Dear Lauren,

I'm 16. Last year my older sister, with whom I used to be very close, came home from school distraught, saying kids in her class hid webcams in her room and bathroom. My father said it didn't happen because it wouldn't happen, and he sent her to a team of psychiatrists. She was put on and then taken off anti-psychotics. She was tested for schizophrenia and is not schizophrenic. She was diagnosed with delusional disorder, meaning she has one delusion about something that could technically be true but simply isn't, so it's considered paranoia and a mental illness, but everything else about her and her thinking is supposed to be fine.

She’s kind of eccentric, but she’s also very smart and very intuitive and so my question is: how do I know if there are really hidden webcams or not? Maybe the doctors were wrong? She says her classmates say things which they would have no way of knowing unless they had seen it from a camera or something. How do I respond? Do I assume she's making it up, or that she's confused, or do I assume that she's telling the truth?

She's asked me to call students and teachers and to read her texts and e-mails from them and to watch taped school events and to put together the year with her like we're detectives, so she can know how insane she is or isn't, so then she can be treated properly. She used to be so bright and full of life and she’s one of the kindest people I know. It’s also hard because if her situation happened to anyone else, she would be the one sitting and listening to the person until something, anything, somehow changed for the better, even if the only change would be that the person would feel heard and loved. Is there anything I can do? I’m just a high school student; I’m not a professional.

Lauren Roth's Answer

Psychotic disorders in a loved one or a friend are really difficult to deal with, for many reasons, foremost of which is that the person you love is not completely in reality. That is part of the definition of psychotic disorders: impairment in reality testing. And it’s really difficult and confusing to try and have a relationship with a person who is not completely in touch with reality.

It’s really difficult to live a life where you’re not sure what is real and what is not.

Psychotic disorders (of which delusional disorder is one, as is schizophrenia) are mental disorders which involve the presence of hallucinations. From what you’ve described, your sister’s diagnosis of delusional disorder seems correct.

So first of all, I do think the doctors are correct. Trusting their diagnosis might help answer some of your questions, like: “Maybe her classmates really did plant cameras?” Think about it: how likely, really, is it that classmates installed a webcam in your sister’s room? More to the point, why would they go to that trouble to do something costly, difficult, and probably illegal? Trust the doctors on this one; they are right. Trusting their diagnosis might allay some of your concerns.

I guess you could term your sister’s delusions “confusion,” but that doesn’t really define what she’s experiencing. We have all been confused at times. Confusion is too benign a word for what your sister is experiencing. Delusions are a more severe type of confusion, in which reality is just not stable. I feel for you, and I also feel for your sister. It’s really difficult to live a life where you’re not sure what is real and what is not.

I think part of your uncertainty regarding how to interact with your sister stems from the nature of delusional disorder itself. When someone has schizophrenia, it’s easier to realize that they are not in touch with reality. On the other hand, delusional disorder involves hallucinations of events that could actually happen, even though they are highly unlikely. Also, as the diagnostic manual of the American Psychiatric Association explains, “A common characteristic of individuals with Delusional Disorder is the apparent normality of their behavior and appearance when their delusional ideas are not being discussed or acted on.”

You cannot heal your sister, as much as you want to do just that.

The fact that your sister can function well in her life, at school, and in your family probably makes it confusing to you when she starts to talk about her delusional thoughts, because it seems that she’s “just a regular person” talking about something she heard. But please realize that her delusions are just that: delusions. They are not real, even though she truly believes they are.

I think the most important statement you made was your last one. “I’m just a high school student; I’m not a professional.” Please remember that, and don’t put pressure on yourself to heal or fix or “be there” for your sister in a way that you are not equipped to do. Even mental health professionals are not always able to dispel hallucinations of people with psychotic disorders. Psychologists, social workers, and other psychotherapists definitely cannot. Sometimes psychiatrists are able to help control patients’ hallucinations with the aid of anti-psychotic medications. I really want you to get this point. You are only a high school student, and not even a professional, and you cannot heal your sister, as much as you want to do just that.

Part of what is hard for you, also, is probably the fact that you used to be close to your sister. Delusional disorder’s age of onset is typically adolescence, not birth, so it’s probably really painful for you to have lost that relationship with your sister, to a certain extent, because of this disease. Tough stuff to deal with.

Be grateful for the good in your own life, and don’t let guilt overpower you.

So what can you do? Love her for who she is. Be there for her in the non-delusional areas of her thinking and life. Like you said she would do for others, you can help her feel “loved and heard” in the non-delusional parts of her life. Ask her psychiatrists how you should respond when she describes her delusions to you. They know your sister and her particular case of delusional disorder, and they might have a certain method they want family members to adopt when dealing with her lack of reality testing.

Again, it’s really difficult to deal with a loved one with a psychotic disorder. Your caring and love for your sister are evident in your question. Because you love her and because you used to be really close to her, I want to warn you about one more aspect of this situation. You don’t need to feel “survivor guilt.” Your sister has a heavy burden to bear, one which you don’t have. Be grateful for the good in your own life, and don’t let guilt overpower you. God obviously didn’t deem it necessary for you to suffer in the same way that your sister is suffering. Accept that as a gift, and don’t allow guilt to ruin the life God has decided to give you.