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Is This Schizophrenia?

Question:

A mother of six is living without food stamps, food and warm clothing. She is also trying to home school her children. They don’t have much interaction with the outside world. I am a teacher at a nearby school and have just met this wonderful family and I am very concerned. Mom is able to hold a conversation very well and is able to look after all six children. After talking with her she has explained to me that Jesus has told her to home school her children. He has also told her to become a Saint. And she has also said that Jesus Christ is living inside of her. She explained to me that His silhouette is right in front of her and He talks to her all the time but mostly when she’s at home. I am very concerned about this family. I don’t know what to do. Any advice? She said she hates doctors. When she had three of her children she delivered them on her own with Jesus. Please help. I don’t know who to turn to or what to do. I don’t want to break down the trust and the relationship that I have started with her. She doesn’t have anyone else.

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Answer:

This is a great question because it illustrates how deeply our understanding of odd behavior is influenced by the way we understand reality. If we come from a fundamentalist religious background of the type where Pat Robertson is a respected figure then this sort of thing might be interpretable to you as genuine religious experience. After all, Pat claims to talk to God, and so too have many revered religious figures throughout history, so maybe this woman is actually talking to God. Talking to God is not the normal religious experience, of course, and most established religious groups would, I think, frown upon anyone who claimed to have such direct gnostic access, but if you essentially believe that God is available to intervene in human affairs and does on occasion, then who can say for sure that this isn’t happening for this woman?

If, on the other hand, you come from a more science-based understanding of reality, then the idea that this woman is actually and literally conversing with Jesus becomes quite the unlikely possibility indeed. For one thing, we know that diseases like schizophrenia exist and that they (and various other conditions) can cause people to become psychotic, which is to say, unable to distinguish between fantasy and reality. Psychotic disorders can be associated with auditory and visual hallucinations (false perceptions) and delusions (false beliefs and ideas that are resistant to alteration). When we say that these perceptions and beliefs are "false" we mean that they are not shared by other people around the person who is experiencing them as true.

For another thing, we also know that when people have psychotic symptoms, they often will interpret those symptoms in religious terms. Believing that one is being visited by devils or angels is popular, as is believing that you are yourself a messiah, or are Jesus himself. Ever heard about the famous book, "The Three Christs of Ypsilanti" ?? That book was about one doctor’s experience doing group therapy with three psychotic patients each convinced that they were Jesus.

To summarize, it is common for psychotic people to have direct "religious" experiences and contact with God, while it is quite uncommon indeed for normal people to have such experiences. Further, when you properly medicate someone who is Schizophrenic and believes him or herself to be talking to God or an angel, they frequently experience a lessening of such symptoms, sometimes to the point where they are once again able to understand that they haven’t actually been talking to God and getting answers; it only appears that way when they are psychotic.

Given this sort of reasoning, which I and most other mental health professionals find quite convincing, it would seem that there is some sort of psychotic-style process happening for this woman you’ve met. As to whether this is caused by Schizophrenia is not something we can know without having her evaluated by a competent psychiatrist. Here is why.

Multiple and distinct problems can cause psychosis to occur. Schizophrenia, is one source of reliable psychotic episodes, but so too are severe forms of Bipolar Disorder, some severe forms of Depression, Schizoaffective Disorder (which is kind of like Schizophrenia mixed with Depression), some drug reactions (particularly to stimulant drugs like Amphetamine and Cocaine), and dissociative disorders. There is a "Delusional Disorder" that is associated with delusions (but not usually hallucinations) which is not Schizophrenia, and a "Shared Psychotic Disorder" which applies to otherwise sane people whose views have been shaped by psychotic people and thus appear psychotic. Psychotic reactions can occur in the aftermath of surgery or drug withdrawal, or even as a part of Alzheimer’s Disease and similar Dementias. A good mental health doctor can sort out which of these possibilities fits best by asking questions and reviewing histories. For instance, Bipolar Disorder can be ruled out if there is no history of mood cycling.

Something is likely going wrong in this lady’s head, I think, but I can’t say what. It is thus a shame that this woman is resistant to seeking help from doctors, because it is thus unlikely that she will ever allow herself to be diagnosed and thus get the help she would appear to need. This doesn’t mean that you shouldn’t try to help her get to a doctor. It just means that I doubt she will take you up on your offer of help.

What is especially a shame here is that she has small children and is potentially abusing them, in part it would seem, as a result of her unspecified issues. You are claiming that this woman has inadequate food and clothing for her children, which might qualify as neglect (a serious form of child abuse) if the deprivation is severe enough. To my mind, the homeschooling agenda is also suspect as a kind of social deprivation (or loss of the opportunity for socialization with a diverse peer group), but many people who are not psychotic choose to raise up their kids in this sort of isolationist mode and so this is less obviously abusive behavior. For better and for worse, our society allows individual parents to control what their children are exposed to and not exposed to as best they can.

As a teacher, you may be a mandated reporter of child abuse, meaning that if you become aware of child abuse, including neglect, that you are lawfully bound to report it to the relevant state agency charged with child welfare. You could potentially be subject to prosecution if you suspect abuse and do not report it (although it seems unlikely that this would actually occur). Check your state laws if you are worried about this possibility.

Ultimately, it doesn’t really matter if you are a mandated reporter of abuse or not, because you have (I think) an *ethical duty* as a decent human being and concerned citizen to report suspected abusive behavior to authorities empowered to stop that abuse from happening. So long as this woman minds her own business she is pretty much free to believe anything she wants. However, when children are involved and neglect is a real possibility, the state ideally needs to step in and force this mother to do some reality testing so that her children are at least minimally provided for.

You might start by simply talking to her about providing better conditions for the children. Maybe there are some church sponsored programs that you can recommend that she will be receptive to hearing about? If it becomes clear that harm is occurring and no change is on the horizon, then reporting child abuse would appear to be the right course.

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