J'accuse

Ever since we started doing psych, there have been uncomfortable flashes of recognition while reading lists of symptoms. And with them a growing burden on my conscience. Basically, I'm starting to suspect my grandfather has some form of psychotic disorder. It's been going on for 20-odd years, and my poor grandma has been suffering alongside him. For years everyone's dismissed it as just "grandpa being grandpa". As he refuses to see a doctor, there's been no attempt at diagnosis let alone treatment. Seriously he's an 83yo man who hasn't seen a doctor since maybe his 50's. The whole family has been complicit by ignoring the problem.

The evidence for:

• He has almost daily episodes of shouted ranting at neighbours and conspirators against him. Possible auditory hallucinations?
  
• He believes they ("they" being the Jewish mafia and suchlike) cause his aches and pains, and electronic devices in the house are used to monitor and control him. He's called my dad in the middle of the night to warn him about this kind of thing. He believes that chemicals are bad and refuses any kind of medication. Although he is otherwise rational, my dad has tried arguing him out of it many times to no avail. Fixed Firm False beliefs = delusions of persecutory flavour, as well as passivity.
• He didn't leave the house for years at a time, used to not pick up the phone, has no friends. Social withdrawal.
  
• He doesn't have signs of delirium or dementia: no fluctuating consciousness or orientation, nor obvious progressive cognitive deterioration.
• My uncle Bac Dai also had some psychiatric condition. I never met him because he lived in Vietnam, but from what I've been told, he was "like your grandpa". He died of dysentery in 2003 because he refused medical care. Fair enough, he also survived VC re-education camps and the war so who knows what exogenous factors might be involved, but it's at least a possibility that there's a genetic link.
  

The evidence against:

• From what I've heard, all this began when he was in his 60's, which is pretty far beyond the normal age of onset for schizophrenia (mid teens to 30's).
  
• In between episodes, he is pretty functional: lucid, intelligent, witty, courteous to guests. I think one of the reasons why nothing has been done is because only grandma and I have seen the worst; dad only comes over for brief visits, when he's on his best behaviour.

I talked to my mum about it, she said something like "I TOLD your dad to do something about it AGES ago and he never listened, but you know what a useless bastard your father is". I talked to dad about it, asked if it was a form of negligence that we haven't forced him to get medical attention? Because it certainly would be if it was a physical condition and not a mental one right?And it's no excuse that he didn't want to see doctors because he's hardly fit to decide that for himself. Dad started talking about the legal criteria for negligence and I wanted to hit my head in despair because it isn't a matter of bloody abstract principles, it's about how our whole family has turned a blind eye to suffering that could have been prevented or at least mitigated by treatment. What if it's something that could have been managed by surgery or drugs or hormone replacement or dietary supplements? Dad said it probably wasn't something organic since his personality had tended in this direction all his life-- though in that case personality could be a predisposing factor in a psych condition! What if a simple blood test could have saved 20 years? My grandma, a warm and bright and sociable woman, has isolated herself because she can never invite friends home for fear he'd blow up and shame her in front of them. If he'd been diagnosed, she might've had access to a carer's pension. If he'd been cured, she might've had a different life. What if, what if.

It's my responsibility. Living with my grandparents through my teens, I was close enough to know the worst. I was woken at 5am by his rants and heard him yelling awful things at my grandmother during his episodes. I remember thumping the walls to get him to shut the f up, and being glad when grandma quietly manoeuvred him so that he would be out of earshot while I studied, bearing the brunt of it herself. I'm not proud of that. Now, at a physical distance and with the more objective perspective of medicine, I can put a name to it as a problem that could be solved. The question is what to do next. He's 83. Should I shatter the status quo and stir familial shitstorms and force dad to force grandpa to see a doctor? It's a callous question, but is it worth it, when he might have only years to live? When antipsychotics might not even work and have all sorts of side effects? I know these are excuses. Maybe it's time someone stopped making them.