Brother Near Crisis Point With Psychotic Symptoms

I am worried my brother has some kind of paranoia disorder.  He believes people are following him, listening and watching him through radio transmissions, etc.  He is not to the point where he’s totally disfunctional but he lost her job because of it and  family relations are seriously strained.  His family and  work have tried to get him to seek psychological counseling but he refuses.  What can I do to help him when he doesn’t think there’s anything wrong with him?

Thank you,
Joe

Joe,
This is always a difficult situation, trying to get help for someone who needs it but is unwilling. This happens frequently. Families often become so frustrated in situations like this because they love the person who is clearly in desperate need of treatment and feel helpless to make it happen..

 In your case, your  brother sounds like he  has some serious psychotic symptoms. That means he cannot differentiate them from reality. Psychotic symptoms can be seen in acute drug use and a number of mental  illnesses such as schizophrenia, Bipolar I disorder and others. He  clearly needs evaluation and probably medications.

Here is what I suggest. You need to use “tough love”. That is not an easy thing to do. I suggest a family meeting with your brother with one person speaking for the family. You must be together on this and speak clearly.  He should be told that he needs help and if he refuses you will no longer support him in some way. (ie money, visits etc). Try to be gentle but FIRM and stick to it. Offer to go with him to an appointment, and support him as much as you can and remind him that you love him. When you do this things might actually get worse at first but that may be necessary to force the issue. Sometimes the  situation needs to turn into a crisis for something to happen.

 At any point if your brother does anything unsafe or threatening to herself or others call the police immediately. They will make a mental hygiene arrest and take him to the nearest hospital for a psychiatric evaluation.  Remember these actions may seem drastic and harsh and your brother may get angry but in the long run they may save him from a much worse situation.

One other thing, I suggest you make an appointment with a psychiatrist or a psychiatric nurse practitioner. If you cant do that speak with his primary care provider and see if she is willing to see him and prescribe if necessary (PCP do not specialize in mental illness and often prefer not to treat them). Do not see a counselor as they will only refer him somewhere else and that will mean another appointment.

Please also remember to take care of yourself.

Good luck
Dr. Duffy.