NIH says that when speaking with disordered person it’s OK to say to them (regarding their view of events which appear to be factually inaccurate or even false) “Everyone has the right to see things their own way.” Question: After having said that, what’s next? Silence (more or less)? Polite disagreement? Or, firm disagreement? Person I am asking about has an aggressive behavior pattern (criminal arrests, detainment for involuntary commitment)>
I think if the person is severely delusional and agitated argument should be avoided. If the person is making accusations, then reassure him. For instance, if the person says you don’t care and have always tried to hurt him, say, “I love you very much and I never want you to be hurt.” If the person is just saying something delusional such as they can wave their hand and cause a house to be destroyed, I’d keep my response noncommittal…Something like “uh huh” or maybe “really.” Disagreement will get you no where with a person experiencing acute psychosis, and could even escalate to violence. In time, when the person has the right meds and if he accepts his diagnosis reality checking is possible. Also keep in mind if the person is very disorganized, he might not even remember later on what he said.
Its hard to understand that statement without the context, and who said it in the NIH. Can you give us a link where you saw it?
I would not do anything that would provoke an argument.
Greater specifics are these: disordered person while in a trainer’s capacity blew up at 8-10 adult students in a class. This person said that she’d noticed that the students (all females) were gossiping about her (could not provide how she knew) and that she was fed up with it. Before the classes normal end, person terminated class and, with anger, told the students off using profanities and made a threat to kill. Police were called and responding officer treated it as a mental health issue. (State it happened in allows for dual looks, criminal and/or mental health.) A few months earlier, in another state without a dual look, she was arrested and convicted for misdemeanor assaults [4 months jail time altogether; however, most of this time was spent in a medical unit where anti-psychotic medication (haloperidol) was administered. The person says that any and all who say (one testified in a court) that her view of what was happening are liars. She’s proud of standing-up for herself.
I am concerned with role in treatment. May I say that I don’t (which I don’t) think that the person’s view is factually accurate of the situation in the context of how most (and society) see it. Or, would doing this harm her?
http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml Is the NIH site.
The link also says, “Be respectful, supportive, and kind without tolerating dangerous or inappropriate behavior.”
If we are being respectful, supportive, and kind it seems like we would just leave a person’s severe delusions alone, unless they ask us our opinion—at that point, using “I statements,” it’s okay to tell the truth leading with “agree to disagree”— because these are symptoms of illness and cannot be reasoned away. But a therapist or other trusted professional might be able to start CBT or DBT or something structured and evidence based to help with the delusions?
Since this person is already feeling backed into a corner in what sounds like a very difficult situation due to mental illness, what would be the motivation for basically telling her that she is lying?
Everyone and every situation is different. But I can only assume that in her situation lots of other people have confronted her and her beliefs did not change.
Thanks for these comments. Any new ones are apprecited too. My take-away is let her know she’s loved, and go slow on anything which may lead to confrontation-episodes. Also, work towards having the professionals help out as much as possible.
There is a good summary of how to deal with people who are suffering from delusions or psychosis (voices, etc.) - and yes, you are not going to have much success in convincing a person that what they believe is true is actually a delusion - its not that helpful to argue, it just causes stress and alienation.
Better to empathize with the feelings (if you thought something like that) while saying is not how you see it. More details here:
First Aid for Psychosis / Schizophrenia
Does anyone have any advice for what to say for somewhat grandiose delusions without reinforcing the idea?
Before this period of psychosis, my son has always had paranoid delusions & been afraid - the government’s out to get him, etc. I know how to reassure him them, and even empathize.
Now, he’s thinking he knows celebrities (not that he is one), that’s he’s invented some things that are famous (not real things), that he’s got a huge bank account somewhere.
So, he’s not scared - he’s enjoying this quite a bit. I’m trying to be non-commital, but how do you empathize with that without saying you agree or believe? or make him think you doubt him and start a big argument?
He’s only been back on meds for 12 days (today will make 13), so I’m hoping those thoughts gradually weaken, but I am at a loss as to how to handle this until they do.
I would talk with the doctor - it doesn’t sound like the medications have really kicked in yet.
Is he getting any therapy? Generally people do best with both therapy and medications.
As for handling the delusion - it sounds like he’s feeling down and insignificant - and this is a way to make himself feel more important and valuable. I’d try to talk about why he’s a valuable and important person irrespective of whether he knows celebrities or has a great deal of money.
Thank you - that’s good advice.
He just came home from the hospital yesterday, so he’ll see his pdoc on Friday. The delusions are there, the paranoia is almost all gone, his thoughts seem to be much more organized.
He has been in therapy, but his thoughts were so disorganized they couldn’t make much, if any, progress. And, he had some delusions about the therapist, so I’m not sure if he’ll go back to see her or someone different. They had just assigned him to a case manager too, but he hasn’t seen her yet either.
But, the plan is medication & therapy.