She is not actually your problem. And the mental hospitals in your country certainly can keep people for more than a month. Where should she go? If there is a place, it's the business of the hospital to direct you to it or itself to keep her. And there is the question of medicines: are there any she can take that would work?

Another thought: paranoid schizophrenia can be a diagnosis of convenience. Maybe take her someplace for a second diagnosis. Bottom line, all the pain you may feel on behalf of your sister will avail you nothing and cost you much. Set limits for yourself and stick to them.

But all sickness is a community issue, mental illness especially so. Your bureaucracy is both intimidating you and bluffing you. Do what you can; be sand and gravel in their gears; don't accept no or can't. And keep in mind yours the ultimate power, because your sister can, and might just, do absolutely anything. And whatever that is, will be their fault. But no easy solutions here. And the best you can do is sometimes the best that can be done.

If your country has nothing, then two things: it's a barbaric state, and you need a different country - easier than replacing leadership.

Hi tim, thanks for your reply.

the mental hospitals in your country certainly can keep people for more than a month. — tim wood

They may be able to, but they refuse to do it. Not sure why, but it's their policy.

Where should she go? If there is a place, it's the business of the hospital to direct you to it or itself to keep her. — tim wood

Yes, but they told me that they are also unsure of where she should go, though they think it's probably a bad idea to send her back to my house, and I agree with them, but I'm still worried about what may happen to her and other who meet her if she just goes wherever she wants.

And there is the question of medicines: are there any she can take that would work? — tim wood

She started taking medicines when she got in the hospital, a few days ago. However, they told me that they were slow in taking effect, and that its effects are rather limited. Plus they told me that paranoid schizophrenia is incurable.

Another thought: paranoid schizophrenia can be a diagnosis of convenience. — tim wood

Maybe, but she definitely has persecution mania, screams like a maniac and has suicidal tendencies.

If your country has nothing, then two things: it's a barbaric state, and you need a different country - easier than replacing leadership. — tim wood

As much as I'd like to go somewhere else, I don't have the money to do it.

Bottom line, all the pain you may feel on behalf of your sister will avail you nothing and cost you much. Set limits for yourself and stick to them. — tim wood

True, I should also mention that although she is my sister, I never talk to her, I never had any kind of emotional bond with her (except when she went insane, which just made a bad bond. But even then I did my best to endure and ignore her), and know almost nothing about her life, besides her Illness. In short, she's not much different than an insane stranger to me.

And so I thought: Would I be willing to tolerate some insane stranger coming to my house to scream, harm themselves, insult me, and constantly complain about how being there makes them want to die? Of course not. Then why should this be any different?

It seems like you have quite a few family members. Morally, you should all work together to help your sister. Takes shifts in who looks out for her. At least until you can find a more permanent solution. It wouldn't be moral to leave your sister to the "wolves" but it also wouldn't be moral to place the burden of her responsibility on to one person's shoulders.

Good luck.

You simply cannot practically look after someone in such a fugue state as an individual while they are in that crisis mode. It is hopefully possible for the professionals to stabilise your sister, get her sleeping regularly and less paranoid and non-violent. There are drug treatments that can help, and a quiet un-stressful environment helps too. Gardening, work with animals, woodland management...

There is no morality that requires you to do the impossible, or what you have no idea how to do. Perhaps there will be times when you can help, but perhaps the family relationship will actually make it impossible for you to help, but on the contrary, will make your presence an aggravating factor. Perhaps, anyway, you have other things to do than take on this responsibility. Listen to the professionals, but with a little scepticism, and refuse to take on more responsibility than you can reliably cope with.

So, what would you people say is the most moral course of action in this situation? Where should she go? — Amalac

This is a thoughtful, generous, realistic, clear, moving, and deeply self-aware description of your situation. It allowed me to try to put myself in your place. In my mind, I substituted myself for you and my children for your sister and reran the tape. I have no advice for you or any moral opinion. I can only tell you what my heart tells me I would do, or rather, what I would not do. There is no way I could ever decide to cut one of my children out of my life. I could never tell myself it was not my problem. I would do something and continue to do something until something worked or until... All that is easy to say. Maybe I'm fooling myself. Who knows what I'd do if it actually happened.

I know - children are different than siblings. I have two brothers and one sister, all of whom I love. All of whom are 50 years old or older. What would I do? I'd like to think I'd feel the same as for my children except that it would be less intense. I'd be able to spread the responsibility out among the rest of my family.

Again, easier said (me) than done (you). This is not a moral question. It is a question for your heart.

One piece of advice - never take advice from someone you don't know on a philosophy forum.

It is a question for your heart. — T Clark

:100:

Morally, you should all work together to help your sister. Takes shifts in who looks out for her. — rocksteady88

That’s one option I have contemplated, but I doubt they’ll agree to do it (they’re quite a busy bunch). I’ll ask anyway.

You simply cannot practically look after someone in such a fugue state as an individual while they are in that crisis mode. It is hopefully possible for the professionals to stabilise your sister, get her sleeping regularly and less paranoid and non-violent. There are drug treatments that can help, and a quiet un-stressful environment helps too. Gardening, work with animals, woodland management... — unenlightened

I pretty much agree with everything you say there.

There is no morality that requires you to do the impossible, or what you have no idea how to do. Perhaps there will be times when you can help, but perhaps the family relationship will actually make it impossible for you to help, but on the contrary, will make your presence an aggravating factor. — unenlightened

That’s right, as I mentioned she doesn’t like being near anyone from her family (since she thinks we are all conspiring against her). The doctors tell me that wherever she stays, the person who takes care of her must stop her, by force if necessary, if she tries to leave the house; which means it’s probably a bad idea to have her live with somebody in the family, since that makes all the parties involved miserable.

But then what should we do? Just leave her on her own? I am concerned of what people might do to her if she wanders around dangerous places, as well as what she might do to herself or others.

Listen to the professionals, but with a little scepticism, and refuse to take on more responsibility than you can reliably cope with. — unenlightened

This is pretty much what I’m currently doing.

Yeah, you sound like a caring responsible sensible person - bad luck! :wink:

It is a question for your heart. — T Clark

And easy to say, but the heart is not a corporate strength, professionally competent 24/7 caregiver. And as well the heart has to reflect and make sure it is not serving its own purposes - which it often does. That is, sometimes the heart must yield.

I should add that the mental asylums in my country cannot permanently keep people there, they can only keep them there about a month or 20 days, as I said before. — Amalac

Which country is that If you wanna share it of course? Really seems extremely weird to me that there aren't places as to keep permanently people with mental illnesses. Are they spread all over the streets everywhere?? Are there only private mental hospitals that you have to pay for and your family can't afford it?

Your problem is really serious and I really wish strength for you and your family. And I hope things to work out at the end.

As for your question, imo, the moral thing to do, is whatever is the best for your sister.And that's clearly to go to a mental hospital where she could get proper help.
If there isn't indeed any mental hospital (even private) in your country, then you should try to send her to another country's private hospital. I know that it won't be easy. Especially if money is an issue for your family. But try everything as to gather it.

Make a serious discussion with all the family members (even distant members), ask for their financial help (it is not a shame at all, you are family after all and they probably know already your situation). Send emails everywhere to each one hospital in your country or other countries too describing your situation.
At a desperate effort, even ask for donation as to raise money for that. Go for it via Internet etc. Remember the goal is one :"Get your sister in a place where she could get help" so chaise it till the end.

I know of course that things won't be easy as I describe it but I hope you get my point. The moral thing is clear here. She needs help from experts. End.

And don't you ever feel guilty for locking up your sister to a " crazy house"! Or that you " abandoned " her. Always remember that when that thoughts cross your mind.
Your sister suffers clearly. She needs help clearly. If you suffer also by having to live with her it won't change anything at all. It will just make suffering persons 2, and that's all.
Maybe it will be even worse cause your suffering would cause more conflicts with her and that's worse for both of you. Just try to be supportive to her in all that long way. Just be there for her. That's your "moral duty" imo.

Good luck my friend.

Which country is that If you wanna share it of course? — dimosthenis9

Costa Rica

Really seems extremely weird to me that there aren't places as to keep permanently people with mental illnesses. Are they spread all over the streets everywhere?? Are there only private mental hospitals that you have to pay for and your family can't afford it? — dimosthenis9

Well, I meant excluding those who are completely and utterly insane, like a man who seriously believed that he is a dog. I think those kinds of people may stay at mental hospitals permanently, but since my sister is not completely insane, they can't have her staying there for life, even if we wanted to pay. Such is, I believe, their policy, but I'll ask them for more details when I have the chance.

Especially if money is an issue for your family. — dimosthenis9

It is quite the issue, yes (though most people in my family aren't poor either).

Make a serious discussion with all the family members (even distant members), ask for their financial help (it is not a shame at all, you are family after all and they probably know already your situation). Send emails everywhere to each one hospital in your country or other countries too describing your situation.

At a desperate effort, even ask for donation as to raise money for that. Go for it via Internet etc. Remember the goal is one :"Get your sister in a place where she could get help" so chaise it till the end. — dimosthenis9

I suppose that's a possibility, the only problem is that I'm quite distant with the people of my family, so I'm unsure if they'll help with money, but I could try asking for donations online.

you suffer also by having to live with her it won't change anything at all. It will just make suffering persons 2, and that's all. — dimosthenis9

Yes, I think the same. And my gut feeling is that she should not come back to my house. But I still feel uncertain.

I work psychiatry currently. I can not speak to the practice of psychiatry in your country, nor will I offer medical advise of any kind regarding specific medications or courses of potential treatment; without assessing your sister it would be unprofessional and, in theory, could result in me losing my ability to practice.

However, I will offer this: Firstly, if you do not feel safe with her in your house, using your definition of safety and no one else's, she should not be there. If you feel unsafe with her, expecting someone else to be safe with her may be unrealistic, therefore, there is a distinct possibility that no one elects to take her in. In that likely event, she will be left to wander as she sees fit. I pose this to you: If the positions were reversed, you are the one causing others to feel unsafe, you are the one whose behaviours and perceptions are causing others to be fearful and are disrupting their lives. Would you be comfortable being passed around the family, the proverbial "Hot Potato" that no one really wants but everyone feels they must be saddled with from time to time, because "we are family"? As you pointed out, you have no more attachment to her than a stranger, therefore, why is she getting more from you than a stranger? I have seen families burn out, sacrifice a great deal, and the end result is exceedingly poor. How much will you sacrifice, knowing at the outset that the end result will likely be exactly the same for her?

I understand the good of the many outweighing the good of the one, and the sentiment behind the good of the one outweighing the good of the many, but endorsing the ambivalence of the one outweighing the good of the many seems truly odd.

Again, I do not know the specifics of your sister's case, only what you have provided, and I do not know the specifics of your country's system, so will not tell you what you can or cannot do. I simply do not have that information. How lucid and how often and for how long make a huge difference in treatment. I agree with the care facility, most people with schizophrenia stop taking their meds eventually and then decompensate and require readmission. Lastly, your medical system may be telling you they must release her as a means to apply pressure to family to provide for her instead. If your family is truly unable to provide for her, then nothing they say will change that, which is also true if it is a simple refusal, however, if there is ability and uncertainty, then perhaps the pressure will have you solve their problem. This is done in North America as well; frequently families are loathe to take home those they feel will be uncomfortable to live with, citing an inability to care for these individuals. The story changes when the hospital calls and says that grandma is going to live in the street. Suddenly someone finds an unused portion of the house to renovate and grandma has a place to live for a few more years.

Having said that, I have never seen Grandma get thrown out of the hospital, unless she chooses to leave on her own.

Hope that helped a little.

So, what would you people say is the most moral course of action in this situation? Where should she go? — Amalac

Where she chooses. Even though her connection with reality is diminished, she ought be involved in any decisions made about what happens to her. All you can do is provide whatever support and advice you can. But take care not to feel responsible for her choices.

Go with your gut.

Have you heard of Protagoras?

I feel really bad for you and your sister. Before hitting the "ethical conundrum", it's maybe worth considering whether, even with sacrifice by yourself, there's actually a good option at all. You can't actually promise to take care of her, however much you may intend to do just that: shy of sending your own self mad, and keeping her a prisoner to boot, she's always going to be capable of (and perhaps sometimes inclined toward) a bad ending.

Okay...

What would you advise to a friend in the same situation, and why?

She's your sister, not your child. Your father bears more familial responsibility, and "I've got work to do," is still an abdication of that responsibility.

Ultimately the decision has been begun at a very high level. The state has a choice in either funding skilled professionals to take care of its most unfortunate citizens, or else going "Fuck it, she ain't paying taxes, who cares?" Before you risk blaming yourself, both your country and your father have passed on this problem. Your sense of responsibility is third-hand at best.

Making yourself miserable for an indefinite period of time, probably forever, with likely no respite in your sister's misery, seems to be multiplying suffering, not minimising it.

You will naturally want to strive to help your sister, she's kin. It doesn't follow that you can. Our altruism toward others is old and won't necessarily find resolution in the society we live in.

Are there other organisations, aside from family and state, who are equipped to assist? Will this cost, and is it possible to raise the money? (Your father, other family, crowd-funding, state funding?)

I'm very sorry to hear about these issues you are having with your sister. Mental disorders are extremely complicated to deal with, and absent some good professional care, it's hard to say much that will be of help.

Assuming her condition is one which ebbs and flows, that is rises to manic proportions and comes back down again, you could try to talk to her when she's in a relatively reasonable frame of mind, try to tell her that she needs professional help and possibly medication. In these moments you might want to point out that there is no reason why anyone would want to harm her, to the contrary you love her and want to help. The crucial part here is finding the right time.

Having said all this, I think you are aware that she is not your responsibility, which is not to say that you shouldn't care, not at all, but only that a person who is in such a state can only be helped to the degree that they want help. If they refuse it at all costs, then you cannot physically force her to go anywhere. I know it's easy and understandable to feel guilty, that means you are an empathetic person, but try not to let that escalate into guilt.

Good luck.

Sounds like a very challenging situation. Hard to comment on specifics unless one knows the ins and outs. I've worked in the area of mental health for many years.

In most countries few people stay in a psychiatric hospital for more than a few days or months. In my country, Australia, the average stay in a psychiatric facility seems to be 7-15 days.

In the latter half of the 20th century most countries practiced deinstitutionalization. The approach is treatment in the community.

Generally paranoid schizophrenia may respond well to anti-psychotic medications and mood stabilizers. If treated, people can generally manage their own affairs in their own apartment in the community. I have known many people with the symptoms you describe who respond well to medication and were happy to receive this treatment. But not everyone wants to take medication and this aspect may present its own challenges.

You'll probably get more helpful advice from people in a similar situation to you. Seek out as many forums as you can more related to this topic and they might be able to point you to some resources available in your area.

Failing that simply sit her down and talk to her when she is in a lucid state and ask her what she wants. For her general health it is known that irregular sleeping patterns are usually a sign of an upcoming episode. Regular exercise, meals and routine could help you all out an awful lot.

Note: If you know of any dietary issues in your immediate family (allergies and such) avoiding these foods could be worth a try too.

Overall focus on the bold text above ^^ Good luck to you and your family. Hope for the best but expect the worst and you'll all get through it somehow :)