Talking to someone with a mental health disorder may look extremely challenging. There are several things that could cause awkwardness and hesitation: 'I’m not sure what to say'; 'I mean well but will I sound intrusive?' 'There’s so much stigma associated with mental health issues, will the person mind that I know about their problem? What if they feel bad? What can I say that doesn’t offend them? I don’t want to upset them…what if I cannot handle their reaction?' Due to our fears, we tend to be overcautious and oversensitive in dealing with people who have mental health issues.
As a caregiver, family member, friend or colleague of a person withschizophrenia, you can support the person by being there for them, and having normal conversations with them.
A person with schizophrenia needs a supportive environment for recovery. The friends and family of the person can create a supportive environment by being aware of the disorder and helping the person when needed.
A person with schizophrenia becomes withdrawn and isolated due to the illness. It becomes extremely difficult for them to identify a problem and ask for help. Here, an external stimulus is required to help the person move into a more functional manner of living. This is why communication – whether it is about practicalities or pure connection – is vital in aiding recovery.
Keeping in touch with people, having healthy social conversations and engagement can be very helpful for persons with schizophrenia to overcome their isolation. Such persons may avoid interaction with friends and family for several reasons. When a person approaches them for engaging with them, it can be beneficial.
The person may already be grappling with feelings of frustration and helplessness, and may not know whom to approach. In such a situation, it is of great help to the person to know that should they reach out, someone is willing to assist them.
You can reach out to the person by telling them that you are concerned about them, and are willing to offer them any support they may need. A simple way to say this would be, “I understand that you have been through a lot, and I just want you to know that I care about you and am willing to help you…”
A person withschizophrenia may not respond in the way we might expect in a ‘normal’ conversation. Your words may be met with silence or monosyllabic answers. In some cases, the person may say that they are extremely interested in what you want to discuss, but their facial expression and tone may not reflect the same. You may be confused and try to understand whether this enthusiasm is genuine, or may wonder why the person is sending out mixed signals. It’s important to understand and acknowledge that these changes in behavior are brought about by the illness. You may need to be patient and persistent with the person and wait for a satisfactory response.
Try not to let your own discomfort, hesitations or anxieties (about what to do and what to say) come into the picture, as this might make it harder for the person to relate to the conversation.
Remember, a person with schizophrenia may not emote; this does not mean that they aren’t experiencing intense feelings. Similarly, they may not speak out loud, but this doesn’t mean they don’t have an opinion.
Approach the person as you would a normal person. They may have some behavioral oddities due to the illness. Engage normally with them.
Begin the conversation with a neutral topic. As a friend or a colleague, it is unlikely that you would be expected to address the person’s health or emotional issues. You could keep the conversation functional (by speaking about work or other practical issues) or light, by speaking about something not related to the person’s struggles with the illness.
Try to reach out and assure the person that you are there for them. At the same time, don’t be too pushy or overenthusiastic with your offers to help; give them some space. Make your intention known to the person and wait for them to approach you. Remember that you may not be qualified enough (or even needed) to help resolve the person’s biggest struggles.
Don’t probe or investigate details of the person’s illness, diagnosis or health situation. Avoid asking probing questions such as 'What happens when you hear the voices?' or 'What do the voices say to you?'
Many a time, we like to offer suggestions as we think it may help a person get over their illness. Remember that the person may or may not be in a position to weigh the consequences of their decision, and that your suggestions or advice may be misinterpreted or taken out of context. Make sure that you’re not sending out messages that may make the person devalue the doctor’s and family’s attempts to help them get better.
If the person presses you for suggestions or advice, weigh your words carefully. Be mindful of the context that they may take your advice in, particularly about treatment. For example, if the person is averse to taking medication and hears you mention a case where medication led to drowsiness and some other side effects, then he or she may stop taking the medication altogether.
If you do know of a good treatment that can aid recovery, suggest that the person discuss it with his doctor, counselor or caregiver. It is best to consult a doctor about any treatment that can be used in a complementary manner and not as a substitute.
The person may approach you with some interpersonal issues that distress them (conflict with caregiver or other family members, etc). If you do not have an understanding of the bigger picture, suggest that the person approach his doctor or counselor for help.
If a person with schizophreniaconfides in you, but you think that there is some information that needs to be shared with the doctor or caregivers, what do you do?
In case the person tells you something that hints at an obvious threat or harm to himself or others (thoughts of suicide, killing others, hurting others, etc.), consider whether you would need to inform their family or caregivers.
It is not essential to tell the caregivers every single thing the person said, as the caregivers may panic or feel helpless. Instead, communicate to them what your concerns are, and what the person said that led you to have these concerns.
Tell the person that harm to themselves or others is not something to be taken lightly. Suggest gently that it may help if their family knows about these urges. Clarify why you’re saying this. For example: “I am concerned about you, and would like to share this information with your family because they can understand and help you deal with this.” This will help the person understand that you’re not betraying them, or doing things behind their back.
Educate yourself about schizophrenia, but keep in mind that not all persons with the disorder show all the symptoms. Your friend or colleague with schizophrenia is not too different from others around you. Being prepared, patient and open can help you maintain a ‘normal’ relationship with the person, and help them get better.
Talk to them like you would with other people. Most of the time, the response tends to be normal. Sometimes, though, the person may react in a way that you may find hard to deal with. The symptoms ofschizophreniapresent differently from person to person, and may change from time to time. Here are some kinds of responses you are likely to get:
The person may not be very communicative, or may behave like they are not interested in you. In such cases, take the lukewarm response in your stride and continue the conversation until the person shows disapproval. (Persons with schizophrenia may not display the emotions they are feeling, and may appear “bored” or “uninterested” to those around them.)
The person may have certain odd ways of speaking or behaving. Don’t draw attention to them or ask why the person is behaving in such a manner. Continue the conversation normally.
The person may react with inappropriate emotions. If this causes discomfort or embarrassment, put off the conversation for a later time, till the person has calmed down and you feel comfortable enough to speak again.
The person may suspect your intentions and get angry with you. Avoid speaking about whatever it is that is upsetting the person. Reassure them that you care for them, and would like to continue the conversation when they are ready to do so.