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#WellnessWednesday: How to support an individual struggling schizophrenia or another psychotic disorder

Image: Unsplash
Image: Unsplash

“I couldn’t believe our sensible, studious daughter. She had changed into a person I hardly recognized. She refused to change her clothes and said she heard voices telling her she was evil and deserved to die” – a mother speaking about her daughter diagnosed with schizophrenia.

Words by: Asanda Madi

What if I told you that everything you believe to be real is actually not real? The memories you have, the accomplishments you’ve achieved, who you believe yourself and your loved ones to be. Let’s say your name is Thando. You are 25 years old, recent graduate from the University of Western Cape who has been working for the past 6 months. That’s what you know is real. Now imagine if I were to tell you that you’re wrong, that what you think is false; your name, history and present are not true. Your name is not Thando, you’re not 25 and you never went to University.

Would you just easily abandon everything you’ve known to be true? No, of course not. Would you believe me? Probably not, you have proof for thinking the way you think. Now imagine someone who is convinced of a certain reality, a reality that is not thumb sucked but one to which they can attach not only emotion but memories, and then ask them to just abandon that. Whether it's thinking that they are the mayor of a town or Michael Jackson’s wife, or that the government is following them. That is as real to them as everything you know about yourself. You think no one could possibly believe that they are pregnant when doctors have told them otherwise or believe that some celebrity that they’ve never met is in love with them. But your mind is not fighting to trick you.

#WellnessWednesday: How to support an individual struggling schizophrenia or another psychotic disorder

A lot of people aren’t aware of psychosis and its different faces and how it impacts those who have it. It can be very difficult for friends and family to adjust. Here are some tips to help you manage:

1. Encourage the individual to seek treatment

Psychosis can be incredibly debilitating. It falls as part of the more severe mental illnesses due to the high risk of individuals.

2. Speak up for your loved one

Family members and friends must speak up for their loved one with psychosis when at doctor’s appointments because they may not disclose all their symptoms or see anything wrong with their behaviour.

3. Learn how to respond when your loved one is experiencing delusions or hallucinations.

It is important not to argue with them because to them what they are experiencing or hearing is very real to them. Do not become detached because you are afraid of how to engage with your loved one’s psychotic thoughts or disorganized behaviour.

How you respond to a loved one with psychosis can make a big difference in your ability to maintain a relationship with them after the psychotic episode. Bear with me while I try to explain: imagine standing next to your loved one while communicating. Try to see what they are saying through their eyes and not your own. You are by their side listening and not challenging them head-on. Focus on the emotion of the conversation not whether the facts are plausible, pick up themes

For example, your loved one says to you: there is a car parked on my street that is monitoring me. Every time I leave my house a car drives by marking down the times I left. They follow me around wherever I drive. I bought extra locks for my house because they came in the middle of the night and drugged me. All my doors are barricaded to keep them out. The police say they won’t do anything to help me. I stay up at night watching and waiting and set up traps in the yard to catch them. I bought a hearing amplification device so I can catch them before they get to my house – example from The Humanology Project

There are different ways you could respond:

  • What are you talking about? First one: there is no monitoring you on your street. No one broke into your house or drugged you. You aren’t making any sense.

OR

  • That must be so scary. That must be so scary to feel like people are always watching you! You’re saying you can’t go anywhere without them following you? That must be terrible to constantly feel you are being monitored. How do you handle this stress? What are you doing to stay safe? So, when do you sleep? And what do you do to get food? If you are always being followed, I imagine I wouldn’t feel too safe leaving the house. Is there anything I can do to help?
#WellnessWednesday: How to support an individual struggling schizophrenia or another psychotic disorder

By listening and being supportive you also get to understand the depth of their psychosis. With this knowledge about what they are experiencing, you will get more information. This information will help you know if they are putting themselves or others safety in jeopardy because of their psychotic thoughts. You will be able to monitor if they are no longer able to care for themselves so that you can try to intervene in a timely manner.” – The Humanology Project

  • Call for help if they are making unsafe decisions that are putting themselves or others jeopardy.

4. It is important for family members to lean on others for support.

This could be your family or your group of friends. You could even join a support group or other online platforms for people with similar situations.

5. Avoid criticizing or blaming the person for their psychosis or the actions related to their psychosis.

It is so important to be compassionate. If you feel yourself experiencing fatigue and becoming irritable, rather distance yourself and recharge. If you are the sole caretaker of your loved one. Try to get someone to help you out for just a night where you can get some alone time.

6. Adapt your communication approach.

Avoid denying or arguing with them about their reality “That doesn’t make sense” “Of course the government isn’t tapping our house”

Do not directly confront them. If you want to be heard you may have to find a different way to communicate. Being heard isn’t always possible when someone is in the midst of a psychotic episode.

Additionally; do not focus on correcting the reality of delusions. Don’t waste time trying to prove the delusion can’t be true with reason and logic. Rather ask them if you can help in any way “I know you are waiting for that letter with the million dollars. Are you managing to leave the house or are you too fearful you will miss it? Have you been able to get out and pick up your chocolate milk? Can I get you some?

7. Don’t take what is said personally.

Paranoia and psychosis can lead to mistrust and suspicion. All relationships can be called into question and be affected by delusions. Don’t get angry, your loved one is not in control of what is happening to them. Their brain is deceiving them and playing tricks on them.

8. Create a safe space for the individual

Do not dismiss their concerns or laugh it off. Even if their concerns are bizarre or shocking they are not amusing to the person having a psychotic episode. Remember that their brain believes these things to be real.

9. Do not collude with the individual’s psychosis

Do not encourage their psychosis by confirming their delusions.

You are encouraged to not argue with the individual. However, that does not mean you have to agree with what they are saying. You don’t need to comment directly. Often a general, supportive statement will suffice. Some helpful things to say are “I don’t know what happened. It sounds very scary” or “There are lots of things that happen in this world that I can’t explain” or “I don’t know what to make of what you are saying. It’s so confusing and upsetting to hear everything you are telling me. How are you handling it? Colluding with the individual is highly possible when you are exhausted.

10. Share love in a way they can tolerate.

This may simply be achieved by giving your full attention to their thoughts.

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