Family and Caregiver Schizophrenia Discussion Forum

My dad has psychosis but doesn't know it, don't know what to do

My dad is unaware he has psychosis. He knows he has anxiety and depression, but not psychosis. It’s been going on for about 6 months now. He may have had a similar psychotic episode 30 years ago when I was really young, but as far as I know wasn’t diagnosed with schizophrenia. He is 60 and physically very healthy, recently retired, extremely smart and well educated, but had always had anxiety and hypochondria.

Covid was/is scary for my dad, he and my mom sheltered at their cottage and have rarely left since March. 6 months ago he went to the city to check his mail at his condo and he found a letter from the municipal court at his city address but for a random person’s name, and my mom just returned to sender. He is convinced that the letter was for him (despite being addressed to a stranger) and he must have committed a crime under a fake name (the “crime” he thinks he committed isn’t even a crime) . He believes he is under investigation and the police are coming for him any day now (and watching him, and monitoring/listening to his calls, looking for him, etc). He is obsessed and convinced he is going to prison. He quit all activities and cut ties with a lot of people to not “bring them down with him”, and made some irresponsible financial decisions in case they freeze his assets. Everyone can tell he isn’t himself and something is off. He’s also having a second delusion where he is certain that he was an absent father and terrible husband, which couldn’t be further from the truth. He was my primary parent, he did everything (my sister agrees!) but he thinks he was always traveling and working. He thinks I’m the one who is misremembering. Both delusions seem to be guilt based.

Another letter was received from the municipal court a few weeks ago, also his address but a random person’s name, but he doesn’t know about it (I hid it from him). I opened it - as expected it has nothing to do with my dad it’s just a wrong address, and it’s a small fine for public urination for a 20 year old outside a night club (the guy’s birthday and location of the infraction are in the letter) - I’ve already confirmed with the municipal court that they have the wrong address, they said they would stop sending letters. I decided not to tell my dad because I didn’t think he would believe me (so far no logic or evidence has helped to lessen the delusion it only makes it worse).

Now my dad wants me to help him find a lawyer and he’s willing to pay “whatever it takes” . I don’t want him to waste all his money on this. But I don’t know how to stop him either. My dad was so worked up he and my mom went to the city today to check the mail again. My mom found another letter from the municipal court and hid it (I’m pretty pissed the city are still sending the letters after I sent them proof they had the wrong address). I’m now wondering if I should show my dad the letter. He’ll see it really is just a wrong address and has nothing to do with him.

My dad talked to a therapist a couple of times but stopped because, according to my dad, the therapist didn’t want to talk about ‘legal issues’. I don’t know how true that is. My dad also won’t see a psychiatrist, he says he knows he should but he’s not ready… He’s been saying that since September.

I don’t know what to do, I’m the only person my dad trusts and I’m the only one that can help him, but I don’t know how. Do I show him the letter or not? Will it make things better or worse? Do I tell him he is having psychosis?

Edit: we’re in Canada, in case it matters.

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Welcome to the site, I’m sorry this is happening for your dad.

Perhaps since he didn’t believe you earlier, that the letter was not meant for him, it won’t help to show him the new one, but it might. When someone is delusional, you can’t be certain how they will see facts. If you show him the letter and how it can’t be about him, and he doesn’t believe you, perhaps he would believe a lawyer if he doesn’t believe you.

It never helped for me to try to explain that my daughter was having delusions, she was certain her delusions were true. Most people can’t see their own delusions (over 60%) and it is called anosognosia. Does your father see a regular doctor (if he won’t see a psychiatrist)? I wish you luck sorting this out.

It might be helpful for you to read About LEAP approach before you talk to your dad. Here’s an overview. http://mhr4c.com.au/coping-strategies/the-leap-approach/
How you have the conversation is really important, and maybe call you local NAMI chapter and talk to someone there? I just went through 7 months of mania/psychosis with my loved one and learned so much about how to communicate and preserve trust. My loved one lacked any insight and it was lockdown/Covid and he just got louder and louder in his behavior until finally he became too aggressive/confrontational and was arrested and finally got help. Remember that for your dad his delusion is very real. It’s as real to him as the fact that you are his daughter. If you can empathize with how he feels (guilty, scared) first you might be able to get him to agree to go see the family physician?

Since retiring, he lost access to his previous doctor that he had through work. However my aunt told her family doctor about what my dad was experiencing and her doctor agreed to take him on as a patient.

30 years ago, when I was 5 years old, my dad took antimalaria pills for a work-related trip and experienced severe side effects. He became depressed and paranoid (thought people would come to hurt us). My mom left him, taking my sister and I with her (she is very proud of this). My dad went to the ER. He told everyone (including my grandparents) he was dying of cancer or had serious heart problems, neither of which are true but that’s what he believed. (My dad is super smart but he didn’t get into med school and ended up always resenting and distrusting doctors). My aunt helped him get back on his feet and eventually months later my mom agreed to return. My mom told me a few of these details years ago but that’s all she’ll say. My aunt doesn’t know if my dad was diagnosed with anything or if he received treatment. I was too young and don’t remember much.

Anyway, so my aunt has been supportive and she explained what was going on to her doctor but when he called my dad he asked my dad if he was hearing voices and my dad got pissed and ended the call. Eventually the doctor called back and recommended my dad pass a few blood tests, which my dad agreed to (results were negative). My dad already had a low opinion and distrust of doctors, and started off on the wrong foot with this doctor, but he is very friendly (I’ve also spoken to this doctor about my dad). So the doctor is ready to send my dad for a psych evaluation, he just needs my dad to ask. But my dad won’t ask.

I also set up a call with a walk-in clinic (now doing phone appointments) for him a couple of months ago. I spoke to the clinic in advance and told them my dad was having psychosis but was good at hiding it and he needed a psych evaluation, they said OK, but during the actual phone appointment with my dad the doctor just talked about physical health stuff.

I’ve thought about just bringing my dad directly to emergency, but I don’t know if he’ll actually go in, and even if he does, with covid, I can’t go with him, so he might not be honest with the emergency doctors anyway.

My mom is no help, she doesn’t think he needs a doctor. She doesn’t want to deal with my dad. She has said multiple times that if my dad is sick she will leave him, and as mentioned earlier, she’s done exactly that before. If I try to talk to her she gets angry. My dad is scared that if he sees a doctor or a psychiatrist, she will leave him. Because they are both retired and covid, they are always home together 24/7. So I have to constantly sneak behind my mom’s back just to talk to my dad.

I keep reading that early treatment is crucial, so I really want him to see a doctor asap but it hasn’t happened yet and I don’t know what to do. My mom is a huge problem, covid is a problem, my dad’s distrust of doctors is a problem… What can I do?

See if he will agree to take something for stress or to help him sleep. Ask the doctor to prescribe him an antipsychotic that will help with sleep and anxiety. Tell the doctor not to ask about hearing voices. That’s a sensitive topic and even if he is hearing voices he may not feel safe sharing that because he realizes how others will react to that fact. Also, he may not realize he is hearing voices. My experience with my love one was that he would think he heard someone say something. Later, I realized I think he was hearing voices and mistakenly thought he was mishearing things. He doesnt need to know his diagnosis and in the end It doesn’t matter. It’s sad but true that this diagnosis has a horrible stigma attached to it. Try to focus the conversation about how his thoughts make him FEEL. I hope you can get him on meds.

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I agree with what @Feelingalone has suggested. Perhaps the most sensitive thing here is that you want to prevent being the cause of your mom leaving your dad again, if she finds out he is ill. It is true that your dad may not want to ever admit to hearing voices, and that it really isn’t as important what he is diagnosed with, as seeing if he will agree to see a psychiatrist to get some type of medicine that will alleviate his psychosis. The more you read on this site the more you will come across ways people have helped their loved ones despite the myriad of varied problems that sz causes. No two situations are alike which makes finding solutions a trial and error process.

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You know, @Clamcake, from what you’ve described, it sounds like your dad may be experiencing a severe depression with psychotic symptoms than schizophrenia (this tends to reoccur, so it is not inconsistent with what you know of an earlier prior experience, and the prognosis tends to be better than schizophrenia).

In a way, the diagnostic distinction is not that important at the moment, as he clearly needs help.

However, if he is aware of being depressed and anxious, can you emphasize this (rather than focusing on the delusions) to get him to engage with treatment? You could emphasize that between covid and his legal concerns, he’s under quite a bit of stress and perhaps convince him to get some help for all of this.

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Hi clamcake. If there is already a diagnosis then that is the first step. If none, given age and environment (socialization, consistency etc…) consideration. I’m tempted to say that a lot of us are experiencing what it’s like to be in facility next in our own homes… and it’s a stressor… as it’s always been on any elderly with failing minds without any orchestrated interactions…
remember to be patient. Walk the F away for a few minutes and come back if you need.