A diagnosis of schizophrenia can be a challenging and difficult pill to swallow, not just for the patient but for the friends and family of those diagnosed. But by understanding what kind of support systems these patients need, loved ones can help patients cope and adjust.
In order to help a loved one with this disorder, it is important to thoroughly understand the symptoms of the disorder and the treatment options available to patients as well.
According to the National Institute of Mental Health (NIMH), symptoms of the disorder (which typically show up between the ages of 16 and 30) fall into three categories: positive, negative and cognitive.
Positive symptoms are psychotic and can come in waves of varying intensities.
According to NIMH, delusions are “false beliefs that are not part of the person's culture and do not change,” and are often experienced by schizophrenics. These beliefs can be outlandish and bizarre or include paranoid beliefs that the person is being plotted against. Schizophrenics may maintain these delusions even if they are proved false.
Schizophrenics may have hallucinations (unreal sensations like sights, sounds or smells) that others do not experience. These can include the “voices” commonly associated with this disorder. These voices may seem to warn the schizophrenic, provide directions or sometimes there may be more than one voice carrying on conversations.
Thought disorders are common in schizophrenics and represent dysfunctional or strange manners of thinking. This could include disorganized, nonlinear thoughts and garbled descriptions. Sometimes thoughts may disappear abruptly from their heads, and some patients may create nonsensical words.
In the physical plane, movement disorders may be present. Agitated motions or repetition of movements could occur. Alternatively, some patients experience catatonia, in which there is absolutely no movement at all.
Negative symptoms tend to be harder to recognize and are often confused with other issues (like depression). According to NIMH these symptoms represent a “disruption to normal emotions and behaviors” and schizophrenics who display them may need help completing routine tasks like the upkeep of personal hygiene.
Examples include a lack of pleasure in normal life, unwillingness to engage or speak with others, or “flat affect,” in which a monotonous voice is used and there is a lack of facial movements and expression.
Cognitive symptoms are sometimes only detected during testing by a professional and are generally more subtle. However, these issues can disrupt a schizophrenic’s ability to function successfully at work and provide for themselves, as well as causing emotional distress for the patient.
These symptoms include difficulties with paying attention and issues with working memory, described by NIMH as “the ability to use information immediately after learning it.” Executive functioning, or how one comprehends information and makes decisions, can also be affected.
According to NIMH there are two main methods for treating this disorder - antipsychotic medications and psychosocial treatments. Both of these aim to improve or eliminate the symptoms of schizophrenia, as researchers are still exploring the disorder’s causes.
These two treatment forms are often used together - the patient may reach a level of stabilization through antipsychotics, then improve their ability to cope with the day-to-day issues of schizophrenia through psychosocial treatments.
There are both older antipsychotic drugs (like chlorpromazine) and second generation, “atypical” antipsychotics (like risperidone) available to patients.
NIMH reports that though side effects can be experienced, they often are manageable or go away after the patient adjusts to the treatment. These can include blurred vision, restlessness, skin rashes, drowsiness, rapid heartbeat, muscle spasms or issues with menstruation. Some may experience a change in metabolism and gain weight.
According to NIMH, for some patients hallucinations and agitation can go away within days of beginning antipsychotic treatment, delusions can fade in a few weeks and major improvement can occur after six weeks of medication.
However, every patient is unique and the right treatment for each patient needs to be found. Sometimes an alternate drug, combination of prescriptions or different dosage amount needs to be established.
The problems with communication, maintaining a job, relationship issues and self-care that schizophrenics often experience can all be addressed through psychosocial treatments.
Seeing a therapist and developing “illness management skills” can help the patient understand their disorder and learn methods to cope with symptoms. The knowledge gained through educating themselves about schizophrenia can also help a patient prevent relapses.
Cognitive behavioral therapy (CBT) helps many patients improve symptoms and fight off relapse. According to NIMH, in CBT, “the therapist teaches people with schizophrenia how to test the reality of their thoughts and perceptions, how to 'not listen' to their voices, and how to manage their symptoms overall.”
Support groups have been growing in popularity as a way for people with schizophrenia to connect and support each other. Lessening feelings of isolation can improve the emotional stress of the disorder.
Since substance abuse is very common in schizophrenics, many patients benefit from specialized integrated treatment for this co-occurring issue. Addressing both issues together can prove more effective for many patients.
Rehabilitation programs that focus on helping the patient function more effectively in day-to-day life are also common treatment options. These programs may include lessons in money management, communication skills, job counseling and specific treatment aimed at improving cognition.
How You Can Help
There are many ways for family and friends to support and care for a loved one with schizophrenia. Enrolling in therapy, knowing how to set boundaries and remembering to take care of themselves can help everyone involved cope and thrive.
NIMH reports that by talking to therapists, family members can be introduced to new problem-solving strategies and coping mechanisms. These can be helpful when it comes to assisting the patient in staying on medication and in treatment.
Talking to a therapist can also ensure that the family is as informed as possible about the disease. Since a patient may be placed in the care of loved ones, it is important that the family is educated and confident in their knowledge about how to move forward.
NIMH stresses the importance of family members in using effective means of encouragement to help schizophrenics cope and progress, saying that, “family and friends can help patients set realistic goals and learn to function in the world. Each step toward these goals should be small and taken one at a time. “
Harsh criticism and pressure usually do not help the situation and can even cause symptoms to worsen, so encouragement versus strict instruction is often helpful.
Rex Dickens, advocate from the National Alliance on Mental Illness Sibling and Adult Children Network and author who focuses on the siblings of mentally ill, reminds friends and family that “a delusion will not go away by reasoning and therefore needs no discussion.”
NIMH recommends neither going along with delusions nor saying they are wrong (remember, these seem extremely real to the patient), but instead expressing that you see things differently, though everyone has a right to their own viewpoint.
By the same token, it is important to maintain an environment of respect and support without allowing the dangerous behavior that schizophrenics may sometimes display.
Resisting treatment is common, as is acting out based on hallucinations or delusions. It may come down to taking the patient to the hospital or getting the police involved if safety is at risk. When the situation escalates, remember to speak calmly and deliberately in simple sentences.
Dickens recommends following this model: “Let some things slide. Ignore what you can't change. Don’t ignore violence.”
Taking Care of Yourself
In trying to support a loved one with schizophrenia, it can be easy for people to put their own health and well being on the back burner. But, according to Dickens, “if you can’t care for yourself, you can’t care for another.”
It is important to remember your own needs and desires and set aside time for yourself. If you begin to feel a large amount of resentment toward the patient, you may be giving too much away and need to refocus some energy on yourself.
It is important to try to maintain a sense of humor and remember to acknowledge the courage your loved one has in coping with this difficult disorder.
As Dickens puts it, “Eventually you may see the silver lining in the storm clouds: increased awareness, sensitivity, receptivity, compassion, maturity as you become less judgmental and self-centered.” Though this disorder is difficult and complicated, it can be a learning and growing experience as all involved develop the skills to cope.