My Sister Thinks She's Schizophrenic...Now What?

I apologize in advance if this isn’t completely coherant. I’m really upset right now and just want to get this out there.

First, some history. My younger sister, we’ll call her G is 18, I’m 22. She has been somewhat mildly depressed for a large part of her life. My family just thought it was her being moody, but it’s gotten much worse over the past few years. Her father passed away in 1998 due to a drug overdose (we have different dads). She was told that it was due to a sudden heart attack and only found out the truth a few months ago. I think that this discovery finally led to her “snapping”, getting much worse, and finally asking for help. Through a series of many somewhat confrontational discussions, my sis confessed that she has been hearing voices and seeing people (she claims that they are ghosts) for many years now, possibly even from childhood. She has gotten so withdrawn lately that many times she won’t answer even the most innocent questions. Just the other day I asked her if her alarm was set as I knew she had work the next day. She just laid there in bed, completely ignoring me. I had to ask several times to get an answer. She seemed to be wrestling with the idea of answering at all.

We went to visit a “therapy center” of sorts for an initial consultation on Wednesday. The whole way there, G fought the idea of going, saying she hates therapists, she doesn’t need one, and she won’t continue to go after the consult anyway, so what’s the point. After the routine barrage of questions, the therapist suggested a combination of talk therapy and psychiatric counseling/possible medication. I know in my heart that G needs this desperately, but she is still fighting it. I have offered to go with her to every visit (not an easy thing since I go live an hour away). Still, she is hesitant.

I suspected that G had these problems years ago, but since she was still functioning relatively normally, I just let it all slide. But now that her “ghost” sightings are occuring more frequently and she has become increasingly more resistant to answering even the simplest of questions, I feel like something has to be done. I am doing everything I can to get her to go to counseling, but beyond that, I don’t know what to do. I feel like I’m constantly walking on egg shells around her, afraid of hurting her or making her fear me.

If anyone has experienced schizophrenia either firsthand or through connection with a friend or family member, I’d greatly appreciate your help. No one that I know has been through this.

On preview, I realized that I forgot to add any family history in here. I don’t know my G’s father’s family well, so I don’t have anything to add in relation to that. Pretty much every adult relative - including me - on my mom’s side of the family has battled with depression to various degrees. A cousin is battling manic-depression. I don’t know her well enough to ask her for help though.

Thanks in advance

She certainly needs to have a full psychiatric evaluation. Which could, indeed should, involve many sessions with a knowledgable psychiatrist. IANA doctor of any kind, but it doesn’t sound quite like schizophrenia to me…a rule of thumb is that with true schizophrenia, the psychoses are so vivid that the sufferer cannot understand that they are not real, while describing them as ‘ghosts’ suggests that she is aware to some extent that these are hallucinations. Psychotic episodes can exist as a symptom of depression, or of other illnesses (Google ‘psychotic depression’ for more), or they can exist by themselves. Only with a lot of gentle probing by a psychiatrist will you know what is the case here.

She certainly needs to have a full psychiatric evaluation. Which could, indeed should, involve many sessions with a knowledgable psychiatrist. IANA doctor of any kind, but it doesn’t sound quite like schizophrenia to me…a rule of thumb is that with true schizophrenia, the psychoses are so vivid that the sufferer cannot understand that they are not real, while describing them as ‘ghosts’ suggests that she is aware to some extent that these are hallucinations. Psychotic episodes can exist as a symptom of depression, or of other illnesses (Google ‘psychotic depression’ for more), or they can exist by themselves. Only with a lot of gentle probing by a psychiatrist will you know what is the case here.

GorillaMan, she truly believes that these ghosts are real, FWIW. For a while last year she couldn’t sleep through the night most nights because “the girl” kept waking her up. She wouldn’t talk badly about the girl because she was afraid of upsetting her.

As for the evaluation, we’re on our way to getting that done. We’re working on getting an appointment. Apparently they’re really hard to get in our area and with our health insurance.

Be sure to check with her insurance company to see exactly what coverage she has (some policies cover mental health but not substance abuse or vice versa). She may have limitations on the number of visits or days (if she has to be admitted). Be sure the hospital gets the pre-certification AND it covers ALL the days or visits.

This type of service can very expensive and you don’t want to see some gigantic bill in the mail.

The first two mental health visits are free. After that it’s $25 a visit. The phychiatrist and therapist are considered to be under the same big mental health category. So now we’re down one free visit with the initial consult and have only one free visit left. I told my sis that I would pay for the visits if need be. I’m still a student myself, so this could get really tricky. But I don’t want the added burden of money to be a reason for why she won’t get treatment. Mom’s got plenty of issues herself with morbid obesity and depression that don’t permit her to get around easily, let alone work to help pay for treatment, so it pretty much falls on me. I was quite relieved when the initial consult therapist only suggested once a week for therapy. I knew a girl who went in for treatment and was required to either go to therapy three times a week and take meds or be hospitalized. Thankfully, it doesn’t seem to be that bad. I’ll check with the policy on admittance, in case it should come to that. As for the potential of a giant bill… I’ll handle it if it comes to that. If getting my sister well means that I have to pay off a huge sum of money for the rest of my life, I will. It wouldn’t be fun, but I’d do it.

Very admirable. I hope it doesn’t come to this. If you find the insurance won’t cover the treatments, work out a payment plan with the facilty in advance. The last thing you want to have hanging over your head is having to worry about a bill. You’ll need to channel that energy towards your sister.

Good luck to you and your sister.

$25 a visit is far less than I would have guessed you’d be hammered for…and I’m glad you’re prepared to make the effort to pay that. Two sessions will certainly be inadequate for any reasonable care to be provided.

The other potential big cost is medication - what would be covered, and what wouldn’t? It’d be terrible to restrict the possible treatments due to financial constraints.

Thanks for the words of encouragement, Mr. Blue Sky and GorillaMan. They are greatly appreciated.

The $25 fee is just what’s left over after the insurance picks up the tab. I agree that it’s a relatively small fee. We are lucky to have a great insurance plan. As for medication, our general prescription fee is $5 for generic and $10 for brand name. I’m pretty sure that the plan would carry over to mental health meds as well, but that’s another thing I need to look into.


She may actually have Schizoaffective Disorder: (I apologize if the text in the link is barely readable, but it was actually the most comprehensive one I could find.) Of course I am not diagnosing her, but the information may be helpful.

My experience with clients who have this disorder (I am a therapist, not a psychiatrist) is that it quite treatable with a combination of meds and therapy, usually cognitive-behavioral therapy. The therapy is never going to work without the meds, though, IMHO. And sometimes the delusions can get pretty scary—people hearing voices telling them to hurt themselves or others, etc.
As for her awareness of what is going on, I actually have a number of schizoaffective clients who know that the auditory or visual hallucinations are different from what others are able to see and hear, but are disturbed by them nonetheless.

Prognosis varies, depending on the severity and the luck in finding med combinations which work. I have never experienced anyone being “cured” of this, but I have experienced those who can manage quite well.

Thanks for the link, lorene. I found the material to be somewhat confusing and can’t tell exactly what it is trying to say. Is it some new form of bipolar?

You know, I wish I’d been able to find a better link. If you try a search for DSM-IV, that’s the Diagnostic and Statistical Manual for the American Psychiatric Assn. You may be able to find a site (I couldn’t but I just did a quick Google) which explains each disorder more fully.

To answer your question, Schizoaffective disorder is best described as a combination of Schizophrenia (the psychotic symptoms like delusions and hallucinations) and a mood disorder (i.e., the affect ), either mania or depression, or mixed. I thought of that because you describe your sister as having some true depressive symptoms along with the delusions, and that seems to fit.

In the fianl analysis, though, diagnosing someone can pretty much be a crapshoot at times, and actually treating the symptoms is a whole lot more important. I do wish you and your sister luck. She is lucky to have you so invested in her health.

Thank you lorene. Your explanation makes more sense to me now. Hopefully, the therapist will be able to tell me more.

There are a few different disorders that are described as schizophreniform, with delusions and hallucinations being the common thread. None of them sound like a whole lot of fun.

Your sister is very lucky to have you to take care of her. I hope everything works out for you two.

Is there a chemical imbalance that can be detected in schizophrenics?

Unless something has been discovered very recently, there are no known biological markers.

DoperChick, if your sister is over the age of 18 (and under 21), she may be eligible to qualify for Medical Assistance in the state of Pennsylvania, which may cover both physical and behavioral health. Even if she already has insurance coverage under a private carrier, Medical Assistance (if she qualifies) may become her secondary coverage (which would take care of any co-pays). In Pennsylvania, she doesn’t even need to go to a Department of Public Welfare Office in order to apply–it can be done online

Worrying about how to pay for physical and behavioral treatment shouldn’t be another stressor in this situation.

::huge sigh::

::plops down soapbox::

Hi, I’m AHunter3 and I’m a schizophrenic.

At least that’s what the psychiatrist with the authority to make the call put down on my chart. Paranoid schizophrenic with delusions of grandeur.

As ultrafilter notes, there’s no lab test and therefore no non-subjective way of arriving at that conclusion. Nor of disputing it. Nor, for that matter, can I honestly report that upon meeting the other people with various “mental illness” diagnoses I felt that I was different from them in any way that would support the notion that they’d made an error, although I didn’t think anything was wrong with me.

And so on the basis of this diagnosis I was held without my consent in a building and forced to take antipsychotic medication that I did not want to take.

Now…I know you are concerened about your sister and you want to believe that there is a scientifically-informed profession focusing on the kinds of problems she’s having, and that they can help her or cure her. So this is probably a public service message you aren’t going to be very comfortable with.

a) No one understands schizophrenia. That’s because once upon a time when medicine and human biological science was much younger than it is today, a wide range of human maladies of the “acting crazy” variety were, for the first time, conceptualized as illnesses rather than moral depravities, demon possession, or other such bullshit – they didn’t know what caused them but they had high hopes that the scientific method would soon reveal them. But what happened over the next century was that whenever these maladies really were understood as the symptoms of an underlying medical condition of some sort – hypothyroidism, epilepsy, tertiary syphilis, various vitamin or mineral deficiencies and electrolyte imbalances, psychoactive effects of ingestion of various mild toxins, etc etc – they were removed from the “mental illness” classification, and the major categories that remain in the “mental illness” bag are the ones that have not yielded their secrets to these investigations. Many of us in the anti-psychiatric / mental patient’s liberation movement (yes there is, and I’m in it) believe that either the behavior/thought pattern called “schizophrenia” is something anyone can experience or be driven to by situation and events (although maybe some are more vulnerable to that than others) and that it has no biological origin (just social, personal, cultural, etc), or else it is a complex of interactions of biological and social factors, and that either way the thrust of psychiatric research – which still follows the reductionistic medical model and seeks a singular cause in the form of a strictly neurological or neurochemical disfunction – isn’t going to find anything useful.

b) The profession is not [solely] a caring profession. Psychiatry from its inception (go Google “Kraepelin” and “Bleuler” if you suffer from the misconception that this mainly had to do with an Austrian named Freud – it didn’t, he’s marginal to the mainstream practice of psychiatry) has had a police function that is disguised and “doublethinked” around. It’s a mechanism for dealing with the inconvenient for the protection and freedom from disburbances of the general public, meaning that the people it exists to please and serve aren’t [necessarily/always] the ones it designates as its patients. It is coercive, as the power to hold such people and impose treatment on them is granted unto the profession, as a rare exception to the general rule that you can’t incarcerate people without charging them with a crime, or take away people’s right to make their own ordinary personal decisions without determining that they lack fundamental competency. And yet these police powers are masked by always describing everything that the profession does in terms of helping suffering sick people by providing them with needed medical treatment. And for this reason the holding and treating of the inconvenient due to their inconvenient is accompanied by applying a diagnostic label to their inconvenient behavior – in other words, historically and as part of what institutional psychiatry is, sociologically speaking – what it’s social function is – the diagnosis is applied as a means to a desired end, the determination that it is necessary and appropriate to hold and treat this person who is disturbing other people. Pragmatically, as an institution, psychiatry could not and does not hold and treat merely those for whom there was an established, sound reason for believing that they have a medical condition of the brain that will respond favorably to available treatment which will benefit the patient.

A mind cannot be “ill”. a brain can be ill, a body can be ill, one can have a congenital illness that causes neurons to do their job inaccurately, and so on. But a person either does or does not have an “illness” regardless of the state of one’s mind, which, with regards to any illness, can only be a symptom.

c) The treatment that psychiatry can provide to people diagnosed “mentally ill”, especially “schizophrenic”, is a very mixed and mostly unpleasant bag. The prevailing treatment of choice for schizophrenia, neuroleptic drugs, work, to the extent that they work, by interfering in a broad, unspecialized way with the way that nerves fire. They are most positively, absolutely, certainly in no shape way or form even remotely comparable to what insulin is for diabetes. There is not an understood deficiency condition that is ameliorated or fixed by adding in neuroleptic drugs which, by their addition, cause the nervous system to function normally. What neuroleptic drugs do is mask symptoms in more or less the same way that turning down the volume on a stereo system with distortion in the speakers can cause the distortion to be less evident. To some schizophrenics, this is a better than nothing – “I don’t hear voices, I can function” - but to many many others it is far far worse – “I can’t think, I’m like a zombie, I’m not even alive like this, I can’t feel, I can’t care about anything except in a dull miserable way”. Oh, then comes the bad news: they all cause permanent brain damage if you use them long enough, including damage to fine and gross motor nerve systems as well as the parts of the brain responsible for thinking and feeling; they, in and of themselves, impair cognition to the point that with or without mental illness you are going to function with greatly diminished capacity if you’re put on this stuff; they are addictive; and they have a wide range of nonpermanent but unpleasant side-effects on both brain and body. Other treatments to which schizzies are subjected are even worse – electroshock, despite the oft-heard declaration that it’s for depression, is used on schizophrenics from time to time and a series of electroconvulsive treatments will do more significant permanent brain damage than neuroleptic drugs and is horribly unpleasant according to most of the people I’ve spoken to who’ve had it done to them.

d) All other things being equal, a person is more likely in the long run to recover from observed symptoms of mental illness such as hearing voices, incoherent or irrational ideation, aggressive or paranoid or withdrawn behavior and mood, etc., if they stay away from psychiatric treatment than if they receive it.
Now, some better news. I mentioned that we have a movement. In addition to organizing against forced treatment and involuntary psychiatric incarceration, and against actual or proposed discriminatory infringement on our civil rights on the basis of psychiatric diagnosis (housing, right to drive, medical confidentiality, etc), we also try to provide user-run self-help services, which are most definitely not coercive. We don’t always know the answers to each others’ problems either, to be sure, but most of the folks who’ve tried it say it’s better to thrash things out with people who know what it’s like than to be treated like a neurological dysfunction by a medical doctor. If you think she’d be interested, I’ll find out what’s available in her area.

My web site, for more reading:
Also, do a SDMB search for my username in conjunction with “psychiatry”, threads since the beginning of the board, and what you’ll get is sort of an informal “Ask the Schizophrenic Guy” thread to read.

AHunter, if I’m not being to personal, how did they figure you to be schizophrenic? Do you exhibit symptoms of the disease? I have a cousin who has the disease and I know that the medications can be worse than the disease itself. That said, are you able to work without being medicated? How do you manage your life without the assistance of meds?

By the way, I’ve always enjoyed your posts. They’re always informative and thought-provoking.

Hey AHunter, it’s good to still see you around. Thanks for the really inspiring post. Do you think what you said above can apply to other mental illnesses like depression and bipolar disorder, for instance? I think it’s possible for a person to suddenly “snap” from something happening in their life when they hadn’t had too many problems in the past. I grew up with a fairly happy childhood until my dad got sick in 1999. Then something in my brain “clicked” and before long I was out of control. One counselor told me I was schizophrenic because I heard voices and saw creatures, but nowadays I don’t really experience that as much. I wonder if some diseases just go away on their own.

Since then, I’ve been diagnosed with bipolar disorder (in 2000 or so) and am not taking any medication for it. I was on Paxil for a year and I agree that sometimes the meds can do more harm than good. At least a dozen medications later and I can vouch for it. I seriously feel like the Paxil ruined my body because I have been sickly ever since taking it, even though I stopped taking it a long time ago. I do go to therapy, but it’s covered by my insurance and it’s nice to just go in there and talk for an hour, because as much as I like to think Livejournal is my therapy, it’s not, hehe.

Some parts of my life are better since Dad has died, in the sense that we don’t have this depressing burden living in our home. Dad was suffering so much that we prayed for him to die, and he finally did a year ago. At the same time, I still have VERY erratic moods and can become insanely angry in seconds. Makes me wonder if I want to go back on medications. Frankly, I’m scared to.

I’m going to give your website a look-see.