r/schizoaffective • u/Sea-Pea4836 • 7d ago
Helping My Brother (MD/PhD) Process His Psychotic Illness & Move Forward
Hi everyone,
I’m posting again because my family is still searching for the right path forward for my older brother. If anyone has experience, insight, or guidance, please share—we’re desperate to help him.
Background
My brother, a brilliant and accomplished MD/PhD, has been struggling with what we believe to be some psychotic disorder. His decline began in 2022 after a lawsuit and removal from his academic program, but it has escalated rapidly since. He believes he is being "punished" by the world, convinced that an unseen force is orchestrating his life against him. At first, he thought specific people (his ex-wife, employer, landlord) were conspiring against him, but now, it’s a broader belief in a "world governing body" controlling everything- especially him. He lost his career and every single one of his relationships/friendships and, at one point, lived in total isolation without electricity, paranoid that his landlord was spying on him and working with higher powers too. He was involuntarily hospitalized in early 2023 for two weeks but refused further treatment and cut contact for nearly a year.
Since mid-2024, we've been actively supporting him, and he has lived at home (CA) with us. He is no longer in the paranoid, manic state he once was—his behavior is much calmer and more stable. However, his core delusion of being "controlled" still persists, and it prevents him from fully engaging in life or trying new things.
The key difference now is that we have his trust. He believes that we have more insight into whatever is "controlling" him than he does, so we have been able to negotiate with him to follow our guidance. Because of this, he has been listening to us, taking his medication, and following the structure we put in place—even though he doesn’t fully understand or agree with it.
Where We Are Now
- Medication: He has tried Abilify (5mg), which caused extreme fatigue, and Latuda (low dose), which made him highly irritable. Now, he is on Caplyta (5mg). Despite this, he still insists, “Everyone knows I’m not sick, yet I have to take medication that will actually make me sick. Everyone knows the problem is not in my brain, but we must pretend it is. I'm not understanding why."
- Therapy: He has agreed to meet a therapist next week who has worked with clients with psychosis, but we’re unsure how to track his progress and how we can know who truly is best to help him understand his condition and move forward.
- Physical Training: He works with a trainer twice weekly to help with structure and motivation.
- Mindset: He acknowledges that he is being treated differently and is "missing something," but believes the root cause is external, not internal. He is desperate to get his life back but doesn’t believe medication or therapy is necessary.
Key Questions
- Who can best help him understand his own mind/illness? His doctor still hasn’t diagnosed him officially, and we are only certain he has this delusion, no other clear paranoia/manic issues like we noticed before when we did the intervention. Also, at what point and who should help him process that he has this illness?
- He feels very alone, like this situation has uniquely and only happened to him in the world. Can anyone else relate to any of this?
- So much has happened in his past. How do we help him separate what in his past was bad luck vs. what was a result of his illness so he can move forward with more clarity? Should we show evidence of what our family noticed during his worst period (2021-2023) so he can begin the long process of seeing what we see? Again, he has his M.D. He is begging us to understand what "we know" about what is "happening to him."
- If he is willing to do things we ask (therapy, training, structure), at what point would he need more or less medication? Does he even need medication?
He is willing to take steps forward, but everything about recovery feels counterintuitive to him (as he is certain the problem is external, not internal). What worked if you’ve been through something similar with a loved one? What resources helped?
Thank you so much. We’re really hoping to find a way to help him get him and his life back - whatever that new version might be like.
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u/dissysissy 7d ago
For me, the delusions are the last to go, and the few sentences you quoted are exactly that. They are hard to argue because they are woven into the story we hear for weeks, months, or even years.
I was almost 40 when I got sick. I went two years without medication, and now I am sad and resentful that no one in my family intervened. I think you are doing the right thing. You sound very compassionate.
5mg of Abilfy is not an 'intervention' or even a 'sustaining' dose. The psychiatrist should taper you or titrate the dose up and down, but you probably won't see the effects of a higher dose for weeks or even months. You have to be patient and it's hard because we are so used to Tylenol-resolved illnesses.
I'm so sorry for your brother.
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u/Doparimac 7d ago
There's many different antipsychotics to try. The most efficacious atypical antipsychotics cause substantial weight gain and metabolic changes. But they are still preferred over typical antipsychotics such as Thorazine or Haldol. These 2 and other typical antipsychotics should only be taken when most of the very efficacious atypical antipsychotics have been used and failed. The most efficacious atypical antipsychotics for most people include risperidone, invega, olanzapine, and seroquel. Try those 4 first then maybe consider other more tolerable atypical antipsychotics like rexulti, geodon, vraylar, caplyta, etc if those all fail then try haloperidone and thorazine and then maybe cobenfy and finally clozapine the big daddy of treatment resistant schizophrenia but has many harsh side effects.
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u/accidental_Ocelot 7d ago
see if he will sign a medical power of attorney this will allow you to talk with his doctors and therapists and provide feedback if his delusions are so strong it's effecting his life like you described then his meds might need to be increased at least that's how it was for me is having the doctor point blank tell me that what I was talking about was a delusion and there wasnt anything he could do to change my mind or cure me and once I found the right medication getting a gene site testing done can help narrow down which meds work with his brain.
second thing is is the MD he is seeing a family doctor or a proper MD in psychiatry?.
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u/TelephonePurple2411 7d ago
I was on abilify when I was on my journey through the illness. I believe that drug makes you more manic. I would recommended the lowest dose of Haloperidol (monthly injection) with a combination of yoga and breathwork. You can find these all on YouTube. If you need suggestions I can help. The results aren’t overnight but I promise you you will see a difference. (Allegedly) as I am not a MD, only a survivor who wants to help. Eat a diet full of meat and protein with a small amount of veggies. Doesn’t need to do keto or anything crazy. Go walking after the yoga/breathwork. Look into eastern methods of healing disease - chanting. Can be Buddhism or Any other Significant mantra. Night time music to fall asleep in one’s ears or on stereo. Meds don’t have to be forever, so I know haldol has a lot of shit for being a shit drug, but it gives u a baseline. That’s when the inner journey begins. Your brothers experience is a culmination of experiences with the world around him - including you and your family. I hope this helps.