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Pamphlet #17a:

Schizophrenia: How Should One Behave?

It may seem odd that one has to ask, "How should one behave towards a person with schizophrenia or an allied disorder?" However, most people do not understand what it is that makes it difficult for people with the disorder to communicate. The general public feels embarrassed and sometimes frightened to hold a conversation with a person who has a mental illness. This pamphlet tries to give some pointers as to how to behave and is for families and for the general public. Mental health professionals may also give out the pamphlet as a tool for the families of their clients.

Speak Slowly & Clearly

We have learned that we need to speak slowly and clearly to persons with schizophrenia — to make the sentences short so that they are not too complicated and to wait to make sure that what we are saying is reaching the person.

Why is this technique useful? A person with schizophrenia explains: "My concentration often floats in and out so that I only hear part of a sentence. Maybe I will miss two or three words. This will make it very difficult for me to understand. Recently I went on a family outing. There were other families there and I could hear everything that everyone was saying to everyone else. The sound and all the people moving about came in on me so much I began to get quite frightened. I was agitated and irritated at the same time. I felt I wanted to defend myself in some way. My dad took me to a quiet place where we sat and had a cup of tea. We didn't talk about it. We just sat and drank our tea and I began to feel less threatened."

Provide Structure

People who are, as we say, living a normal life have structure in their lives provided by their work and family life. People with schizophrenia and are not recovered enough to work also need structure. This the family and the professional carer (psychiatrist, social worker) can attempt to provide. Routines which that are comforting and predictable are useful to someone whose medical condition often makes life very unpredictable. It is useful to help them set up a schedule and a few tasks to accomplish at certain times of the day or week.

Is it possible to achieve this? Some people with schizophrenia are very disabled or become so from time to time. It is not always possible for them to follow a schedule, although it is beneficial to try to maintain a definite routine, like getting up at a regular time, or going for dinner with a family member on a regular day.

Accomplishing Tasks

The famly and the person often feel more comfortable with each other is the person who is unwell is invited to perform a few tasks. Remembering that this may be difficult for them it is important to apply the same principles as in normal conversation, that is be clear and uncomplicated when explaining what is to be done.

When your relative, client or friend attempts a task but isn't able to complete it or does it wrong it is not at all helpful to say things like: "Can't you get anything right?" or "I might as well have done it myself". Even when you are very frustrated, stay calm. See if the task can be broken down into even more simple steps. to create the possibility of success and to encourage the feeling of being useful. Give only one instruction at a time.

Maintain Equilibrium

Sometimes you may feel you are walking on broken glass when your relative or someone you know is having a particularly difficult time. At that time you have to summon up all your energy so that you can maintain their trust while at the same time maintaining equilibrium at home. Here are some ideas towards that goal:

These behaviours should also be adopted by the general public. Avoid the following:

When a Crisis Comes

Sooner or later when a person has schizophrenia a crisis will occur. When this happens there are some things you can do to reduce or avoid the potential for disaster. Here are a few pointers:

Changes in Circumstances

It is quite common for people with schizophrenia to move often, possibly in the hope of making things better for themselves. This complicates things for their professional carers, their families and their friends, because s/he fails to tell people of the move. The best solution is to keep in regular contact not less than once a week, for family and friends, and not less than once a month for professional carers.

This cannot be considered "over-protective". It is just one way of not losing contact with someone you love. It is very difficult for people who are unwell to take responsibility for keeping people informed. Some members of the public take the attitude: "Well, s/he has to learn!" But it may be that learning is not possible for someone who is not always stable, and whose thinking can be muddled. It is important for everyone to realize that this is the result of illness and not willful behaviour.

By keeping in touch regularly and being willing to discuss day-to-day activities and problems we can avoid the complications that arise when we are not involved, e.g. a pension or social assistance cheque fails to arrive and the person is cut off from benefits. Bank communications, bills, etc., are not received and not paid. Rent is neglected, and the person is evicted. Possessions are left behind. Premises are left unclean. Our advice is look after these matters if you suspect your friend/ relative won't.

Offer Choices

People like to feel that they are in control of their lives. Sometimes it is difficult to persuade someone with schizophrenia to do what is best for them. Thus it is useful to offer a choice. "Will you take a walk now or after lunch", might be a way to suggest a walk, a shower, or any activity that you may feel useful or enjoyable. Another choice is: "Will you take your medications this morning or later on?" This suggestion may avoid any confrontation that might occur about taking medications.

People with schizophrenia often have feelings that change very frequently, so that what someone may refuse at this moment he or she may agree to do later in the day or week.

Going to the Doctor

A person with schizophrenia gives their perspective: "A lot of people I know complain that they want to get real counseling from their psychiatrists, but often the psychiatrist is mainly interested in the medications. They would like to talk about their housing and they would like to talk about what the psychiatrist can do to help them get back to work, or at least what would be their strengths if they tried.

"I am sure there are people who have found their psychiatrists helpful like this, but with me the trouble is that I find it difficult to stay in the office more than a few minutes and generally answer "Fine", to any questions. If he suggests that I see the social worker, which just seems like another burden for me! Making appointments is difficult especially if I have to make a phone call. I need a lot of encouragement and real physical help in order to do this. I have such high anxiety just walking in the out-patient door that by the time the doctor says 'Come in,' all I want to do is get out of there!"

Holiday Time

"I dread holiday times when families are all supposed to get together, eat and drink and generally enjoy each others' company. For me, times like these bring back feelings of disappointment, resentment, sadness and a whole host of other emotions. Christmas, for example, has not been a good time for me or the family for many years. There were times my brother was in hospital, times he was home but barely stable, times he had to be taken to hospital during the holiday, times the police came. If I dread it, what does it mean to him? When he thinks a lot is expected of him, he usually handles it well for a few hours, but after that he 'crashes' - I mean he retreats to his inner self, or he gets extremely agitated. Last year each visiting family member took my brother aside for a mini-visit, a one-on-one chat and that seemed to work a little. At least he knew everyone cared. But when it came to the big dinner he disappeared to his room. He just cannot process a lot of noise, people, snatches of conversation-it's just too much for him."

Final Thoughts

Do you help frail, old ladies across the street? Use some of that attitude in rethinking your treatment and interaction with a person who suffers from schizophrenia who may live near you. This doesn't mean that you need to be overly friendly, but don't ignore them. Engage them in conversation, but don't be intrusive. People with schizophrenia, like a physically frail person, cannot defend themselves as well as a person in full possession of physical and mental powers.

Some people are on heavy doses of medication that may slur their speech or make them react slowly. (Quite often this is mistaken for drunkenness.)

Take into account that sometimes the person may be anxious and may withdraw. Let people withdraw, but "leave the door open". Maybe ask them to visit you when they feel they are able. Offer a cake or a plant or some other friendly gesture. Send or drop off a postcard or greeting card with a brief, friendly message every so often.


To be reproduced only with permission.

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