By Dawn Brown, Director of the National Alliance on Mental Illness HelpLine Services, as told to Danny Bonvissuto
My son, Matthew, was rare in that he was diagnosed when he was 8 years old. Most often, schizophrenia manifests in the late teens or early 20s.
At 18, he had a psychoticย break and required hospitalization. Eventually he found treatment that was effective, but it took quite a while.
Once we found something that seemed to address his symptoms on several levels, he became treatment-compliant, which means heโs taking his medication on schedule. But medication is a small part of the treatment plan. Heโs also keeping his appointments with his psychiatrist and therapist and doing what he can to maintain his overall health and wellness.
Heโs 38 now. He enjoys his life. He has friends. He has places he goes during the day that keeps him engaged with others. But itโs been a journey.
The most difficult part is when someone first begins to experience symptoms. Itโs rocky. There will be many ups and downs. Over time it does get better. An engaged, informed loved one is often the best indicator of the outcome for a person with schizophrenia.
โThe Perfect Storm’
Very often when people begin to have symptoms, or when they have full-blown psychosis related to schizophrenia, they resist treatment. Itโs the perfect storm. You have young adults coming into their own, theyโre experiencing symptoms, people are throwing around labels, and theyโre resistant to having a serious mental health condition.
For a parent or caregiver, this is a very difficult situation. Theyโre adults at 18 and can make decisions about going to the hospital or taking medication. As a parent, you lose the power to make them do these things.
Listen and Empathize
In terms of getting someone to engage in treatment, we advise family members to listen. Donโt just hear, but listen to what their experience is. Their reality is different than most peopleโs reality. I wouldnโt say you should agree with what they say if itโs delusional. But you can empathize.
If they think someoneโs out to get them, you can say, โThat sounds very scary. You must be very worried.โ
Thatโs their reality. Imagine that it were true. Thatโs what your loved one believes.
Then listen for anything that might motivate them to get treatment. Many people with schizophrenia have trouble sleeping. Treatment will help them with their sleep cycles.
Maybe they want to get back to college. You can say, โI know youโd really love to go back to college, and thatโs what I want for you, too. Letโs see what you can do to get back there.โ
Work with them to achieve their goals — not what you want, but what they want.
Ideally, after youโve listened and empathized, you get them to agree to some therapy. At that point you become what I call a recovery partner, working with your loved one to find solutions and help.
At First, Treatment Is Trial and Error
A lot of people stop treatment because honestly, the medication available for schizophrenia isnโt always effective. It can have horrible side effects and people lose hope, so they stop.
One of the side effects is obesity. If you have a young woman whoโs being told she needs to take this medication and she gains 30 pounds in 3 months, she wants to stop. The voices have stopped. But within a week or two the voices are back and the cycle starts all over again.
Itโs common to try different medications at the beginning of treatment. That was true of my son as well. He tried four or five antipsychotics that targeted the more active part of schizophrenia — the hallucinations. But when he found one that worked, it was almost like a light switch turned on in his brain.
Matthew has obesity and some other unpleasant side effects. But he also has the awareness that he needs the medication and that the side effects arenโt as bad as the psychosis itself. Thatโs a very mature place to be.
I offer people hope to keep looking and donโt settle. Always work in conjunction with a psychiatrist. And get the person with schizophrenia to sign Health Insurance Portability and Accountability Act (HIPAA) consent so the psychiatrist can work with other mental health professionals. Itโs very likely that, over time, if youโre persistent in seeking treatment options, youโll find something that works.
Explain What The Medications Do
People with schizophrenia should be fully aware and informed about anything they put in their bodies. Part of them being a participant in their treatment is understanding the pros and cons of any type of medication and how you hope it will affect them.
Positive Reinforcement
Once the medication has become effective and the symptoms have receded, you can have a conversation about it. โRemember last month when you were hearing voices and couldnโt sleep? Remember how scary and awful that was? Now that the medications are working, itโs a good thing. A really important step.โ
Itโs positive reinforcement. Youโre reaching them on an intellectual level about what theyโre doing and what results theyโre seeing. They can think through cause and effect: I like the effect, so Iโm going to keep doing this.
Taper Treatment if Itโs Not Working
Itโs never a good thing to abruptly stop treatment for schizophrenia. If theyโre unhappy with their side effects, or if the medication isnโt effective, impress the importance of working with their psychiatrist.
These are powerful medications that change the chemical balance in their brain. You might have to taper down one medication and work another into the regimen so your blood levels are sufficient. You want to avoid extremes, and donโt want to be completely knocked out.
Respectfully listen to why they want to stop and look for alternatives. There are a lot of combinations of options out there. It takes patience with the process to find the ones that work. They donโt work immediately: It takes a couple of weeks. Talk about what will be least disruptive to their life.
