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Ask the Experts

Question:

What is my last hope for getting help for my 47 year old son? He has refused all contact with me for five years because I tried to get him to a doctor for evaluation. He is a binge drinker, and a coke user, and he has many delusions (that he gets messages from the TV, that he wrote an entire season of "The Sopranos," that various entertainment personalities visit his house when no one else is home, and on and on).

He holds a master's degree in business and was an investment banker until he just fell apart.

What can I do?

Answered by: L. Fredrick Jarskog

Some people who develop schizophrenia or a related psychotic illness have very little insight into their illness and often refuse psychiatric evaluation and treatment. This frequently leaves family members feeling frustrated and helpless.

In this case, the situation is further complicated by substance abuse.
There are several things to consider, although there is no clear answer. Obviously, he did not appreciate your efforts to help him receive treatment in the past. This may be especially true if it resulted in an involuntary hospitalization. If your son is willing to accept help from other family members or friends, appealing to them may be a way to get him to reconsider treatment from someone other than yourself.

Eduction about the benefits of treatment would be a good place to start. If he is willing to get help or treatment for any of his problems (substance use, a medical problem, social/functional problems) this could also represent a way of beginning to involve him in a system of care, even if he is reluctant to address the mental illness at this time. Given the severity of his substance use, this problem may by itself bring him to the hospital and represent an opportunity to initiate treatment for his mental illness.

Finally, if you are not already a member of NAMI (National Alliance on Mental Illness, you should consider joining (www.nami.org). This is a useful way to meet families with similar concerns. It is a place for education and support, and to learn how to access help most effectively in your area.