Supporting Someone With Schizophrenia

Schizophrenia is a condition in which perception and belief separate from shared reality — most often hallucinations and fixed false beliefs — alongside a loss of drive, expression and the ability to organise thought.

Also called: Schizophrenia spectrum disorder, Psychosis.

ICD-10 F20 · ICD-11 6A20

Dangerous, split, hopeless. None of the three.

News stories and films show people with schizophrenia as violent and unpredictable. The word itself gets used to mean "two-faced". Both pictures are wrong. People with schizophrenia are far more likely to be harmed by others than to harm anyone. And the illness has nothing to do with a split personality.

START HERE

The same message, two replies

Tap any reply to see what it does.

the voices are bad today. they keep saying everyone at work is laughing at me

Lands well

That sounds exhausting. I'm glad you told me.

This takes the experience seriously. It does not agree that the voices are real, and it does not argue about it either.

i know theyre not real. it doesnt help

Is there anything that helped last time? Or do you want to call your care team together?

This points back at their own relapse plan and their own support. It also offers to do it alongside them.

music helps a bit. maybe ill call them

I can stay on the line while you do.

This is practical company. Stress makes voices worse, and feeling less alone helps.

Lands badly

they're not real, just ignore them

This is well meant. The voices sound completely real. Ignoring them is exactly the thing they cannot do.

have you stopped taking your meds?

This might even be relevant. As a first reply, it sounds like blame.

forget it

honestly you're scaring me a bit

This is honest. It also confirms their fear that people see them as dangerous.

Seen. Doesn't mention the voices again.

AND WHAT TO DO

If you are close to someone with schizophrenia

• Do not argue about whether the voices or beliefs are real. Talk about how they feel, and about what might help.
• Learn their early warning signs together. Poor sleep and pulling away are two common ones. Agree in advance what you will do.
• Keep the stress at home low. Keep inviting them to things.
• Ask about family intervention. It is designed for you as much as for them.
• Look after your own health. People caring for someone need support too.

MYTH CHECK

Six things people say. Two of them are true.

Answer before you read the answer. It sticks better.

Schizophrenia means having a split personality.

Verdict: myth.

It has nothing to do with multiple personalities.

The name means "split mind". It was meant to describe a split from reality, not a split into two people. Dissociative identity disorder is a different and unrelated condition.

People with schizophrenia are dangerous.

Verdict: myth.

They are more likely to be victims of violence than to commit it.

Most people with schizophrenia are never violent. The risk rises mainly when the illness is untreated and drugs or alcohol are involved. That is true of anyone.

Nobody recovers from schizophrenia.

Verdict: myth.

Many people recover fully or live well with it.

Outcomes vary widely from person to person. Three things improve them. Early treatment, staying in care, and support with work and relationships.

It is caused by bad parenting.

Verdict: myth.

This old theory has been abandoned.

Genes and a mix of life stresses drive the risk. Blaming families caused real harm. Families are now part of the treatment instead.

Heavy cannabis use can raise the risk of psychosis.

Verdict: true.

True.

Daily use is linked to several times the odds of a psychotic disorder, especially with strong cannabis. The link is strongest in people who start young.

Voices can seem as real as someone speaking in the room.

Verdict: true.

True.

Brain scans show the hearing areas are active during voices, just as they are for real sound. The brain has simply failed to label the signal as its own.

WHAT THE MISUNDERSTANDING COSTS

14.5 years — shorter life, on average, for people with schizophrenia.

shorter life, on average, for people with schizophrenia.

Most of that gap comes from heart disease, diabetes and lung disease. These get found late or treated less well. Part of the reason is that symptoms get blamed on the mental illness.

Fear and stigma also delay the first contact with care. And every month of untreated psychosis tends to make recovery harder.

THE SAME ACT, TWICE

What it looks like, and what it is

Tap a card to turn it around.

Talking to no one.

They are answering a voice that sounds as real to them as yours does.

Lazy. Stays in bed all day.

These are negative symptoms. The drive to start anything has gone. It is not a choice they are making.

Paranoid about the neighbours.

Every small noise feels like a message meant for them. Staying inside feels like the only safe option.

Stopped taking their medicine again.

The side effects were unbearable, and nobody ever asked them about it.

Flat. Doesn't seem to care.

They feel far more than they can show. Their face and voice do not carry it any more.

Can't hold down a job.

They could, with the right support. Most people with schizophrenia want to work.

BACKGROUND

Where the stigma comes from

The news

Rare violent crimes involving psychosis make headlines. The everyday reality of people living quietly with the illness never does.

The word

People say "schizophrenic" to mean contradictory or unstable. That turns a person's illness into an insult.

The films

Films confuse it with split personality. They turn it into a plot twist, or into something to be frightened of.

The history

Locked asylums, and years of blaming mothers, left behind a deep sense that this illness is hopeless and shameful.