Schizophrenia: An Information Guide
What families say they need and want
Upon return from hospital, people with schizophrenia and their families face many challenges. Below is a list of things various
families have said were most helpful when their ill relatives returned to the community:
- journals and books about schizophrenia
- talking to the ill relative to learn about the illness
- support from people in their social network
- case management support
- a support group, such as the Schizophrenia Society
- a job for the ill person to go to
- contact with hospital staff and family doctor
- a good sense of humour
- police support.
Stressors after discharge
When people are discharged from hospital after the active phase of schizophrenia, some symptoms may remain. They may be withdrawn
and prefer to spend time alone. They may be preoccupied with their own thoughts and fantasies, leading to problems with concentration.
Personal grooming may slip. They may sleep during the day and be up at night. Interest and energy for activities they previously
enjoyed may disappear. They may resent being reminded of daily routines.
You may find these behaviours and attitudes very stressful. As a result, it is important to find ways for your ill relative
to carry out his or her responsibilities. It is helpful to set reasonable expectations and to work out a structured approach
to accomplishing tasks.
It is common for people with schizophrenia to feel uncomfortable in the presence of others, especially as they recover from
the effects of an active phase. Interpersonal contact can be very difficult for a number of reasons, including fear of people,
lack of confidence, and feelings of inadequacy or being different from others. You need to understand these problems, but
at the same time you need to emphasize the importance of social contact to the person’s health. Encouraging them to “do their
best” and helping to set up structured interactions can benefit people with schizophrenia. Just carrying on with regular family
activities helps build up tolerance for interaction with others.
Finding the right pace
It will take time for you and your ill relative to establish a pace that supports recovery. Often you may be “out of sync”
with each other, with one or the other moving too quickly or too slowly. To get “in sync” it may be helpful for everyone to
negotiate a daily routine that includes elements of self-responsibility, activity and social contact.
You can help by being open and supportive to the ill relative’s efforts to reconstruct his or her life. Recognizing that people
do things differently will prevent needless arguments over the “right way” to perform a task.
Suggestions regarding inappropriate behaviour will be heard more easily if they are delivered in a low-key manner. It helps
to emphasize the positive. You may need to provide more input and perform more tasks in the early stages of recovery. As the
ill person progresses, you will need to do less.
Coping with schizophrenia may raise a variety of issues and needs for different family members, depending on their relationship
to the person with schizophrenia. For example, children of a parent with schizophrenia are likely to be confused and upset
by their parent’s changed behaviour. They may be afraid, hurt or ashamed When schizophrenia affects children, parents will
often feel guilty and burdened.
The needs of siblings are sometimes overlooked. Like parents, siblings may feel self-blame and guilt. It is also common for
siblings to be afraid of becoming ill themselves. Supportive family counselling can help all family members to address their
needs and concerns.
Support is critical to the well-being of ill people. It is important that couples in which one partner has schizophrenia find
ways of maintaining and expressing their affection for each other. Task sharing is an important element of primary relationships.
If couples can agree on what tasks ill partners perform as they recover, it will be easier to move forward. If the ill person
cannot act as a confidante, his or her partner should seek an alternative source of support, possibly through a relative’s
group. If a couple experience ongoing difficulty in their relationship, couple counselling should be considered.
The needs of the family
You need the support of relatives and friends to cope effectively. Keep in mind that all family members are important and
have their own needs. You need to find a balance — which will vary according to the changing circumstances of your lives.
If you don’t take time for yourself, you risk becoming exhausted or “burned out. Other people, such as friends, therapists
and the clergy,may be willing to help and should be called upon when the need arises.
At times you and your ill relative will disagree. The best way to handle disagreements is to make sure that the ill person’s
point of view is made clear. This will avoid any misunderstanding in perspectives. By stating thoughts and feelings calmly
and matter-of-factly, it is more likely that you will resolve your differences of opinion constructively. It will not help
to give in to unreasonable demands out of sympathy or fear.
Most people with schizophrenia would never harm anyone. In fact, they tend to be timid. However, a person with schizophrenia
may make threats or strike out in response to hallucinations and delusions. This can be surprising and frightening to those
around him or her. Aggressive behaviour toward others often results when people with schizophrenia think others are hostile,
or when they feel crowded or trapped.
If they are upset, do not trivialize their feelings. Do not tease, insult or nag them. Do not to get too close either emotionally
or physically. If violent threats are made, remain calm and take steps to ensure your safety Help from friends, neighbours
or the police may be necessary. Therapists should be informed, and can give you ideas to prevent or deal with similar episodes
in the future.
You and the person with schizophrenia can learn to deal with anger and conflict in a constructive manner. You may meet with
therapists to talk about how to prevent violent episodes in the future. Some hospitals and outpatient clinics offer family
education programs to help relatives learn coping and communication strategies.
Depression and suicide attempts
Some people with schizophrenia feel depressed, unlovable and hopeless. Occasionally, they may be in serious danger of taking
their own lives. This is most common in young men during the first five years of their illness. Suicidal thoughts may also
be a sign of relapse. People considering suicide often talk about it.
If your relative expresses such thoughts or ideas, they should be taken seriously and discussed with the person’s therapist.
If the therapist cannot be reached, take the person to the emergency department of the hospital where treatment was previously
provided, or to the nearest general or psychiatric hospital. The risk of suicide may make family members overly cautious.
Conversely, some families underestimate the risk. Encourage the ill person to share any feelings of depression as possible
warning signs. If you can recognize suicidal thinking, you will be more prepared to act quickly and competently in times of
Organizations for families and friends
Many families and friends join support or self-help organizations where they can meet others who are struggling with the same
problems. Members learn from and support each other at all stages of care. See Appendix 2 for names and addresses of support