a middle-aged woman with hallucination

I only met this patient once in a video call. But the situation was so dismal, I would like to talk about it even though I only had very limited information. 

The patient was a 46-year-old woman. She had two failed marriages, which left her two kids, one 22-year-old daughter and one 12-year-old son, and her daughter was with her in this video call. She might have a part-time job, but I was not clear about how she made a living for her and her family. 

She claimed that there was a certain male who cared about her very much for a long time. She first began to sense the existence of this man about 6 years ago when she was still in her second marriage. Because this man did not want to break her marriage, he never presented himself, but she knew that he would always protect her and help her. 

After her second divorce, she saw the face of this man from time to time in magazines or on TV. She believed that this man loved her and wanted to marry her. About two weeks ago, she heard this man calling her in her neighbor’s house. So without talking to her neighbor or getting their permission, she just broke into her neighbor’s house, which led her to be sent to ER. Afterwards, she saw a psychiatrist and began to take psychological medicine under the supervision of her daughter. And this video call was a follow-up. 

At the beginning of this video call,  the patient was calm and polite. She spoke softly, slowly and smiled regularly, so I did not notice that she was abnormal. Later, when she began to talk about this man who loved her so much, it was very obvious that she had a delusion and hallucination. The nurse practitioner who talked to her in this video call kept reminding her that the man was not real and only her delusion, and she should keep taking her medicines which would make her better. However, the patient insisted that she was 100 percent sure about the existence of this man. In addition, she could clearly see the face of this man earlier this week. Apparently, she had never clearly seen the face of this guy because he always had a mask on his face. Therefore, she was more assured than ever about this guy, and even if everyone in the world told her that she was crazy and he was only her imagination, she still believed in him. 

Then she told her daughter that although she knew her daughter cared about her and wanted the best for her, she was fine because of this man. She did not want to keep taking her medication, because she already got this man’s help and support. As long as she had this guy, she had everything she needed in this world. 

With the proceeds of this conversation, her daughter became more and more upset. Later, the daughter began to argue with the patient, and recalled the distress, agony and desperation she caused to her family, especially to her. It seemed that the patient accused the daughter of having sex with her step-father, and colluding with her aunt against the patient before. The daughter said that she knew that her mother was not serious about these allegations, and she only said them because she was sick, it was still very hurtful to her. The daughter begged her mother to take the medicine and get better, but the patient still claimed that she did not conjure this man, and she was fine because she had the love and support from this man. At the end, the daughter wept, but the woman still did not want to take the medication.

Finally, since the patient refused to take the medication, the nurse practitioner said there was nothing they could do at the present time. Nevertheless, she urged the patient to think more about her children and reconsider her position. It was so unfair to put all this stress of taking care of a mentally ill mother and a young brother on the daughter, who was only 22-year-old. The daughter was so young, and she should have a wonderful life ahead of her just like her contemporaries. But her chance of a happy life was ruined by the mental disease of the patient, and how could a mother do such cruel things to her children if she could alleviate the situation. The nurse practitioner also reminded the daughter that if she sensed the patient had any intention to harm herself or other persons, she should call 911, and ask the authority to forcefully treat her mother.

It was such a dismal situation. This middle-aged woman craved affection, protection and support from a male so much, she made up a person. Mental illness hurts the patient as well as the loved ones of the patient so much. I was very sorry for her daughter. She had such a heavy burden of taking care of a sick mother and young brother. I hope this patient could take her medication and have her disease under control.