Over the past few years I have given many speeches and presentations to groups interested in mental illness; most talks have been to caretakers, especially parents of young adults with mental illness. After I conclude my remarks and begin the question and answer sessions, I am almost always asked what caretakers can do to better help those with mental illness. From my experience of living with paranoid schizophrenia, as well as from personal communication with numerous others with this mental illness, I have compiled a list of common mistakes caretakers should avoid. Here are the top five:
Five Mistakes to Avoid
1: The Tough Love Approach
Support is often abused by those with alcohol and other drug addictions, and thus caretakers are often wary of enabling the individual they care for; therefore, they often adopt a “tough love” approach to be sure they are not adding to the problem of addiction. This approach should NOT be taken with someone with schizophrenia. There is much disability caused by negative symptoms (severe apathy, a loss of motivation, a lack of joy, reduced desire to socialize, flat emotions, etc.) of the illness, and the tough love approach in terms of supporting the individual with schizophrenia has serious risks, including homelessness. While a kick in the butt might be what a drug addict needs to get his life straight, it is constant support and medication that a person with schizophrenia needs to simply cope with the disorder.
2: Too Much Emotional Support
Support is necessary for the individual with schizophrenia to deal with his or her illness, but caretakers often err on the side of getting too close emotionally. Regardless of what the individual was like before developing the illness, nearly all people with schizophrenia need to keep people at an emotional distance. Caretakers should respect this boundary and not be offended that it is likely needed to maintain health.
3: Raising the Expectations Bar
As the individual with schizophrenia recovers from the latest psychotic episode, there is a natural raising of expectations as to what the individual can and should do. However, the bar is often raised too quickly for the individual to keep up. This results in added stress on the individual and health setbacks. Many family members have noted that just as their ill relative was doing great, there was a setback and or psychotic relapse. No doubt these setbacks are partially due to increased stress from rising expectations.
4: Being Critical of Individual or Symptoms
It has been well established in the psychiatric literature that people with schizophrenia have a heightened sensitivity to criticism. Caretakers with critical dispositions should actively limit their criticism for the health of the person under their care. Additionally, many with schizophrenia do not have good control over their symptoms, so caretakers should not blame them for having the symptoms of the illness. Caretakers of patients undergoing chemotherapy for cancer do not blame the cancer patients for having cancer or for vomiting, and neither should caretakers of those with schizophrenia blame the individual for being ill.
5: Preventing Smoking
The smoking rate in the United States in around 20% of the population; amongst people with schizophrenia, the rate is upwards of 90%. And, nearly half of all cigarettes smoked in the U.S. are smoked by someone with a mental illness. It has been found, both anecdotally and scientifically, that smoking cigarettes helps with the symptoms of schizophrenia. The nicotine helps reduce paranoia and hallucinations, and it improves memory and concentration. Nicotine does, however, change the blood level of many antipsychotic medications, so care should be taken when an individual changes the amount he or she smokes, including beginning smoking or quitting smoking.