Family and Caregiver Schizophrenia Discussion Forum

How to differentiate between a delusion and reality

so my sister is doing better. I have written about her before, she is a doctor and this is her first relapse after her first episode five years ago.

its hard to treat a patient who is also a doctor. she is aware enough to have taken a leave of absence from her hospital, she knows there is something wrong and she is unfit to be practicing (this happened last time too).

she is recovering but she recently decided to cut down on her meds on her own because she was getting tremors. she also changed her medication on her own. ever since she has done that her delusions are creeping up on her again. she still has to see her doctor soon and i will inform the doctor what meds she is taking now but the way she is interacting with my parents is different from before. She has always held resentment towards my parents for various reasons (mostly justified reasons), and they are her care givers but the way she is lashing out on them now is different from before. she is someone who is extremely polite in her language, she is now using extremely disturbing language, she is using such profane words that it seems like it is another personality that has taken over.

even at the height of her delusions before, her vocabulary was hers. this time around it isn’t. is it something that a SZ person goes through and we are experiencing it for the first time, or is it past trauma that is making her this angry? because i feel she keeps vacillating between her delusional self and her lucid self. The thing i can’t understand is that when she is lashing out at my parents and reminding them of their mistakes, she sounds lucid to me. its just unsettling to hear her use such harsh and profane language. How do i differentiate between whats real and whats not. Because i dont want to constantly treat her like a patient, she makes so much sense!

she is hurt and maybe now she is speaking about things from the past, but then there are also delusions. i just want to help her. please advice.

MM88, so sorry your sister is going through such a hard time. When my son was very ill he said and did things that he would not do when he was more well on medication. I would not bother trying to read anything into his behavior and when he used vulgar language I would ask him to please stop being rude when he was swearing at the doctor!

Even though you may not be able to communicate with her doctor unless she has signed a form saying you can or you have some form of power of attorney for medical care, you can still fax or leave a voice mail for the doctor with a brief description of your observations and concerns about her meds. Her doctor cannot discuss her care with you but you can always tell them your concerns.

Thank you for your response Bloom. and thank you for your support.

We have the power of attorney but what i can’t understand is that i can see her being lucid and delusional six times during the day. when she uses vulgar language, which is very unlike her, she is talking about genuine trauma. How do i talk to her then? should i speak to her like a SZ patient or as my very able and intelligent elder sister? its so confusing.

In general, I think you will do best if you always try to talk to her as your very able and intelligent sister.

The challenge here, of course, is that your sister, when not actively symptomatic, is able to listen to reason but when she is symptomatic she is not, so the degree to which you try to argue with her reasoning might differ. But probably a lot of the communication could remain the same.

A good question to ask yourself might be, “What would I say/do here if I were seeing her as my able and able and intelligent sister vs. a person with SZ?” and see what differences arise for you. And then you can evaluate and decide on a course of action.

I have problems with this myself. I had a clinician friend point out to me a few weeks ago that I seemed to be interacting with my SZ husband more as a clinician than as a wife (i.e. that I was treating him too much like a SZ patient). I thought this was an excellent observation, and I have to say that when I try to react more from “wife” mode, things tend to be better between my husband and myself. But that does not mean that I don’t find it quite challenging.

MM88, I just remembered another experience I had. The psychiatrist told me that he would have to tell my son that I had given him the information about “my son smoking pot” because he would need to be honest about where the information came from. I was ok with that at the time because he did get substance abuse counselling for it and he was at the beginning of his illness and not well at the time.

You might want to keep this in mind if there is a concern that the info you provide would interfer with your sisters trust in you or your relationship with her.

I have also experienced that information may only be considered but the Dr may not do anything with it. One time I had concerns about my son being able to take his meds on his own but that concern was not an issue with the psychiatrist and my son landed back in the hospital within a few days for a number of months.

So the information you provide may or may not be considered.

I’m really sorry to hear your sister has relapsed. I found this article about dealing with a person experiencing delusions, it had sound suggestions to I thought I’d share it. Maybe you can let your sister’s doctor know (via a letter) what your concerns are, most psychiatrists welcome a first hand account from a loved one to help with their determinations they make for the patient.

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Would she be open to " talk therapy" seeing a counselor? Her anger sounds like a reality that she my never have addressed and dealt with in a healthy way and it comes out in ways that are unfamiliar to you.