Monthly Archives: June 2012

The Lone Gazelle

“What is it like to be insane?” she asked.

“Medicated or unmedicated?” he replied.

“Well both, I suppose.”

“Unmedicated, it is pure hell, an unadulterated pain from which there is no remittance. You are a lone gazelle, being hunted by a pride of fiery lionesses, eager to feed themselves and their hungry cubs. You go left, then right, then left again. They are all around you; there is no escape. Panic strikes as the countdown to your death begins.

“But then, like an accidental lightning strike, a park ranger arrives and fires two shots into the air, scaring the hunters away.”

“Then what?” she asked.

“Then the ranger aims his rifle — at you. And, looking at the ranger with pleading eyes, you wait…eternally frozen, for a shot that will never be fired.”

“And medicated?”

“Same thing, except they only want to maim you.”


March 15, 2004

Just so you know…

My life is far from perfect.  My recovery is still only partial.  I still rely on meds and therapy (and probably will for the rest of my life).  I still have good days and bad ones.  And, so far anyway, I’m still fairly limited as to what I am able to do socially and occupationally/educationally.  I hope to improve, but I have to be honest and tell you that, while I feel I’ve made great strides, my recovery has not been anywhere near complete (100%).

Like I said in a post I put up earlier (last year, I believe), I have a lot to prove to myself yet.

Take care and best wishes…


PS  Also, to give you a frame of reference, I’m 41 years-old.  I’ve been in therapy since I was 26 (15 1/2 years as of this post), and I’ve been fighting and recovering from this disease since I was at least 11 years-old…probably earlier than that.  Not saying that your loved one (or you) will have to work that long to get markedly better, because you may not.  The meds are better than they were 15+ years ago, and early detection along with more awareness as a society is helping.  Oh yeah, and my psychiatrist recently told me to hang in there…even better meds are on their way!  YAY!!!

Getting Help for a Loved One – Step #4: Following Through

Hey, All!

Except for possibly a post about alternative living arrangements and involuntary admissions, this is the final part in this series. So…

Back to our infamous analogies!

THE COSMETICS ANALOGY: You found a date! Great! Your make-up is good to go and it’s time to enjoy your night on the town, right? Yep. At least for now. But, let’s say that you and your date really hit it off and you eventually decide to start seeing each other exclusively. Great, right? Well, yes, maybe. Before you don those rose-colored spectacles, remember past exclusives. “Relationship maintenance” ring a bell? Yep, all successful relationships require maintenance. Let’s be truthful, we all have our needs, wants, and desires when it comes to relationships. Keeping our wants, needs, and desires in some sort of quasi-balance with our mate’s wants, needs, and desires can be a tricky task. And yet to be successful, that’s exactly what we need to do! Congratulations, you’re on your way to having a lifelong best friend — assuming you read plenty of John Gray books, you remember proper toilet etiquette, and you eat your Wheaties.

THE HOME ANALOGY: So, your home is finished! Time to move in and enjoy all of the great things about your new abode, right? Yep. At least for now. Hopefully, your contractor was professional and did an exemplary job on your house. Still, you’re going to have upkeep on your new residence, correct? Correct! Immediate upkeep means paying the mortgage, paying the utilities, and doing the seasonal yard work so that your local municipality doesn’t fine you for grass that has grown up to your groin. Longer-term maintenance includes interior design changes — painting, new appliances and furniture, upgrades on electronic equipment, and eventually a new electrical system for your house (to keep pace with the new technology you’ll surely spend too much on!). Over the next several decades, the list of maintenance projects, home improvements, and tasks required to finish that basement will take some time, energy, and of course, money. So, strap on your hardhats, because owning your own home just became a lifelong project! Really: Congratulations. Getting to this part, while still potentially labor-intensive and while still potentially marked by setbacks, can also be filled with its fair share of celebrations and joyous moments, like bringing your newborn baby into the home.

So, I’ve beaten the analogies into the ground. Sorry if you found them too extraneous. I hope you found them at least a bit amusing.

Now, to the real world.

Topics to be covered:  first hospitalizations, subsequent hospitalizations (if applicable), treatment teams, med adjustments, hiring (and firing?) mental health professionals, going to (or back to) school or work, relationships (of all kinds), keeping the environment schizophrenia-friendly, and that dreaded word: relapse.

Let’s start out with your loved one’s FIRST HOSPITALIZATION. Again, I’m going to assume a couple of things — first, that your loved one is responding reasonably well to medication (and was voluntarily admitted), and second, that he or she is fairly able to be active in at least some of the programs and activities available on the unit, some of which may be mandatory but in my experience, most of which are encouraged but voluntary. Here’s a quick rundown:


Wake-up = probably between 6:00-7:00 AM
Breakfast by 7:30 or 8:00 AM
Visit from psychiatrist = between 7:00-9:00 AM
Community Meeting - plans and goals for the day = 9:00-9:50 AM
Group Therapy = 10:00-10:50 AM
Break time = 11:00-11:50 AM
Lunch = Noon-12:50 PM
Group activity (arts, crafts, games, etc.) = 1:00-1:50 PM
Break time = 2:00-2:50 PM
Group activity = 3:00-3:50 PM
Break time = 4:00 - 4:50 PM
Supper = 5:00 - 5:50 PM
Evening free time, including a 2-hour visitation period.
This is a generic day but one that is not unlike
a lot of the ones I've experienced.

My advice: If you aren’t able to make it to visiting hours, at least call your loved one once a day. If you are able to make visiting hours, ask your loved one if she wants you to come. Sometimes, there is a limit on the number of visitors a person can have (two is customary). Nothing says you have to stay the entire two hours, but your presence may mean a great deal to your loved one, especially because he’ll be in an unfamiliar place with unfamiliar faces. If you aren’t able to make it to visitation, explain to your loved one that you are very sorry and that you will do your very best to make it to the next one (or one soon thereafter). This assurance (along with phone calls) will probably be much appreciated by your loved one. Also, try your best to meet with a member of your loved one’s treatment team at least once during the hospitalization (more is better — up to a point).

Average stay (in my experience) = anywhere from 4 – 10 days (for a first hospitalization involving schizophrenia – in a conventional hospital mental health unit, my estimate would be 7-8 days minimum).

Some things to expect when your loved one comes home:

  1. Your loved one may feel awkward. Remember, he’s just survived one of the most horrific brain diseases out there. On top of that, he’s been in a relative cocoon for the past week to ten days. To be thrust back out into the “real” world might be a shock to him at first. Recall the phenomenon of stimulus-overload. This can happen fairly easily, even to the most-seasoned veteran but especially to a first-timer. Expect it. Plan for it. Going out to eat at a busy restaurant probably isn’t going to do your loved one any favors. A quiet ride to a familiar place (like home) followed by a light meal might be more his speed.
  2. Do not expect that taking a pill is suddenly and magically going to make your loved one better, able to leap tall buildings in a single bound (or do work around the house, or go back to school, or get a job right away). Unfortunately, it doesn’t work like that. The aim from an initial hospitalization is to stabilize the patient as quickly as possible, so that they can be released as soon as possible. Don’t blame the treatment team (including the psychiatrist) or the hospital. It’s our health care system that needs fixed. So, contact your government representatives!
  3. Expect a relatively stable but slow progression toward partial recovery. Yes, there will be setbacks. Yes, there will be successes. The overall trend should be toward recovery, however. This is done with medication adjustments and a continuing beneficial professional relationship with a competent talk therapist.
  4. Then, there is the question of which symptoms should be alleviated and which shouldn’t. First, in my opinion, there should be a general trend toward better mental well-being. If there has been no progress whatsoever after the first hospitalization, then your loved one’s treatment team needs to be notified of that. As far as symptoms, all symptoms are troublesome; however, most people report that the positive symptoms – hallucinations and delusions – are the most troublesome. [“Positive” symptoms are simply traits that are present in the afflicted individual that shouldn’t be there. They are in addition to the normal range of traits or experiences the individual should have.] Most anti-psychotics target the positive symptoms of schizophrenia. Which one will work best for your loved one is determined by your loved one’s individual response to particular medicines or med combinations. Last word:  Some people experience weight gain with anti-psychotic medication. If this occurs and it is troublesome to your loved one, please let her doctor know.
  5. As for the “negative” symptoms of schizophrenia, these are traits that should be present but are lacking in the person with schizophrenia. Some of the newer anti-psychotics (or more appropriately, medicines that target schizophrenia) address these symptoms which include avolition (lack of motivation), lack of proper hygiene, poor educational/occupational performance (especially with regard to one’s expected or previous abilities), and poor cognitive abilities (e.g. the ability to grasp abstract concepts like the meaning of “A stitch in time saves nine” or “People in glass houses shouldn’t throw stones”). In today’s world of psychiatry and psychology, I would be concerned if these were  prevalent. Notice I said “prevalent” instead of “present.” Chances are some of these will be present, especially in the beginning stages of treatment. Expect these to improve as the months go on.
  6. Finally, expect some (possibly a considerable amount) of social awkwardness. Schizophrenia has a tendency to disrupt the social maturation process. It’s going to take time to catch up with others who are your loved one’s age, and I’d venture to say that “catching up” is the wrong way of viewing it. Everyone will have their capabilities and potential along with their timetable for reaching these potentials. Encourage and offer opportunities for social, cognitive, and emotional growth but don’t push the issue. Pushing the  issue is a surefire way of having a setback and hopefully not a relapse.

SUBSEQUENT HOSPITALIZATIONS can sometimes be demoralizing for your loved one. If this is the case, offer genuine encouragement and support. Let them know that you are going to be with them during the recovery process and that better days are ahead but that those better days are going to require a substantial amount of work — on their part as well as yours . Also, let your loved one know that “getting to work” on their problems is not an immediate need. Give them time to rest and recuperate. Usually, subsequent hospitalizations are required for relapses, emergencies, and/or a major tweak in the medication regimen (e.g. the introduction of a new medicine). Again, ensure your loved one that he or she has a support system he can rely on.

A good TREATMENT TEAM is really hard to put a price tag on (literally and figuratively-speaking). In my experience, a good treatment team has the following qualities (at a minimum):

  1. The members of the team, which usually consist of a psychiatrist, a psychologist or licensed clinical social worker, and possibly a recovery coach are HONEST with everyone involved, including with the client, the clients loved ones (if they are involved in the treatment process), and other members of the treatment team.
  2. The members of the team LISTEN to each other, to the client, and to the client’s loved one and consider each party’s point of view. They attempt to reach a consensus in an agreeable manner.
  3. The members of the team CHALLENGE the client, the clients loved ones (when applicable), and other members of the treatment team to strive for better results. [Note:  This is not like Basic Training at the United States Marine Corps boot camp, however.  And, challenging should be congruent with achievable goals. Also, as with most endeavors of this nature, breaks and possible setbacks are expected. That said, an overall trend toward better health should be expected.]
  4. The members of the team INSPIRE HOPE in the client, the clients loved ones, and other members of the treatment team. Why hope? Simply put, there is plenty of it to be had.
  5. The members of the team (along with the client and their loved ones) RECOGNIZE WHEN THEY ARE WRONG about something and are able to approach the client, loved ones, and the team about the issue in an atmosphere of nonjudgmental acceptance. While this may sound a bit Utopian, this kind of open, mutual communication is the goal. This makes progress a lot easier.

MEDICATION ADJUSTMENTS happen in virtually all cases. I can’t tell you how many med adjustments I’ve gone through since 1997. Definitely too many to count. Don’t view med adjustments as setbacks. I would venture to guess that 99.999% of people being treated for schizophrenia have undergone at least one med adjustment (probably well more than one) in the course of their treatment. And, the need for med adjustments can be advised for any number of reasons and by any member of the group (clients, client’s loved ones, and members of the treatment team alike). Of course, the only member of the treatment team (in the vast majority of the United States) who is able to prescribe medication is the psychiatrist, so he or she will have the final say in all med adjustments, but there is nothing that says that another party can’t suggest something. Two major reasons for med adjustments that I can think of are symptom reduction and alleviation of unwanted side effects (weight gain probably being the most prominent but not the only side effect).

HIRING MENTAL HEALTH PROFESSIONALS (MHPs) during and immediately after a first hospitalization is usually not something that is consumer-driven. In other words, your loved one will most likely be assigned to a particular member of the treatment team (usually a psychiatrist and a talk therapist) rather than getting the luxury of choosing the members of their treatment team. A little secret: You can change. You have every right to request or sometimes even make a change in your treatment team. There may be a process, especially if you are working through a clinic or agency; however, if you are simply not satisfied with the results, you can change. It took me  three years to figure that out. Some reasons to change: Look at the above five characteristics of a good treatment team. If any member of your treatment team is not living up to your expectations regarding any of those five areas (or others you may have come up with on your own), first talk to the person and try to work it out. This is not only good practice and etiquette, it will also show the clinic or agency that you tried to work things out with the mhp before “jumping ship” on him or her. My number one reason to let an mhp go: A particular member or members of the treatment team have stopped INSPIRING HOPE in me.  Hope is the #1 fuel I get from a treatment team. I lose that for an extended period of time, and I lose hope in them.

GOING TO (OR BACK TO) SCHOOL OR WORK is a dilemma faced by many people who are recovering from schizophrenia. Not all people are able to do this. In fact, the jury is still out on whether or not I am able to do this. I’ve signed up to volunteer at the local hospital and, if all goes well there, I will be looking to return to school, but to be honest, I won’t know if I can do those things until I’m in the thick of doing them. Which brings me to a couple of points I think are worth mentioning: (1) Volunteering can be a great way to test and even develop your skills. My advice: Choose something you CAN do rather than something you want to do, and start out slowly; and (2) all work is meaningful work. I don’t care if you’re plucking weeds at the county courthouse after you have had to give up your dream of becoming the next great theoretical physicist. The work is still meaningful. A sage mhp convinced me of that one. Also, you may have setbacks in this area. Most people do. Rest assured, you’re not the only one who has fallen. Hopefully, you will stand up from your fall and regain your strength to try again.

RELATIONSHIPS. Wow, I could write a lot about this one. Suffice it to say, take them slowly. You are going to make mistakes. I know I have. And, a lot of my mistakes were ones that people 10 to 15 years younger than I make. Remember the whole “interruption of the social maturation process” deal? Yeah, so do I. Let yourself make those mistakes. It’s normal. You are may get involved with a group of people who don’t have your best interest at heart. You may even get involved in a romantic relationship or two that doesn’t work out. And, you may even experience a temporary or permanent split with your family. If you experience these things, let them happen. For caregivers: unless you see that your loved one is in serious trouble, let them make and learn from those mistakes., regardless of how age-inappropriate those mistakes may seem to you. It’s natural and healthy. If your loved one is not making mistakes (and learning from at least some of them), then you should probably be worried about their progress.

KEEPING THE ENVIRONMENT SCHIZOPHRENIA-FRIENDLY. This is probably not possible 100% of the time. My advice on this one: keep expressed emotions at a minimum. For me (and I would venture to guess for most people with schizophrenia), this is the #1 environmental stressor. When tensions are high, stress levels for people who have this disorder can skyrocket astronomically. A safe bet: to prevent setbacks or relapses, keep the emotions to a minimum and the lines of communication at a maximum.

THE DREADED WORD: RELAPSE. Defining a relapse is kind of difficult, since it means different things to different people and different things can trigger a relapse. Three major contributors to relapses:

  1. Going off of medication and/or not going to therapy sessions.
  2. Stimulus overload (includes exposure to expressed emotions) for an extended period of time especially with the inability of the afflicted to distance herself or get away from that environment in order to decompress.
  3. Major life changes (perhaps a death in the family or of a friend or significant other, moving to a different city, death of a pet, major non-psychiatric illness/disease, loss of job or dropping out of school, other major life stressors).

What is a relapse and how does it differ from a setback? A setback is usually a minor event, is shorter-lived than a relapse, and most often easier to overcome than a relapse. It is often not caused by a major life stressor, although sometimes it can be. An example of a setback: Having to drop one of your college courses in order to make it through the semester. Chances are that’s a relatively minor event, and especially if your loved one is able to continue with the rest of her classes, it is also relatively short-lived and relatively easy for that person to overcome. This goes for all of the topics of this post: assure your loved one that you will be there for them during the setback. That knowledge and your follow through on that pledge should pay big dividends down the road.

However, there is still the issue of relapse. Relative to a setback, a relapse is usually a major event, is oftentimes longer-lived (or more impacting) than a setback, and more difficult to overcome. A classic example of a relapse in someone who has schizophrenia is if he or she decides to discontinue taking their medications AND stops going to therapy. If one or both of these occurs, contact your loved one’s treatment team right away. Do not hesitate. Now, if your loved one misses one dose, don’t get overwrought; however, if your loved one starts missing a string of doses and especially if it is apparent that they have no intention of starting back up again, contact your loved one’s psychiatrist or talk therapist ASAP — sooner than ASAP. If this is the case, you are headed for trouble, and the possibility exists that you will either have to have your loved one involuntarily committed or start over with Step #1 of this series. It does happen, and at that point, you have to ask yourself (and possibly your family) if you have it in you to go through the struggle again. Don’t feel bad if you don’t. Sometimes finding alternative living arrangements is best for everyone involved, not always but sometimes, and only you (and your family) can make the decision to try again or whether a different arrangement would be best for your loved one and you and your family.

Holy moley. My fingers are tired. And, I bet you’re tired of reading. That’s it for now. Like I mentioned, I might do a post or two on alternative living arrangements and involuntary admissions but think I’ll take a break for a while!

Take care and best wishes…


Getting Help for a Loved One – Step #3: Approaching Your Loved One with the Option of Getting Help (and Dealing with Rejections)

THE HOME ANALOGY: So, you’ve drawn up the plans for your new dream home. Master bedroom and master bath. Large kitchen. Deck with built-in hot tub. Playroom. Entertainment center. Spiral staircase leading up to a balcony that oversees a lake. Now what? Well, you’re probably going to have to find an experienced contractor to build your new palace. That means agreeing on a price and signing the contract. Good luck with this process, because all of those juicy amenities are probably going to cost you more than your budget allowed. Code words: REJECTIONS and COMPROMISES before you finally get to YES, WE CAN DO THIS!

In the real world, this means CHOICES, CHOICES, CHOICES. Not to mention patience, patience, patience. Provide your loved one with choices and learn to accept rejection, not as a defeat but as another opportunity to build that trust discussed in Step #2. Remember, accepting your loved one’s rejections is a great way to build trust. Expect rejections. That way you won’t be surprised when they happen, and if they don’t happen, then you will be pleasantly surprised. Chances are, they are going to happen.

Let’s assume your loved one is not in treatment and has never been in treatment. He has not been exposed to the world of talk therapists, psychiatric nurses, crisis intervention teams, and psychiatrists who are going to give him mind-altering drugs. All of these can be pretty intimidating to your loved one, so do not bombard him with statements like: “Oh hun, there are psychologists, psychiatrists, psychiatric nurses, social workers, and crisis intervention teams just waiting to help you feel so much better! Let’s go!” Chances are this tactic will send your loved one into stimulus shock, making the voluntary trip to the ER or clinician’s office a no-go.

Before I go into the approach that worked for me, I have to say that I had three things that helped me in my decision to accept help and give medicine a try:

  1. I graduated with a Bachelor of Arts degree in Biological Sciences with minors in Microbiology and Chemistry in a pre-med curriculum. I excelled in school and given my knowledge of genetics and neuroanatomy and physiology, I probably had a leg-up on voluntarily seeking help. This is probably not something your loved one has. It’s possible but from a purely statistical perspective not probable.
  2. I was very confused and was in a lot of psychological as well as physical pain. I knew I had a problem. I knew that I was used to solving most problems by myself. However, I also knew that the years I had spent in trying to solve this riddle were spent in vain. And the pain was unbearable. I was desperate to rid myself of the pain.
  3. I was afforded Steps #1 and #2 of this series.

All of this led up to my willingness to accept the help that I so desperately needed. Will the following advice work for your loved one? I hope so, but the honest answer is: I don’t know for sure. I’ve outlined everything I know to give you and your loved one the best chance for success and relief; however, as much as I’d  like to, I can’t say with 100% certainty that this will help you and your loved one. I wish I could guarantee 100% success. Unfortunately, I can’t.

So, here it goes. This is what helped me.

After living homeless in Seattle for three months, spending 35 days in a Navy brig, and spending much of December 1996 homeless in Boston, I returned to my parents’ home (at their invitation). For three weeks, I made demands on their lives. I was determined to break their will and make them feel the pain I was feeling. They accommodated most of my demands and calmly explained why they couldn’t accommodate others. They were steadfast in their approach.

After three weeks, I realized I wasn’t going to be successful in making them feel the same pain I was feeling. So, I crashed. Three days in my bed. I barely came out to eat, and when I did, I only appeared when they were not around. After these three days, my parents came to my room and asked me a few questions. The last question, which I found to be ludicrous was posed by my father: “If you were called to substitute teach, could you go?” I replied no, I could not.

Then, I was told that a hospital about 30 miles away had a bed open for me. My parents had been in contact with some mental health professionals for a period of time, and on this particular evening, they had placed a call to St. Mary’s Hospital in Decatur, Illinois. A bed was available if I wanted it. There was no mention of dozens of mental health professionals waiting to help me. Just a bed. That’s it. Of course,  I knew I would have to be evaluated but for the time being, all I knew was that there was a bed and a chance for a solution to my problem, my confusion, and my pain. It took me two seconds to make up my mind. I jumped out of bed, showered, shaved, brushed my teeth, and got dressed.When we arrived at the hospital, I was interviewed by a very kind, gentle lady who asked me some cursory questions. Then, she asked me if I was suicidal. I replied that I was.  Next, she asked me if I was homicidal. I replied that I was. She didn’t come down hard on me for answering the way I did. Instead, she encouraged me to stay the night, something that I learned later would have been done involuntarily if I had not accepted it. However, her approach made it easier for me to accept her offer.

When we arrived at the hospital, I was interviewed by a very kind, gentle lady who asked me some cursory questions. Then, she asked me if I was suicidal. I replied that I was. Next, she asked me if I was homicidal. I replied that I was. She didn’t come down hard on me for answering the way I did. Instead, she encouraged me to stay the night, something that I learned later would have been done involuntarily if I had not accepted it. However, her approach made it easier for me to accept her offer.

I was offered a pill that night: Risperdal. The next morning when I awakened, I felt better…not just better, A LOT BETTER! In fact, I felt pretty damn good! That was the moment when I knew I had a mental illness. There was no denying it. Feeling bad before medicine + feeling better after taking the medicine = MENTAL ILLNESS.

The years between then and now have not always been easy ones, but I have survived. Due to personal circumstances, my parents and brother and I are no longer on speaking terms. Their lives are more at peace without me and my life is better without them. But for that short amount of time, we came together and succeeded.

Three weeks is a very short amount of time. To put it in perspective, I was 26 years-old when I accepted help, and by that time, I had been struggling with schizophrenia for at least 15 years, maybe longer. My point:  Don’t necessarily use my example as a measuring stick. Your situation is unique to you, and there are many factors that will play into your story. Some of these factors will be in your control; some will be in your loved one’s control; others may be out of everyone’s control.

I’ve decided to share my story because sometimes I think people need a personal story to inspire hope in them. Sometimes, having a generic, one-size-fits-all roadmap doesn’t quite cut it. I believe this is one instance when that may be true. If my story inspires hope in you and helps, then I believe I’ve succeeded. Even if you don’t follow the path exactly as I did,  I hope that some of the suggestions in this series will prove helpful. I hope you are able to forge your own way to recovery.

Getting Help for a Loved One – Step #2B: Providing a Schizophrenia-Friendly Environment (The Don’ts)

In Step #2A of this series, I outlined numerous “DO’S,” steps that can be taken to provide an environment that is conducive to your loved one accepting help. In this post, I will delve into some of the DON’TS, actions to avoid in order to provide that environment that will hopefully lead your loved one to accept help.


DO NOT ISSUE  ULTIMATUMS REGARDING BEHAVIOR. Someone behaves in a way that does not jive with your house rules or the norms of societal behavior, so you issue that person an ultimatum: Either shape up or get out! While this may work in some instances, when it comes to providing a schizophrenia-friendly environment for your loved one, this tactic will likely backfire.Not only are ultimatums likely to be met with resistance, they will probably be met with a great deal of animosity and resentfulness. Trying to control an afflicted person’s behaviors or coerce them to act in certain ways will likely be seen as a very aggressive act. Remember the “foreign country” analogy from Step #2A? You got it. You’re out to get them. At least that is how many of us would interpret the situation. And feeling like someone, especially a well-meaning

Ultimatums are likely to be met with resistance, as well as a lot of animosity and resentfulness. Trying to control an afflicted person’s behaviors or coerce them to act in certain ways will likely be seen as a very aggressive act. Remember the “foreign country” analogy from Step #2A? You got it. You’re out to get them. At least that is how many of us would interpret the situation. And feeling like someone, especially a well-meaning caregiver, is out to get us is not very conducive to providing an environment where your loved one is likely to accept help.Besides, the chances of your loved one having the ability to change her behaviors? Probably nil. If she were able to think clearly, perceive the world around her in appropriate ways, and act on those thoughts and perceptions in culturally-acceptable manners, chances are very good that, given that option, most of us would choose sanity over the much more painful and confusing alternative. If ultimatums worked to somehow change our behaviors, then there

Besides, the chances of your loved one having the ability to change her behaviors? Probably nil. If she were able to think clearly, perceive the world around her in appropriate ways and act on those thoughts and perceptions in a culturally acceptable manner, she would. If ultimatums worked to change our behaviors, then there would be a lot of happy people and a lot of jobless psychologists.

DO NOT ISSUE ULTIMATUMS REGARDING TAKING MEDICATIONS AND GETTING HELP. Issuing these types of ultimatums is a sure way of tearing down that trusting relationship you’re striving for. Also, these ultimatums probably have an incredibly low rate of success. Taking a mind-altering drug, regardless of its true therapeutic nature, is a very intimate of a decision for the afflicted person. Although you may have your loved one’s best interest at heart, issuing them an ultimatum to take their meds or get help (or both) will most likely be seen as an aggressive act, evidence that you are trying to control him. Coupling this with any expressed emotions is a recipe for disaster.

DO NOT RESTRICT YOUR LOVED ONE’S LIFESTYLE. You would probably like your loved one to smoke less and bathe more. Unfortunately, these things probably aren’t going to happen.

Nicotine is a powerful drug, especially for people with schizophrenia. According to some estimates, 75%-90% of people with schizophrenia have a nicotine addiction. Limiting your loved one’s supply of nicotine can impair his or her ability to interpret, react to, and cope with his environment. Suggest e-cigs or vaping but expect for that idea to be rejected. If it is, move on from it. Perhaps, you can revisit it at a later time.

If your loved one refuses to bath, try to sweeten the pot. Nothing says you can’t make a deal with her. Entice her with a reward like ice cream, chocolate, or extra money for that nicotine addiction. If she bathes once or twice a week, consider it a win-win situation for both of you. If your loved one simply flat out refuses to bathe ever, then it may be time to think about alternative living arrangements. Avoid ultimatums. If it gets to that point, your best bet may be to go ahead with the involuntary hospitalization or alternative living arrangements. Fighting too much (or more than is productive or necessary) over this issue will probably hurt your relationship more than if you simply took the inevitable action, something that may also hurt your influence over your loved one to stay in treatment down the road. Remember what I said about expressed emotion? In my opinion anyway, the severity as well as the duration of those expressed emotions can have direct, detrimental effects on your relationship with your loved one. In other words, if you can’t limit one (i.e. the severity), then at least attempt to limit the other (i.e. the duration). Might make a difference. I am not well versed with this one, so use your own judgment. However, remember that nicotine addiction, avolition (lack of motivation), and poor hygiene are all (especially together) symptoms of schizophrenia. Okay, not everyone who is addicted to nicotine has schizophrenia (so technically, it’s not a symptom), but most people with schizophrenia have an addiction to nicotine, so I included it. Still, I think you get the picture.

  1. DON’T BEAT YOURSELF UP WHEN YOU MAKE MISTAKES. Another way of putting this is to allow yourself to make mistakes. They’re going to happen. The trick to dealing with them is not to feel guilty about them, or to minimize the guilt you may feel about making a mistake. Guilt, especially when dealing with a severe brain disease like schizophrenia, is wasted energy. Not only does it make you feel bad (and possibly resentful of your loved one), but it also adds to that expressed emotion I keep talking about, and that puts your loved one on edge. See the cycle? Fall into that trend and that trusting relationship you’ve spent so many hours, days, weeks, and possibly months to develop will quickly go down the tubes. Besides, your time and energy (when devoted to your loved one) should be spent trying to come up with ways to help her, even if that help is simply spending quality, nonjudgmental time with her (which by the way, in my opinion, can be one of the best ways to enjoy your loved one and build trust with them). Like I said, you’re going to make mistakes. When they happen, if it’s appropriate (use your judgment), address those mistakes with your loved one. Note: As a gauge of whether or not to address a particular issue with your loved one, one “measuring stick” might be how much distress the situation seems to be causing your loved one. Little distress = probably not worth addressing due to the fact that addressing it might just aggravate your loved one and  his symptoms (e.g. paranoia). Severe distress = probably ought to address this situation quickly and with as little expressed emotion as possible (and in an honest manner). Distress that is somewhere in between = use your judgment.

These are 4 “DO NOT’S” that I was able to think of. Perhaps, you can think of more. If so, please share them with us!

Take care and best wishes…



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