My mother-in-law is paranoid delusional. Help!

Factual Questions
1

First, background:

My MIL broke her hip about two years ago, and had hip-replacement surgery. There have been some moderate complications, but she is still able to move about, albeit with a cane and a limp. The whole experience left her extremely wary of doctors.

Sometime during the cycle of surgeries and physical therapy (I think, for the first time, worrying about her and her husband’s mortality), she started to become increasingly worried about the state of her financial house. (She has no financial savvy of her own, has no idea about wills and estates and such, etc… You can read the companion thread about that here).

But what should have been a passing stage has snowballed into what seems like a full-blown mental illness. She now is absolutely, utterly convinced that she is secretly guilty of some undefined financial mismanagement, and that government agents are stalking her, waiting to haul her off to prison. This, in turn, will bankrupt the family with lawyers’ fees and bring shame to her whole family.

(This is not exaggeration or hyperbole. My wife is visiting my in-laws, and called today wih the tale of a ruined lunch out because she was convinced agents were stalking her in the restaurant.)

As a corrolary, she has about a thousand boxes of accumulated possessions in her home (being at once a savvy shopper and a shop-o-holic). She maintains that somehow the government will find out about these possessions, and [insert paranoid uncounterable “argument” here] will result in similar government action/prison time/devasating financial ruin.

If you try use logic to demonstrate the folly of her delusions, she uses a combination of circular reasoning and stonewalling until cornered, and which time she shifts the discussion to a slightly different topic and starts over. A year ago she was a resonable and reasoning person, but now it’s like… well, I’m not sure. She has constructed these elaborate fantasies of financial doom and cannot be talked out of them. Logic and reason bounce off of her. She talks and frets almost every waking hour, has terrible nightmares that she then confuses with reality, and is starting to become physically ill (literally, vomiting) due to the overwhelming worry.

Worse, even in times of elevated rationality, she cannot be convinced to seek any kind of help. Her husband managed to get her prescribed on Zoloft, but there’s evidence that she’s only pretending to take the pills, and discarding them. Meanwhile her “condition,” if that’s what it is, grows worse, and since her husband works from home and has to take calls, it’s starting to threaten his job. (Today, at that lunch, FIL got a work call that he needed to go to his car to take, but MIL wouldn’t let him, because “he needed to stay and protect his daughter (my wife) from the government agents.”)

Since this is GQ, here are some (hopefully) answerable questions:

  1. MIL’s descent into madness started around the time she was taking Vicodin for the pain of her hip surgeries. Are there any knowns side-effects of painkillers that can trigger paranoid delusions?

  2. She clearly needs professional help, but refuses to seek it on her own volition, since she doesn’t realize or believe she’s sick. She refuses to take pills. What recourse does the FIL have to get mental health help for a wife who refuses it?

  3. When she goes on one of her “all is lost, and they’re out to get me” rants, is it better to “play along” and sympathize, or keep battering her (gently or not) with logic, pointing out the absurdity of her positions and hoping she snaps out of it?

  4. Assuming we could get her at least to see a psychiatrist, is there a way to better the odds of finding a good one? (When my sister was a kid she had some metal health issues, and the first specialist my parents found for her ended up making things much, much worse, by proscribing meds whose side-effects were way worse than the original problem, and refusing to discontinue them. We want to avoid anything like that, basically.)

I feel so badly for everyone involved: my MIL for obvious reasons, but also my saintly FIL who’s life is becoming a hell, and my just-as-saintly wife, who is blowing a week’s vacation right now (with our 6-month-old daughter in tow) to be with them (we’re in Boston, in-laws are in Virginia), helping FIL unpack boxes and trying fruitlessly to help MIL while she grows more and more delusional. She calls me every day, miserable, wondering what they can do.

Any thoughts, advice or answers would be greatly, greatly appreciated.

Thanks!

-P

2

IANAD.

You mention that MIL refuses to take pills, so I’m assuming she is no longer taking Vicodin? Is she taking any medications at all?

MIL could be suffering from dementia. Mid-60’s is relatively young, but not unheard of. Her age, the gradual change, and inability to separate dreams from reality remind me of other relatives’ experience with dementia (The particular obsession is also familiar to me - my great-grandmother also became convinced that she’d committed some gross financial crime and the IRS was going to throw her in jail).

Since it sounds as though simply getting her to meet with a doctor is going to be a struggle, you may need to shop for one without her. Does she have a regular doctor already? Could FIL talk to him/her, explain his concerns, and get some referrals?

As you’ve already discovered, she’s not functioning rationally right now. Arguing with her doesn’t work, and it won’t cause her to “snap out of it.” It sounds like arguing just makes it worse - can you change the subject or distract her when she starts going off? It won’t “fix” the delusions, but it might calm her and make life easier for your wife and FIL.

I wish I had more to tell you. I was pretty young when my great-grandmother died, so I can’t tell you much about how we handled it. Mainly we kept her away from the things she thought she could still use, but couldn’t really (stoves, hot water). Since MIL is convinced she’s in financial trouble, FIL may want to supervise her access to bank accounts, credit cards, and other financial resources.

My own MIL was diagnosed with Alzheimer’s disease a few years ago, and we’re just sort of dealing with it as it comes. What we’ve learned from the experience so far is mainly, don’t let doctors blow you off. If what you’re hearing doesn’t make sense, something is wrong - this is all stuff that can be explained to the non-professional. We’ve also learned that Alzheimer’s and the usual diseases of old age sort of compound each other - yes, she’s losing mental acuity to the disease, but she’s a lot more with it when she doesn’t have a bladder infection, bowel problems, or a raging infection in her chest cavity.

3

First off, your family has my prayers. My grandmother was a diagnosed paranoid schizophrenic all her life, but it got steadily worse as she got older. She also refused to see doctors, although in her case it was because she had been subscribed Thorazine and it just turned her into a zombie.

My thoughts, and like CWThree, IANAD but I’ve lived through it.

First, your wife and FIL should talk do a psychiatrist or psychologist, even if your MIL refuses to go. Partly to learn about the latest on age-associated schizophrenia, but also to hopefully get them in contact with a caretaker’s support group.

Second, we learned early on that the best way to defuse my grandma’s paranoid talk was to have her focus on something she loved and turn the conversation to that. She loved animals, gardening, kids… so we’d bring pictures, take her to nurseries, have dogs come visit, etc.

Best of luck to you and your family.

4

IAAD, a psychiatrist even, but not your mother’s doctor. Without evaluating her, I can’t offer a diagnosis, so this here’s just general information which may or may not be helpful.

Vicodin is notorious for causing delirium, especially in older people, but that clears up when it’s cleared by the body. I ran a quick literature check but couldn’t find a case where it triggered a persistent psychosis.

Sometimes depression can accompany pain, such as might be experienced by someone with bad joint pain, surgery, loss of mobility, and complications of healing. Then the depression makes the pain worse, which leads to less mobility and impaired healing, which increases disability and worse depression … a downward spiral.

Paranoid delusions are commonly associated with psychosis, mood disorders, and dementia. It’s not easy to sort out, especially with a patient who distrusts doctors. By definition, delusions are not resolvable by presenting evidence to the contrary. I generally avoid confronting my patients with the illogic of their own delusions until they’re well enough to start questioning themselves.

In the USA, it is extremely hard to get treatment for a patient who doesn’t want it or feel she needs it. Adults are presumed competent to make their own medical decisions until shown to be otherwise. This can be very hard for family and loved ones of a sick person to accept, but it means that the patient has to be really out of touch with reality before his decisions can be overridden.

When the patient’s beliefs are causing disruption of her own life and starting to put family members’ health at risk, she may well be unable to make reasoned choices about her health and need for treatment, and it may be necessary to get a temporary guardianship. Depending on where you live, you can petition family court, or probate, or circuit court to issue an order for this. Attorneys who do family law might be helpful. Your community mental health service is another possible resource. The court can order a psychiatric evaluation in order to determine whether a guardian is needed, and this can open the door to diagnosis and treatment as well.

Sometimes a sick person will be grateful to have the decision-making taken over by someone else, but often it seems like betrayal. It’s one of the hardest things in life to force a mother to do
something while she’s begging you to save her from it. It’s painful for everyone involved.

As a general rule, a brain that has functioned well, providing logical thought and balanced moods, is a brain that gets back on track fast with a little proper medication. This has to be qualified when considering older people as small strokes can interfere with the process, but it’s still a consideration.

So, it’s a painful situation for everyone involved. My thoughts, hope, and best wishes to you all.

5

I’m wondering if you can use her psychosis to help get her to a doctor. Maybe you can tell her that one of the best defenses, in fact, the only defense that has ever worked and kept a family out of poverty, with the IRS or whomever she fears is proof of medical problems–make it sound like aches and pains, of course.

You could even copy an article off the internet, change some words to fit your case, and show it to her. Tell her doctors know about this, and are often sympathetic if you explain the facts–they are rich, and have to protect their money, too.

6

Thanks very much to you who have responded… it helps to hear opinions and advice. Ragiel, it’s particularly nice to hear from a Doper psychiatrist.

MIL is not currently on painkillers, and hasn’t been for a while. It seems that when she takes her Zoloft (which she’ll only do if FIL makes sure of it), her days are better. When she only pretends to take it, she’s worse.

I asked my wife if the FIL had gotten a psychiatric referral from their family doctor. The answer was: “the doctor said the issue was out of his league, and just gave my dad a hotline number to call, rather than a specific referral.” I don’t know if FIL has actually called the hotline, or what specifically it is, but in general I get the sense that the doctor wasn’t very helpful.

Arg arg arg.
-P

7

Here in Florida you can Baker Act someone, which forces them into a three day stay for observation, if you can prove they are a danger to themselves or others. Does your state have something similar?

As for playing along with her, that’s not the issue. You don’t want this to drag out. Get her some help ASAP. Today, if possible.

8

Oy. Been there. Done that.

My MIL began her paranoid delusions out of the blue about two years ago as my husband was preparing for deployment to Afghanistan. (no pressure there…sigh)

Her delusions even included her son (my husband) and his Army were in the alley behind her house trying to get her. At any rate, after several months of horrible crap, my BIL finally got her to the right doc that was able to diagnose and treat her with meds. We saw her a few months ago and while she’s aged about a hundred years, she’s at least functioning.

There’s no good explanation as to what happened to my MIL. She was my FIL’s caretaker during a long bout with Parkinson’s Disease. He died in 2000. Since we don’t live near her (Indiana - Florida), we’ve wondered if she was deteriorating for a while and we just didn’t notice when we would visit.

Family history is that her father and brother suffered from some kind of schizophrenia so now my husband worries that he may also develop some kind of mental illness as he ages.

I understand what your family is going through. My email addy is in my profile if you or your wife want to talk.