Need advice about handling situation with a close relative with schizophrenia(?)

Hello!

First post here, if I miss some of the rules, please let me know and I'll fix it! Also - I'll try to be brief, but I tend to write long, so apologies for the long post. But I'll always be happy to add more details.

Information about the ill person - my mother-in-law has schizophrenia. Or something like that. I don't know too many details because, well, I've never needed to know them, and it's a fairly unpleasant subject, so I haven't talked much about it. But she's had it for more than 20 years (for reference, I've been married for 13 years and have known my spouse for 16 years). Also the last time she saw a doctor was before I had even met my spouse, and I know that medicine in this field has advanced quite a bit since then. Any paperwork that she might have had about it is long gone as well, so I really don't know the precise diagnosis - assuming one was ever made. I know that some paranoia was also involved at some point.

To complicate things, she doesn't think she has any problems and doesn't want to see a doctor - or so I've been told. Nobody has tried to do anything about it in over a decade (more about that a bit lower). In her mind, she is completely OK, and everyone else has issues, except her. And, yes, that goes with a pretty toxic personality too. My spouse tells of a pretty unpleasant childhood with her. Although how much of that is her illness, and how much of it is "herself" is hard to say. Or even if there's any difference anymore.

Currently she lives with her mother (my spouse's grandmother) and is not working anywhere. As I understand, she just stopped showing up to her work one day and that was that. I don't know exactly when it was, but also before I met my spouse. She doesn't have any disability paperwork because she didn't go to the doctors enough. She's just unemployed and survives on the pension of her mother and the contributions of me and my spouse (we try to help as much as we can).

She doesn't tolerate stress at all and easily melts down, but since her life has been quite peaceful for a long time, she's OK to visit from time to time and doesn't cause any trouble. Our kids like her, since they've never seen her bad side.

About attempts at medication - this is what I know: she did go to see some doctors initially, but has never agreed that she has a problem, even after a diagnosis. She has taken some drugs which did actually improve her condition, but she never stuck to them for long. Some family members then tried to sneak the drugs in her drink/food, but she soon found out in each case and didn't accept food from that family member anymore. TL;DR - medication failed because she didn't want to be medicated. Eventually family members stopped trying to get her to a doctor or get her to take drugs, because it just wasn't working. Again, this all was over 16 years ago.

Current situation and my problem:

As I said, she has lived more or less peacefully with her mother for the past 16+ years. Unfortunately, her mother (I'll call her "granny" from here on) is getting quite old - over 80 years already - and her health is finally starting to fail. Usually granny went to a summer retreat for 3 months every year in our summer home (used to be a farm where granny herself lived and worked with her husband, but that was looong ago). This year however she was unable to do so. She attempted it, but two weeks in had to be rushed to the hospital, and ever since then she's stayed at home with my mother-in-law. She is not as mobile anymore as she used to be either.

Now, granny is super sweet and the nicest person I've ever known, but this situation is taking its toll even on her, so she's become less tolerant of her daughter's antics. On the other hand, my mother-in-law is getting stressed over the health of her mother, and, as I said, does not handle that very well. Long story short, instead of the usual insignificant bickering the two of them have had from time to time, this time they're really starting to get on each other's nerves. Both me and my spouse are worried about them.

Some options we've considered:

• Taking granny in with us. It would be a bit of a squeeze, but we could manage. However we have two kids (kindergarten and school aged) and between them they manage to bring in a new cold virus every other week. Being all reasonably healthy people, we just shrug it off, but for granny the last few times she caught a cold was already pretty challenging. We're afraid that we're going to harm her more than help her if we bring her in.
• Rent another apartment and move one of them there. Not very pleasant financially, but we could afford it. Luckily both me and my spouse make decent wages. However we're also afraid to leave granny alone. She's not very strong anymore, and her daughter does help her in daily tasks. Both renting and apartment and hiring a helper might be beyond our means.

To be honest, we just don't know what to do... It feels like the "right thing" would be to get some sort of help for my mother-in-law, but how to do it if she doesn't want to be helped? Or if we leave her alone, how do we help granny?

Hello, and welcome to PC.

Two thoughts come to my mind right away.

One is that while mental illness can be a challenging subject to discuss, avoiding discussing it because it's an "unpleasant subject" - well, that perspective might very well contribute to the woman's lack of medication compliance. I certainly wouldn't want to be thought of as an "ill" woman who is afflicted with an "unpleasant subject."

I am not a mental health professional, but I know enough about mental illness to ask what it is that indicates your mother-in-law has schizophrenia? What, exactly, are her "antics"?

Hi, Beth!

I think I might have left the wrong impression about not talking. It's not that we don't like to talk about mental illness or stigmatize it or whatever. When the illness first appeared, her family did try to address it properly. As I said, doctors were tried. Mind you, this was sometime around mid-90's. We're from a post-Soviet country and at that time had only recently regained independence. The state of medicine back then was not stellar to begin with. Nevertheless they did try what they could, but nothing worked. Eventually they just... gave up.

By the time I arrived on the scene, the dust had already settled. My future mother-in-law was now living in a safe, stress-free environment (alone with her mom) and everything was fairly peaceful again. I've never even seen her bad side (just hints at it, more below).

However for my spouse and everyone else the subject is an unpleasant one, since it brings back a lot of painful memories. So, I have asked some questions here and there, but I've never pushed them into telling the whole story with all the nitty gritty details. There has been no reason either - the situation was stable and nobody had any desire to do anything to upset it again. They don't even believe that much can be done (and perhaps they are right).

Ok, about the actual symptoms. As I said, I haven't witnessed too much of them myself, but enough to be certain that everything is not ok.

First off, there's definitely an element of paranoia. I've heard stories about how, when she still worked, she used to think that all her colleagues want to poison her. When I first started dating my future spouse, and for several years after that, she wouldn't leave the house, answer the door or the phone. If she was home alone, we had to schedule visits in advance and used a special pattern of ringing the door bell (which has actually stuck with us as a habit now). Thankfully, this has gotten better in the last decade or so. She can now go to the store, take out the trash and do other little erands, as well as is not afraid to answer the phone anymore.

For the actual "schizophrenia" part, I haven't seen much evidence, although she does definitely get various odd ideas quite often. My spouse says that she "sees things nobody else does" (mostly metaphorically, meaning misinterpreting the situation at hand), and that once they got a glimpse of a calendar where she had made some sort of notes and that it was nightmarish.

Then she also often laughs about things that nobody else finds funny (and haven't even been intended to be funny).

She has complained that at night somebody is shaking the house and she can't get any sleep because of that. This was some time ago, and back then I discovered that it's a real thing that even otherwise healthy people can sometimes experience. The cause and treatment are unknown.

Lastly, about the "toxic personality". That's how I labeled it, although perhaps it's not the best label. I haven't witnessed this, but my spouse has talked about it at length. She is never at fault for anything, it's always someone else's fault. She can go off and get angry for insignificant things and blow them out of proportion. She feels that everyone else is inferior to her. And she likes to manipulate everyone to make them do things for her so that she doesn't have to. She's smart and knows how to put things so that it always seems that she's the one being unfairly treated. My spouse describes living with her as "tiptoeing around her all day long, hoping that nothing would trigger her".

There's probably lots more, but I'd have to ask my spouse to dig up some unpleasant memories for that.

Mind you, we all still love her and would very much like to see her happy and healthy again. Although, I'm not sure she isn't fairly happy right now. Unfortunately that can't be said for people around her...

I'm sorry; your situation sounds complicated. I am aware, as much as possible, that the post-Soviet situation was extremely difficult in so many ways for the people.

It is impossible, and would not be ethical, for me to try to "diagnose" your mother-in-law. Sure, it sounds like she has mental health problems, though. Perhaps trauma and stress exacerbated her organic illness? Certainly governmental situations can cause immense amounts of stress for people, especially for those who are already somewhat fragile. That is just my thought.


How much space do your MIL and granny share? I'm wondering if the 2 of them might remain living together - but in a larger space so they don't have to interact as much. It sounds like the other options might, in the end, be even more troublesome for all of you.

The post-Soviet situation wasn't a paradise to be sure, but I doubt it had THAT kind of effect. I only mentioned it to say that the medical care she received back then was likely far from the quality people expect in the western countries. In the internet, the default assumption usually is that everyone is from the USA unless stated otherwise.

As for her precise diagnosis - that's not even what I'm seeking so much at the moment. From what I've heard, back then one label that was put on it was "paranoid schizophrenia", but I have no idea of how accurate that was, and our understanding of mental illnesses has also greatly expanded since then. It's quite likely that today she might get a different diagnosis.

What I would like to find out is... I don't know... some sort of direction to move in. Some ideas on what might be tried and what should be avoided.

What is the currently generally accepted best practice when someone has an obvious mental illness, but denies it and refuses to see a professional? AFAIK you can only force a treatment on someone if they become dangerous - but this is (thankfully) not the case.

About the space they share - It's a 3-room apartment. Not a very big one, but quite sufficient for two people. Can't avoid running into each other though. They've also lived there for the most part of their life. Moving to a bigger space... well it's an option, sure, but I think it would be pretty stressful for granny. I can't imagine at that age moving to a new place and making it feel like "home".

When you really reach inside, what do you think is the wisest option now and for the future?

Umm... If I had an answer, I wouldn't be posting here. So far I've had no ideas that I would consider good.

One last option is, of course, to go see a licensed professional (doctor). I know my spouse won't be thrilled about that, so I'm leaving it as the last choice. Before I do that, I wanted to try to find an internet community like this one where people with more knowledge and experience hang out, to see if they perhaps have some useful advice.

After all, I myself have very little knowledge on the subject. The only general principle I know of is that in all cases of mental illness (and, well, life in general) you should treat people with compassion and respect. Anger and insults will not help anyone. I'm more than happy to stick to that, but in this case, being the supportive shoulder is just not enough...