the weather, If you’re lucky they’ll listen if you ask them to put something on or take it off. Somehow, despite how disordered they appear once you finally get to talking or listening to them, you realize they survive through sheer base instincts. Ones that can be overridden by the delusions in their brain.

I would look up your state provisions for involuntary commitment, as they can include risk of harm to self without suicidal ideation or threats to self harm, if your family member cannot care for themselves. Health Care Providers and Judges are extremely reluctant to inform the public about this as there are genuine concerns about abuse. However, the majority of patients can manage to keep their symptoms in check long enough to survive a doctor’s visit OR to actually prove they can keep it together, but only with an extraordinary amount of will power.

This isn’t to say that a patient can magically get rid of their own illness, but that to a limited extent they may be able to discern between their delusions and behaviors (not fully releasing those ideas) but without treatment medication. The difficulty with this route or thought is that many, and I would hazard to say most, patients don’t have this degree of insight OR only manage the functional state long-term once they find the right meds. It is a night and day difference.

Sorry for the mini rant. I hope all goes as well as can be hoped.