How does one support the schizophrenia patient?
Supporting a family member who has schizophrenia can vary tremendously depending on the severity of the illness and any comorbid psychiatric or substance use disorders.
Should one challenge and argue the hallucinations and delusions? The answer is ‘it depends’. There is no one answer and it depends on how entrenched these delusions are, and the personality and likely response that the person will have when challenged. Some individuals are able to discuss their beliefs in a pseudo-rational manner. Others become highly agitated and suspicious, with the real possibility of physical aggression and violence. In these situations, it is best not to challenge any irrational beliefs until the individual is more calm and predictable or in a more controlled environment.
On the other hand, one should also not be supporting or entrenching false beliefs. A reasonable approach is to tell the person that though you cannot hear or see what they do, that you do believe that it is happening to them. The same goes for the delusions. You might not have the same belief but you can understand that it is distressing to them.
Sometimes supporting your family can also mean that you have to admit them to hospital if ill, or call the police if they become threatening or violent. Having schizophrenia is not an excuse for violence or assault, and carers have the right not o be threatened or assaulted. Patients still have a choice in the final decisions which they make. Patients have to learn to take responsibility for their actions, even when they are acting under the influence of drugs, alcohol or illness.
The same should go for illicit drug abuse. By tolerating this practice, you are enabling it to go on, and are actually part of the problem.
Patients can ‘deskill’ in certain areas of their lives, eg looking after their personal environment and personal matters, shopping, cooking, organising their life, going to college and even how to look for a job. There are two factors to consider. The first is the repeated hospitalisations. These can easily make a patient institutionalised very quickly. After they get admitted, almost everything gets done for them, and this is a pattern which they can learn to expect. As a result they ‘deskill’ in a number of areas of their lives.
The second factor which needs to be considered is the actual illness itself. Schizophrenia is associated with negative symptoms and neurocognitive symptoms. The negative symptoms mean that patients will often be withdrawn and lack motivation and drive to do anything meaningful. The neurocognitive symptoms mean that patients higher intellectual functions including memory, attention and concentration, and organisational abilities, may be affected.
Combating these 2 factors can be very difficult when trying to support the schizophrenia patient. It can be very difficul to differentiate wilful neglect and laziness from the illness itself. But it is something that needs to be done to make the patient with schizophrenia more self sufficient. Whether it is negative symptoms, neurocognitive deficits or institutionalisation, the approach is similar.
Patients need to be in a environment which promotes structure in their lives, and which promotes and encourages independence. There should be clear boundaries and the penalties or consequences should be clear, and above all, they should be enforced.