My sister has been writing these unusual things in her notebook that are scary and make no sense. For example, she says that her family was killed by imposters for money and that her family are now those imposters she has been having this delusions for months now. She was diagnosed in March but was experiencing these delusions since December 2019. Right now she is taking abilify 5mg, will these delusions last forever? I thought the medication was supposed to help take these delusions away.
Drugs work largely on symptoms and communication within the brain, so disordered thinking and hallucinations are usually first to improve. While she may have fewer new delusions and less elaboration on existing delusions, they may persist or gradually fade. This is from my own experience and observations of my brother’s delusions. Negative symptoms take even longer to fade, and often very little or none at all.
To help you understand this, I’ll use an analogy. It likely won’t fit perfectly— my intent is to help you relate to what your sister is going through by way of experiences you’ve shared or observed.
Let’s think of a delusion induced in most children: belief in Santa Claus. With most kids this fades over time— it’s rarely an on/off switch. Doubts sink in over time, or older kids will tell them, some may tease them for being babies that still believe in Santa, yet they snap back to believing out of fear they’d no longer get presents if they don’t believe. They may feign belief (or disbelief) for social reasons like to avoid teasing by non-believers or not wanting to disappoint their parents or younger siblings by killing the magic, etc. They likely have a large neural network reinforced over the years by stories and emotional experiences related to Santa and it doesn’t get reprogrammed in an instant or overnight. It takes time to wear down all the associations and memories and reintegrate what Santa now means to them. For example, I remember finding a price tag from a local store and showing it to my parents and before they could explain, I said “I guess Santa shops there too.”
Now you may scoff at her delusions and devalue them, like a child who wasn’t raised to believe in Santa, but they served various meaningful functions for her and will take some time to fade. They explained her hallucinations and aberrant thoughts. They made her feel special and accomplished that such remarkable things were going on and she was able to figure them out like an ace detective. They kept her occupied and focused when many other things in her life weren’t going well. They also kept her company, when other people seemingly abandoned her or misunderstood her. You have to ignore that the delusional behaviors caused many of the problems they solved, because for her (like Santa) they seemed very real.
Not many kids grow to adulthood continuing to believe in Santa, but some developly disabled adults do, and SZ is a brain disease that does visible structural damage to brains. So it follows delusions may persist. However, your sister may also realize that there’s a social cost to sharing them, so she won’t mention them or write them down in a hidden notebook, perhaps even coded somehow to protect from prying eyes.
My delusions faded over time, and I tend to think of them as alternate unproven theories of my experiences. I don’t know whether they are true or not, and they felt very true to me. But through medication and talk therapy what was vivid, compelling and all consuming have diminished in importance, but the memories haven’t vanished and there’s always the possibility they may return, similar to people’s memories of waiting up for Santa or putting out cookies or what have you. And these memories are so strong that generations inflict the same delusion on the next to share their value.
Personally I have a strong opinion that delusions will be especially hard to shake without talk therapy or CBT of some kind to put delusions in context and extinguish delusional behavior. This may be why for some people ECT can be helpful, I don’t know. I just think handing someone some pills and expecting similar miracle technology to The Eternal Sunshine of a Spotless Mind is wishful thinking. Recovery is hard work and takes years of steady improvement.
Edit: To be clear, I am an advocate of anti psychotic medication like Abilify. However, I feel AP medications are incomplete treatments for all SMI and supplemental CBT or other supportive talk therapies are helpful when appropriate and feasible. I am a part-time caregiver of a sibling and father with SMI and in addition was diagnosed with SZA over 30 years ago.
Until you find the right dr. and the right medication mix.
Get her on more medication and in the hospital. . GEt her in CBT theapy after the meds start working.
Thank you for responding, you made me more aware of what my sister may be going through and Thank you for explaining your experience and thoughts about the process, it helps me to understand more.
This was a very helpful response. Last night my boyfriend called, woke me up, with his revelation that he is the first coming of Lucifer reborn in submission to Christ. He spends some mornings weeping at the foot of crucifixion statues. He knows he is a prophet and his mission here is to minister and bring people to God. I think he has always held a strong conviction of his holiness and his genius and singularity, but when he’s delusional it manifests as thinking he’s a saint or Christ or an angel or a fallen angel, or Batman. Before it was Buddhist gods, like Ganapati or Hanuman. To me, it speaks of a strong religious conviction and his desire to be a priest-like figure in the world, but the trappings are the delusion. He won’t seek treatment. It’s going on 6 months now and I despair he ever will. I also think he feels overwhelmed by the world and how to function in it, and the appeal of a cloistered religious life where his needs are met is deeply appealing and he doesn’t have work to make money. He’s said as much. While I understand and empathize, those institutions don’t exist anymore, and he’s alienated himself from family and friends, and now me, because his needs are voracious. I’m at the end of my rope. I don’t need him to be normal, I just need him to get help.
Thank you for your continued thoughtful participation in this group. For folks like me, a parent with an adult son it really help me understand how best to help him grow.
Thankyou @Maggotbrane always so articulate precise and helpful to our concerns.