How do we deal with an angry FIL?

A fellow caregiver asked...

My father-in-law is really giving my husband (his son) a really hard time. Every day he calls my husband, accusing him of stealing his money and different things. My husband is the only child, so he has this to deal with by himself. He is so stressed and I really feel bad for him. His dad calls him all day while he's trying to work, and he also calls in the middle of the night going on over and over about the same thing. Could you please give me some advice?

Expert Answer

Kenneth Robbins, M.D., is a senior medical editor of Caring.com. He is board certified in psychiatry and internal medicine, has a master's in public health from the University of Michigan, and is a clinical professor of psychiatry at the University of Wisconsin-Madison. His current clinical practice focuses primarily on geriatrics. He has written and contributed to many articles and is frequently invited to speak on psychiatric topics, such as psychiatry and the law, depression, anxiety, dementia, and suicide risk and prevention.

I only have part of the story, so I am going to have to make a couple of assumptions. The first is that his concerns are not accurate; your husband is not doing any of the things your father in law is suggesting. If that is the case, your father in law is struggling with delusions, a form of psychosis in which someone has fixed, false beliefs. The fact they are fixed means trying to reason with him will not help; he believes what he believes. Even if you hire the worlds best accounting firm to go over his finances and reassure him that no one is stealing his money, he will not be reassured. He is likely to assume instead this accounting firm is part of the problem. I don't know if he is also demented, but if he is that would add to the problem and make it that much more difficult to stop the calls.

Since reasoning with him won't help, it is likely he will need anti-psychotic medications to help him. Before a physician starts such medications, however, it will be important he or she look for the cause of the delusions. There are a number of medications and medical problems that can trigger a psychotic episode, so that must be addressed first. If this is caused by a medication being used to treat some other problem, such as steroids, medications for Parkinson's disease or various psychiatric medications, the drug will likely need to be changed. If this is caused by an illness such as dementia, some other brain injury, thyroid disease or alcohol withdrawal, the psychosis may respond to treatment of the underlying cause. Unfortunately with dementia, we are generally unable to treat the underlying cause, though its progression can be slowed. If it is caused by a psychiatric illness such as depression, mania or schizophrenia, or if it is caused by dementia, it is likely the best approach will be the initiation of antipsychotic medication. There is a question I have addressed earlier on the caring.com site that goes into more specifics about antipsychotic medications.

Until your father-in-law's illness is properly addressed, I would not recommend arguing with him. It is likely only to further inflame his anger. I would suggest expressing concern about his belief, and then try to gently change the subject. Your husband may need to change his phone number at work and/or find a way to screen his calls. This may also have to be done at home. It is likely with antipsychotic medication the intensity of your father-in-law's delusions will decrease, but they not disappear completely.