General Question

Jeruba's avatar

If I think someone may be psychotic, how do I speak to them?

Asked by Jeruba (55823points) December 26th, 2023
24 responses
“Great Question” (5points)

If they’re experiencing a reality that I can’t see, do I comment, ask questions, or just leave it alone?

What if they seem to be experiencing hallucinations or delusions?

What if they’re insisting that I acknowledge something that I can’t see or hear or feel? Do I just agree with them? Do I tell them what’s really there? Do I try to persuade them that what they’re experiencing is not real? Do I lie? Do I take notes?

If I don’t go along with their misperception, how do I deal with their anger?

Is the goal to placate them, to reassure them, to create doubts in their mind, or what?

This isn’t someone I can just walk away from, at least not in the long term.

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canidmajor's avatar

Consult a professional, ASAP. Maybe get a referral from your PCP, they can probably recommend an appropriate practitioner. If this person is delusional, they may pose a threat. Tell everything to the professional, and when you make an appointment, be sure to mention that this is an immediate concern. These behaviors could escalate into violence, you may have to consider that this person should be committed to be properly treated.

Please waste no time.
Thinking of you, fingers crossed that this can resolve well.

chyna's avatar

^I concur. Do not let them put you and the other person off even for a few days. This seems very dangerous. If you can’t get a medical professional immediately, then call the police.

JLeslie's avatar

Are you going to be visiting with someone who has diagnosed schizophrenia? If so, they most likely know they hallucinate and as long as they aren’t feeling very paranoid where they might act out, you probably will be able to interact with them without much trouble. If they ask you if you see something that’s not there you can just tell them you don’t see it. If they have some sort of delusional story you can use benign responses and let doctors deal with trying to bring the person back to reality.

Don’t be combative, I wouldn’t think you would be. They might be very glad you came to visit or if they are very out of it, especially if their medication isn’t well adjusted yet, they might seem kind of out of it and it might be sad or frustrating for you.

If you mean you think someone you know is hallucinating and they need medical help for a new diagnosis that’s something else. Are you trying to help them or convince them to get help?

I’ll send the Q to RedDeer.

Hawaii_Jake's avatar

This is very difficult. When I do this, I have security personnel nearby.

Think of your safety first. Get to a safe place behind locked doors.

If they are jovial, let them know you’re happy that they are happy.

If they are angry, get behind a safely locked door and call the police. Yes, placate the aggressor until you are in a safe place.

If they are rarely angry, you have little to fear. Sudden shifts in hallucinations are not common. The vast majority of mentally ill people are not violent.

Good luck.

Jeruba's avatar

Thank you all so much for your thoughts and concerns. I am not with the person now. I expect to visit with them soon. Lately their text messages have been strange, citing indescribable experiences and complete absorption in some kind of mental state.

There’s been no diagnosis, and no meds.

I saw them a few weeks ago, and things were not right, but they were nonthreatening. A lot of weirdness followed by text, with all the usual possible miscues—absence of expression, tone of voice, context, etc. And then sometimes they seem perfectly normal.

But when they insist that x is the case, and demand to know if I can see x, and do I believe x is there, or (getting angry) asking if I am being dishonest and just humoring them, which is disrespecting them; and in fact I don’t believe x is the case, what do I say?

If a person were in their right mind, would they ever even ask if I believed their experience was real?

What might happen if I said I thought they ought to see a psychiatrist, or that I believe they are hallucinating?

janbb's avatar

I have no answers but I am sorry you are in such an anquishing situation.

i assume the person you are going to see is not in any kind of controlled or supportive environment since they are not on any meds?

Hawaii_Jake's avatar

Thank you for that important clarification omitted in the OP details.

I simply wouldn’t visit them.

JLeslie's avatar

Oh my. I think it’s hard for us to really know the exact situation. It probably makes a difference if they are closely related to you, trust you, and if they feel very afraid. Will you be alone with the person? Do you think they need to be evaluated? If you have a local behavioral hospital they might have a 24 hour walk-in department.

It’s unusual for hallucinations to start in later adulthood. Women get diagnosed later than men on average, women usually 20’s or even 30’s. Men it’s usually late teens or in their 20’s. Not sure if that’s helpful to you.

My grandfather was schizophrenic and we played checkers and he interacted with me a little, but he was fairly absent of being able to really interact with us. He was also slightly hard of hearing making things worse. When he was younger he was more competent though, I knew him when he was in his 60’s and older. He held down a job during his entire adult life and was quite intelligent, just schizophrenic also.

When I worked with schizophrenic patients (I am not a psych or medical professional, but I worked in a behavioral hospital) they mostly wanted to get better, and were calm, and thankful for help, but the random rare patient was violent, either out of fear or frustration.

janbb's avatar

@Jeruba I’m wondering if you could arrange to visit with them in a semi-public place such as a coffee shop or a library? That way if they do become violent, there will be people around and you will be safe. As for the question of validating their delusions or not, could you say, “I believe that you see them” or would that only anger them?

Tropical_Willie's avatar

Get a professional; you talking to them . . . is not what they need !

Like someone on opioid overdose, they need Narcan not someone talking to them.

LuckyGuy's avatar

Serious question…
Must you go alone? Would it be helpful if someone from here went with you? Would that be beneficial for you?

Hawaii_Jake's avatar

I’m sorry this is so difficult. My training is too work with individuals who are somewhat receptive to aid. I’m feeling this is above my ability.

When I have worked with individuals who were not in any program, I simply remained cheerful and played along with their hallucinations. If they asked me to interact with their hallucination, I would say I think it’s best for them to interpret for me.

flutherother's avatar

I can only answer from what I have read, but it’s better to focus on the person’s feelings rather than confirming or denying their experiences. You can say things like “I understand that you see things that way, but it’s not like that for me”. You could also ask them if there is any practical help you can give them and it is important to respect their wishes and discuss things with them rather that trying to take over. In their more lucid moments, you can plan with them how best to respond in any future crisis.

I’m sorry you are going through this and it might also be worth looking at what support might be available for you as a carer.

LostInParadise's avatar

@Jeruba , Could you give a specific type of thing that they are seeing and asking you about?

janbb's avatar

Is this person asking to see you?

smudges's avatar

I’ve had this happen. I was at a friend’s apt. and we were getting ready to go out for the evening. She began talking about the blood on the wall and I asked what she meant. She said “Don’t you see it? It’s all down the wall coming from the top. It’s running down.” I said “No, I don’t see anything.” She continued in this vein for a while longer, saying someone might have been murdered in the apt above her and should we call the police.

Because of my own issues and having been in a psych hospital, I figured she was hallucinating and was either bipolar or schizophrenic. To be honest, I was a little scared; I was in my mid-late 20s. I asked her if she wanted to call her doctor and she said no.

Basically I just gently denied seeing what she was seeing, but acknowledged that she did see it. Some part of her seemed to be lucid because she agreed that it could be a halIucination. I asked if she had any meds she was supposed to take, and when she said yes I urged her to take a dose. I don’t remember if she did or not. We talked a minute about her diagnosis (bipolar), and in a few more minutes we went out as planned. I was nervous and thinking she shouldn’t be going out, especially to a bar, that she should probably call her doctor or go to a hospital, but didn’t want to argue or push her.

How do you know your friend has no diagnosis or isn’t on meds? not questioning you, just wondering if something is going on that you don’t know about Could you call a psych hospital and speak with someone to help you figure out how to deal with it? Would you feel comfortable giving your friend’s name if they asked for it? They could set up a police or mental health visit to your friend and your friend isn’t apt to know who called about them. Unless your friend is in their teens or 20s, they probably do have a diagnosis and may be supposed to be taking meds but either aren’t or they need a dosage adjustment. People just aren’t able to go through life being psychotic at times without it being detected and handled. The person needs help.

I hope something I’ve said here helps you handle it. Like others have suggested, perhaps you could just not visit them. I’m not sure if they would even notice that you didn’t. I think if it were me, I would probably call a hospital and get their thoughts, but you need to do what you feel comfortable with.

The questions you asked in the OP can’t really be answered, especially by a layperson. I would guess that each person, even each psychotic episode can be different and the only person who would really know what to do would be a professional Even they would be going on past experience dealing with this, education, and guessing what this particular person might do.

SnipSnip's avatar

Try to avoid being there. Say goodbye in his or her world. The advice used to be to never “play along.” The last I read about this was what I have suggested here.

kritiper's avatar

By phone or while beating a hasty retreat.

LostInParadise's avatar

The obvious solution is to walk away, but the OP is saying that is not possible. Why is that not possible? How are you related to this person? Are they a relative, neighbor, business associate? We need more information.

canidmajor's avatar

@LostInParadise, no, we don’t need more information, it is personal information, the statement that @Jeruba can’t walk away should be taken at face value. It is none of our business why.

KNOWITALL's avatar

I personally usually confront the delusions head on. Sometimes it snaps them back to reality, sometimes it enrages them, sometimes they cry realizing they need help. Whatever decision you make, I’m proud of you for just being there for them. Hugs.

Hawaii_Jake's avatar

Do not confront a delusional person outside a clinical setting with trained professionals, including security, in attendance.

YARNLADY's avatar

I discovered that my brother was aware that he was hallucinating and did not expect me to see the same thing. We mostly just talked about what we were planning to do together, and he sometimes said “just keep on talking and I’ll try to follow”

seawulf575's avatar

Sorry to hear you are going through this. I went through similar stuff with my dad from the time I was about 11 until he died 30 some odd years later. Of course I couldn’t escape him before I was 18, so I had to deal.

Dad saw spies out to get him everywhere. They were tasked with ruining his life. He went through several different phases. He was pretty sure mom was working with the spies and my older brother, who took every opportunity to pick a fight with dad, was not his favorite person. I often got put in the middle.

Some things I just shined on. Example: eating dinner and no one ever talked. One night, out of the blue, my dad just said “No.” and went on eating. We all stopped and I asked him “No what?”. He continued to ate and said “just no.”. Obviously he was having an internal conversation and had made a decision but didn’t want to talk about it. So we just let it go.

Other things were a bit more difficult to shine on. We lived on a cul-de-sac and one day a car was turning around and just paused in front of our house. Dad freaked out, running outside yelling at them to get out of here. Kinda hard to shine something like that on. We got him calmed down and pointed out it was likely someone just checking out the neighborhood or looking for an address. But he didn’t want to believe that so we didn’t push it.

The harder part comes on what to do for the long term. Dad needed help, but refused to admit it. We (mom, bro, and I) went to see a psychiatrist who really felt he needed help too. But because he wasn’t violent and really didn’t present any immediate threat we couldn’t get him committed. We did talk dad into going one time. The Dr. prescribed some pills but dad walked away feeling the Dr. was a quack. The pills remained untouched. Eventually I turned 18 and moved out. Mom divorced him and he spiraled down to where he was living in a tent at the state park. Eventually he pulled himself back up to at least where he could hold a job and support himself. But it was difficult to watch.

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