In recent years I have given many speeches and presentations to groups interested in mental illness; most of the talks have been for caregivers, especially parents of young adults with mental illness. After I wrap up my remarks and start the question-and-answer sessions, I’m almost always asked what caregivers can do to better help people with mental illness. From my experience of living with paranoid schizophrenia, as well as from personal communication with many other people with this mental illness, I have compiled a list of common mistakes that caregivers should avoid. Here is the top five:
Five mistakes to avoid
1: The Tough Love Approach
People with alcohol and other drug addictions often overuse support and thus caregivers are often wary of empowering the person they care for; therefore, they often take a “tough love” approach to ensure that 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 the negative symptoms (severe apathy, loss of motivation, 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 may be what a drug addict needs to turn her life around, what a person with schizophrenia needs is constant support and medication to simply cope.
2: Too much emotional support
Support is necessary for the person with schizophrenia to cope with their illness, but caregivers often err by becoming too emotionally close. Regardless of what the individual was like before developing the illness, almost all people with schizophrenia need to keep people at an emotional distance. Caregivers should respect this limit and not be offended because it is probably necessary to maintain health.
3: Raise the bar of expectations
As the individual with schizophrenia recovers from the last psychotic episode, there is a natural increase in 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 additional stress on the individual and health problems. Many family members have noted that just as their sick relative was fine, there was a setback or psychotic relapse. Undoubtedly, these setbacks are due in part to heightened stress from rising expectations.
4: Being critical of the individual or the symptoms
It is well established in the psychiatric literature that people with schizophrenia have a heightened sensitivity to criticism. Critically disposed caregivers should actively limit their criticism for the health of the person in their care. Also, many with schizophrenia do not control their symptoms well, so caregivers should not blame them for having the symptoms of the illness. Caregivers of patients undergoing chemotherapy for cancer do not blame cancer patients for having cancer or for vomiting, nor should caregivers of people with schizophrenia blame the individual for being sick.
5: Prevention of smoking
The smoking rate in the United States is about 20% of the population; among people with schizophrenia, the rate exceeds 90%. And nearly half of all cigarettes smoked in the US are smoked by someone with a mental illness. Cigarette smoking has been found, both anecdotally and scientifically, to help with symptoms of schizophrenia. Nicotine helps reduce paranoia and hallucinations, and improves memory and concentration. However, nicotine changes the blood level of many antipsychotic medications, so care should be taken when a person changes the amount they smoke, including starting or quitting.
