The Family and Schizophrenia

Schizophrenia is a mental illness that is caused by a chemical imbalance in the brain. The victim lives in a state of altered reality and will exhibit strange behaviors, bizarre beliefs and often experience visual and auditory hallucinations. In their psychotic state, their thoughts and hallucinations seem real to them. Sometimes only the family members may be aware of the unusual behavior and strange statements that are clearly false.

My own father has been a schizophrenia patient since he was a young man. He began treatment when I was just an infant. A lifetime of trying to understand this serious mental disorder has taught me that dealing with a schizophrenic patient can be difficult and requires a lot of patience and knowledge. I hope that my experiences will be able to help others out there who may be dealing with a family member who is suffering from this illness.

Fortunately, my father has always responded well to medication and has been able to lead a fairly normal life, with only an occasional psychotic episode. He is retired now and seems to be in the best mental condition of his life. The stresses of employment and child rearing are behind him and he enjoys his life. Many patients are not so fortunate. The medicines required to control schizophrenia can have unpleasant side effects which discourage many patients from staying on their necessary medication. Their illness can prevent them from being able to take care of their basic needs and without a good support system they often end up as one of the homeless population or in jail, where they rarely receive the treatment they need.

The support system is usually the family, but support can also come from professional care givers, church groups, shelter operators, friends, roommates, or professional case managers. For the purposes of this article I will refer to all potential support systems as "family."

It may be difficult to get a person who is showing signs of schizophrenia to agree to get treatment. In their altered state, everything seems fine to them and they don't think they need psychiatric help. Convincing the patient to get treatment in the early stages of the illness is much easier than waiting until they are exhibiting extreme psychotic behavior. Forcing the patient into treatment is considered a violation of his civil rights in most states, unless the patient is a danger to himself or others. Even when they do submit to an evaluation, they may not volunteer their strange thoughts or ideas to the mental health professional, usually a psychiatrist. The psychiatrist must personally witness the bizarre behavior or ideas for himself before he can order a commitment to a mental health institution. The family members need to speak privately to the person doing the evaluation, to discuss the patient's bizarre behavior and ideas. When the family members give this information to the psychiatrist, he can later question the patient about these delusional thoughts and strange behaviors and make the appropriate diagnosis.

Initial treatment will usually require hospitalization while the mental health professional continues to evaluate the patient and stabilize his condition with the proper medication. In past history, mental institutions had the reputation of being gloomy, dungeon-like places where patients were often restrained and not much real treatment was provided. Mental illness was stigmatized and families would hide their shame. Now it is known that mental illness is a biological condition that often has genetic components, and can be treated with anti psychotic drugs. Many hospitals now have mental health units which are as clean and bright as the rest of the hospital, where patients are treated with the dignity and respect they deserve.

Once the patient returns home, it is vital that the family continue to offer support. Schizophrenia is not a disease that can be treated once and then goes away. The family needs to ensure that the patient takes his medication and goes to follow-up appointments. If the patient stops taking his medication, psychotic symptoms may reappear. Early warning signs of an impending relapse are increased emotional withdrawal or a change in sleep patterns.

If a patient does become psychotic, there are ways to respond to him that can help avoid a full-blown episode. If the patient makes statements that are bizarre, don't tell him that he is imagining things, and it does no good to play along, either. Tell him "I know you believe that is so, but I don't see it that way." Always speak in calm, reasonable tones. Don't shout, criticize, or threaten. Comply with reasonable requests, and avoid continuous eye contact or touching the patient. Being respectful and kind may keep the situation from escalating into dangerous or violent behavior, but if you do fear for your life or safety, or that of others, the police may need to assist you in getting the patient to a mental health facility if the patient refuses to go voluntarily.

With the supportive attitude of family, the schizophrenic patient can return to a normal life. Reduce or eliminate stress within the family, and help him set attainable goals, without pressure and criticism. Letting him know what he is doing right is the best way to keep him moving toward his goals.