A close relative, male, 50-ish, an actor by profession living in California has become very delusional. He sees pornographic images in photographs of his family and has most recently started seeing these images in pillow cases, slipcovers, drapes, etc. He destroys this pictures, and he has done a lot of destroying, in various very detailed ways. He does seem to be able to carry on in a normal way, casual friends or observers would notice nothing unusual and he seems to understand that he needs help. However his family, his wife, sisters, etc has encouraged him to see medical help for last several weeks, no clear evidence that he has. He has no history of any mental disorder or violent behavior. I am very concerned and am of the opinion he should be in some form of treatment immediately, would like your opinion regarding prognosis and treatment options.
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What you’re talking about here (with the visual hallucinations and delusions) is something in the psychotic or ‘schizophrenia’ spectrum of mental disorders; possibly paranoid schizophrenia with a late life onset, possibly something else. It will be important to evaluate any medications or drugs that your relative might be using (legal and illegal) – some drugs (cocaine, amphetamine and other stimulants in particular) can create hallucinations and paranoid delusions and should be brought to the attention of a doctor immediately. Psychiatric help is needed – not just medical help. There are excellent medicines today that calm down psychotic symptoms. In many cases, these medicines can make continuing normal-ish functioning possible for people who otherwise would be in bad shape. The sooner your relative is properly evaluated and set up, the sooner he can benefit from whatever treatments are appropriate.