Schizophrenia is among the most stigmatized mental health conditions, and the least well understood. If you have a friend who’s been diagnosed with schizophrenia, you probably have some questions about their condition and about how you can offer support.
It’s worth clarifying up front that schizophrenia is not the same as having “multiple personalities,” formally known as dissociative identity disorder. I hear this misunderstanding all the time, like when someone says the weather has been “schizophrenic” because it’s cold one day and hot the next. Schizophrenia is something completely different, and understanding the actual symptoms can help you know how best to be supportive.
The actual symptoms of schizophrenia can vary a lot. Based on the diagnostic criteria, two individuals can both have a schizophrenia diagnosis without having a single symptom in common. Symptoms are commonly classified as “positive”, which means something present in schizophrenia that isn’t present in those without the condition; and “negative”, in which something that’s typically present is missing.
The positive symptoms may be more familiar:
- Hallucinations, in which the person perceives something that isn’t there. Auditory hallucinations are most common, like hearing voices that aren’t actually present.
- Delusions, in which a person is convinced of false beliefs about the world, themselves, or other people. For example, they might believe the president is speaking to them personally during his speeches, or that aliens have stolen their mind.
- Difficulty with concentration and with organizing thoughts and speech
- Problems with movement, like making repetitive movements, or staying in one position for a long time
Negative symptoms can be just as debilitating, but are often harder to recognize:
- Lack of pleasure in anything, similar to what people experience in depression
- Limited speech
- Lack of emotional expression
- Social withdrawal
- Lack of motivation
- Difficulty taking care of oneself, like personal hygiene and cleaning their living space
Supporting Your Loved One
Schizophrenia can be a devastating diagnosis, since it’s a chronic condition and often leads to major changes in that person’s life trajectory. But that doesn’t mean a person with schizophrenia can’t enjoy their life and their relationships—including with you. These approaches can help:
- Educate yourself. There is a lot to know about schizophrenia—not only about the general diagnosis, but about your loved one’s specific experience of it. Consult reputable sources like the National Alliance on Mental Illness (NAMI) and the National Institute of Mental Health (NIMH). It may be helpful to know about things like medical and psychological treatments and the common side effects of medication (such as profound sleepiness and weight gain).
- Know the data on risk for violence. Keep in mind that, despite how schizophrenia is portrayed in the media, in reality, most individuals with this diagnosis are not violent. There is an elevated risk, but it can be hard to separate the effects of schizophrenia per se from frequently co-occurring conditions, like substance use disorders. As with any relationship, use common sense.
- Don’t take the negative symptoms personally. If your loved one isn’t saying much, or doesn’t seem to want to spend time with you, these may be negative symptoms of the condition. So as much as possible, know that the person’s withdrawal isn’t about you. Continue to be a positive presence in their lives and to offer your support.
- Don’t argue. It can be tempting to debate with a person’s delusions, especially if the delusions are making your life more difficult. For example, their beliefs about being spied on by the CIA might lead them to tape over the windows, or disable your WiFi. By definition, delusions are firmly held beliefs, so trying to reason with the person’s delusions is likely to be frustrating for both of you, and probably won’t help your relationship. (It’s worth noting, however, that some studies have shown that cognitive behavioral therapy may reduce delusional thinking.)
- Seek support. The more supported you feel, the better you can support your friend or family member. One good option is NAMI’s free 8-session “Family to Family” educational support group. The family members I’ve referred to it gave it glowing reviews. And of course you can reach out to the people close to you for practical and moral support, or you consider talking with a therapist. If your loved one approves, you might also join them in one of their therapy sessions to explore with them and their therapist how to be most helpful.
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