Is this SMI or not?

Hello all,
For those who have read my two prior posts, thank you…I am trying to figure all of this out and appreciate the insights, patience, and support. As I think about this more, I wondered if sharing some observations over the years could be helpful. I really struggle - is this really SMI? Or just someone who has figured out how to get what they want and for some reason doesn’t seem to be bothered by doing/asking of others what most would not be ok with? Is the below really indicative of someone who is seriously struggling/MI? I have a lot of empathy for our parents if they are dealing with SMI, but I don’t know if the below is consistent with that or just someone who “games the system”…and our parents for some reason just are happy to cater endlessly. It’s very confusing! Over the years these are observations about my sibling:

  1. Very superior attitude about everything-knows better than everyone about every topic. In clinical profession (but never licensed, suspect that wasn’t an option as sibling probably exhausted the people trying to supervise them, I know sibling was asked to leave one internship placement prior to getting degree). But highly superior and haughty about knowledge, definitely feels more skilled, gifted, incredible and better than anyone else.
  2. Has to control all aspects of arrangements - and always used food (endless allergies for themselves and their child), atmosphere (“child didn’t like noises”), and so on to dictate what was eaten, where to eat, what time to eat, etc. clearly had figured out that food demands were an avenue that enabled being able to control a huge amount of the day’s arrangements- for everyone since mealtimes are a time of gathering. It was exhausting.
  3. If things didn’t go their way there would be “hell to pay”. Very clever about manipulating. If didn’t get their way it was “but you don’t care about my child’s food allergies”? At first I really was sympathetic about the food allergies, but I began to understand that it was a vehicle for manipulation and control - because they were ever changing. For example, would very often eat the very thing they were allergic to the night before the next day (with no issues).
  4. Very angry over what seemed like minor upsets. Example: one time at a big family gathering my mom & I came home with some pasta for my father - we happened to stop at a food store & my mom mentioned he liked that pasta so I suggested we get him some. Everyone else was eating leftovers, for which there were a lot and that plan had been discussed. Sibling was FURIOUS that they had not been asked if they wanted something. Then would not participate in the next family event because of being so extraordinarily angry over not being asked whether they also wanted some take out pasta.
  5. Hysterical about safety. Won’t go home to their own house unless someone follows them home and watches them get inside.
  6. Highly, highly manipulative about arrangements. You had better do what they want otherwise you will end up with endless phone calls, texts, etc with multiple different configurations for arrangements. And if you do do what they want it’s still a lot of this but just less. It’s like a game to see if people will jump. You agree to do what they say, and then suddenly something changes and they start rehashing arrangements. It’s like they enjoy seeing people squirm and if they snap their fingers the person will jump. But it’s never enough to just be bossed around, it’s like you do what they say and then the bar gets raised. Parents always give in and no one says no. And sibling seems to relish when people seem upset but “can’t say anything” without seeming like a jerk (e.g, the issue of controlling the day with the food issues, sibling knows this is a hard argument and uses this to make ever changing demands, more and more outrageous, but of course if you even say one drop of something that seems like you are frustrated…well, you don’t! But sibling senses you are upset and starts poking at you, and seems to truly enjoy that you are upset/frustrated but can’t say anything. Gets this creepy smile like “I’ve gotcha! You want to get mad but you can’t because I’ve figured out how to infuriate you but if you dare to express one drop of frustration I’ll go after you even more for not being an understanding/nice person”. It really is strange. I’ve always wondered what sibling gets out of this — having a person enjoy being around them is not the goal. It’s whether they can make you get to a place of being angry and knowing you can say nothing. Why do that?
  7. Phone calls and texts: endless. And endless absolute desperation not to be alone.
  8. Odd / over interpretations of what people say/do. Example: person walks up to the house. Assumption is that this person is coming after them. Never just that they could be the UPS man, or something.
  9. Endless visits to the ER by the sibling - either for themself or their child. Like one time 5 times in 9 days. The physical things were often not major. Such as going to the ER for a twisted knee, with dramatic scenes of not being able to get off the floor, but the next day having no signs of anything and walking normally.
  10. So, so, so much financial support. I mean incredible. Hasn’t worked for years and lives a life equally luxurious as one of our highly paid siblings (who works a ton), but with seemingly zero worry about money.
  11. Last time I was around my sibling it was just my sibling, myself, and my parents. I had a quick trip into town, less than 12 hours. I was trying to have a snack with them and my sibling was talking so loudly that I literally couldn’t hear my mother who was sitting right across the table from me. My sibling was talking about their pets with my dad but just drowned me out. I finally excused myself and left the table as it was pointless to be there (I am guessing my sibling wanted to make sure I didn’t get a chance to talk to my parents.) Then after my parents took me to the airport, within 15 minutes of being in the car the calling began. One call after the next. Looking through different lens, I wondered if talking loudly drowns out voices? And maybe talking to others is helpful for staying grounded and quelling voices?
  12. When I was growing up, my sibling constantly interrogated me about whether I talked about them with my friends. I really never did, but my sibling would harass me endlessly until I “admitted” that yes I did talk about them. Then after I said that, would start crying and say how sad they were I did such mean things. Then would return later and yell at me about what an awful person I was to do such a thing. I would then explain that I really just said that because they would not stop harassing me about having “said all these things about them to my friends”. Then sibling would go after me for lying.
    I know all of the above really isn’t how most of the world interacts. But is this really SMI or just a clever person who enjoys getting their way? I increasingly am thinking that these are signs of psychosis combined with some very serious personality things. But maybe I am reading too much of all of this! Thanks for any thoughts.

Honestly, I think your quote above outlines the major problem.

To me, SMI includes hallucinations (with schizophrenia usually hearing voices) and delusions (strong beliefs that aren’t supported in the “real world” like being positive about something that probably isn’t possible or true).

My daughter had obvious SMI issues: she spoke/yelled at people who weren’t present as if they were present and she believed odd things like an out-of-body New Yorker was coming to her and causing her pain in her legs while she slept at night.

Other symptoms like rudeness and dirtiness and not being willing to work also existed, but if your sibling “hasn’t worked for years and lives a life equally luxurious as one of our highly paid siblings” well it seems only natural to me that they are taking more and more advantage of everyone.

Hi MtnMan,

One of the first things we are taught at NAMI’s Family to Family class is the importance of maintaining our own lives. They recommend that we find a therapist for ourselves, this surprises many of us with family members with an SMI. Why do we need a therapist?

A therapist can help you figure the things out that you want figured out. A therapist is a necessary tool for supportive family members. We have a responsibility to “contain the damage” that can happen when a family is struggling. While a therapist can’t solve your family’s struggles, they can help you understand and deal with them.

Best to you, hope

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@oldladyblue thank you for your insights! I struggle a lot with understanding “what is what”. Lots and lots of therapy over the years which I am so grateful to have and continue to have. Maybe one day I will understand if this significant support/catering was because without it things totally fall apart (which I could see). Or just someone who has figured out how to get what they want. The strange “cutting off” behavior as I described in prior posts drew us to try to understand. It had never occurred to us that SMI could be in the mix, but then we learned it was present on one side of the family, but well hidden. So there is a lot of genetic vulnerability. I note that a decent number on here talk about the ability to hide symptoms such that other family members who are not around all the time truly do not know that SMI exists, or didn’t until something dramatic happened. And sometimes just feel it is “catering” not realizing that there are far more issues at play. We all live out of town so all these observations I described are highly likely very much the tip of the iceberg. My family was always masterful at hiding problems and putting on a face that all is ok. (Which is why the cutting off of everyone as I wrote in my other post is even weirder, as having the entire family around for events and holidays etc to convey the happy family picture was always very very important. Until they discarded everyone!) why do I think about this? I worry that if it is SMI something really awful will happen. Or already has happened. I suppose I can just accept that they don’t want help. But one day they will need help, they aren’t young. And there is a child in the mix and a person (sibling) who at least by my above description/observation doesn’t seem like someone who could possibly take care of our parents in a health emergency. Sometimes I think the best thing is to just let go of it all, but it’s hard as they are my parents. I still love them even if they only love my sibling…and hate us (?). It is just natures way, I suppose. At least for me.

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Sounds more like histrionic personality disorder but I’m not psychiatrist. I’m a medical provider and we studied mental and personality disorders in school though.
For comparison my son has paranoid schizophrenia. When he is off his meds he can’t sleep for days and is super paranoid, has other physical behaviors (like catatonic), can’t eat, is very confused. He’s never been bossy or demanding. When he’s on his meds he’s very compliant and agreeable. Not really like himself anymore but not difficult. He tries to work, he shows up and works and participants but he recently was let go and I have no idea why. He just started another new job recently. He has some anxiety being around people and sometimes just won’t talk to anyone besides me, not even his siblings. Although at Thanksgiving he was much more sociable than usual and he really seemed to have fun, but he left right at 6pm which is his typical med time and he goes to bed pretty early now.
Overall your sibling’s behavior sounds more like personality disorder not mental illness, although I’m sure someone might argue those are the same. The difference for me is that the latter is often treatable with meds / therapy, the former is pretty difficult to treat, but can probably be managed with good boundaries, at least if the parents set boundaries that would help, but sounds like that ship has sailed.


@carrot_cake_lollipop yes I agree that a personality disorder is definitely in the mix, I have thought that for a long, long time. I think that is almost a certainty. But then there is the fear of all the neighbors talking about them, and not wanting to go outside because of fear that everyone is following them and talking about them. Completely unrealistic fears about creatures snatching their child (like simply couldn’t happen, would have to be a mystical creature). So maybe something happened to make all this worse? Because my sibling has always been extremely difficult and we just went along with it, then suddenly something seemed to happen and our parents and sibling went into hiding and cut everyone off. I realize it is sort of a fruitless exercise to try to understand this, but it does help to hear what people say. It feels really scary to wonder if everything is ok. I am at peace if they are happy and safe and just don’t like us anymore. Of course it makes me sad but I am ok, I’ve worked through that sadness and anger and so on. It’s just so hard to let go thinking that maybe the lens is very different from my assumption all along - that maybe my parents are in a bad situation, not one where everyone is living happily ever after.

You know, that is probably best to accept. Hard, but best for you. I think perhaps giving yourself love and care is most important.

It is often hardest to let go of what one cannot change. And honestly, whatever diagnosis a doctor would assign to your sibling doesn’t really make that much difference overall. For instance, my daughter had six different diagnoses over the years, from as many different hospitals and doctors, and the latest one was made AFTER the psychosis that was evident from schizophrenia had died down. So she isn’t even currently diagnosed with schizophrenia. I didn’t personally care what diagnosis her current doctor gives her as long as she doesn’t change her successful medication.

A diagnosis won’t necessarily help your sibling or your parents. And they won’t let you help them anyway, even if there WAS a diagnosis.

So, perhaps do some nice things to help yourself and let go of what you think should be happening in your family, and just accept that it is what it is. Perhaps they will ask for help in the future, perhaps not.

You are missing the love from your parents that you should have had, I understand. Can you learn to let go, and learn to love yourself?

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@carrot_cake_lollipop , I am glad that your son is settling into his “new life”. That he is, “Not really like himself anymore but not difficult.” seems very good to me. It is sad to see the personality changes of the “before” and “after” SMI, but getting through psychosis to a “new life” is a good thing, a lucky thing, and something that not all who suffer ever reach. I feel emotional everyday for those who are swallowed up by SMI and can’t ever hold a job again. I know how lucky my family is that my daughter came out of the hell-hole in her mind to be a new her. I hope your son keeps on finding his path and glad you are helping him.

Every year when open enrollment happens for I remember the words of a stranger on the phone who was helping me find insurance for my daughter when she was newly stable on Haldol. I told him the new insurance coverage HAD to cover her Haldol Dec Shot. He gently asked why she needed to take it, and I told him her schizophrenia story. He said to me, “my parents got me through to the other side of schizophrenia. I am forever grateful to them. Don’t give up trying to help your daughter.”