Nephew is trying to change his name and schedule a circumcision. I understand both of these things are sort of “text book” (changing identity and appearance) but… worried that as an adult he may actually follow through with something that is potentially dangerous — or that if we get in the way of it, it could lead to self harm. Anybody deal with something similar or have any advise on re-focusing him or otherwise?
I’d look to his track record on actually getting things accomplished in the past. People with SZ are notoriously poor at executive planning and follow-through and prone to avolition. My tendency is to be long on ideas and short on execution delusional system or no. This said, keep an eye to their persistence, and triage and categorize the relative harm and ease of pursuing such notions.
For example, with circumcision there’s arguably some transient physical and other lasting harm to him, the harm to others is purely emotional and while irrevocable, plenty of males lead productive lives without a foreskin. And a name change, while emotionally hurtful, is more of an inconvenience or possible societal embarrassment and not irrevocable. Both require mustering resources and on the whole people with SZ are resource and organizationally poor, so starving them of resources like money or transportation or “salting the earth” by calling lawyers and doctors ahead of time and explaining the situation can be relatively easy.
You seem new to this, but I’m sure others will back me up on this: you will hear many “crazy” notions come out of your nephew, and some will be repeated ad nauseum, but relatively few will come to fruition and over time you will get a sense of what’s serious or important and what’s not. My mind often goes to song lyrics, so I’ll leave you with some TLC wisdom— “don’t go chasing waterfalls.”
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This is one of the most powerful tools we have - basically going behind our family members’ backs and contacting someone to block an action or, on the positive side, to help process an action by telling them about our family member’s smi. Our Family to Family teacher called it “using the back door”.
People worry a good deal about HIPAA, - YET- while their doctors can’t disclose medical information to us without our family member’s permission - there is nothing in HIPAA that says the doctors can’t listen to us or read information we send them about our family member.
I have done this several times when it was necessary. Its basically the reason I am always there when my son is hospitalized for other issues. I don’t go there with the intent to tell them, I am there in case its necessary for them to know.
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I related this to my sister recently, and she cited it to clerical worker so she could pay my brother’s bill after he had declined the HIPAA form we’d filled out for him to sign. We find you can often slip-in things by him like that by offering low-friction help setting up appointments and filling out paperwork.
In this case medical staff colluded with us and told us to check a box on the HIPAA form that allowed information sharing within the healthcare group as as preemptive measure. That way we could leverage a doctors appointment to gain access to psychiatrist information in the future. He was hoping his GP would prescribe psych meds (harsh old-school stuff like Navane) without seeing a psychiatrist. Oh well, it was worth a shot.
In general while imaginative within their delusional worlds, the SMI lack imagination about others cooperating behind the scenes towards a greater good. It’s not unlike the trust of a child, so it pays to be careful and use and reveal (and conceal) these tactics thoughtfully.
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Thanks to all of you for your responses. Yes, I count on him not following up on his ideas, so I will do whatever possible to focus his attention on something else. But when he brings something up repeatedly — a name change, for example — I try to respect it as well. This is all very helpful, though. Much appreciated, and much love to you all.
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