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Their reality is not your reality: understanding people with schizophrenia



It can be difficult to support a person experiencing the hallucinations and delusions of schizophrenia. Here’s how to help.

How can you help a person get care for a serious mental illness if they’re convinced they’re not sick?

That’s the challenge for some people with schizophrenia. They may seem like they’ve lost touch with reality, seeing or hearing things that aren’t there or having beliefs that aren’t supported by facts. They may also have a lack of personal insight that makes them unaware they have any symptoms at all.

While this can seem bewildering to families of those with schizophrenia, it’s important not to abandon hope. By educating yourself on the condition’s symptoms and treatments and offering empathetic support, you can indeed help a person with schizophrenia get the right care. “A family’s togetherness means a whole lot,” said Albert Wu, MD, a psychiatrist and medical director at Horizon.

Discover what schizophrenia looks like and what treatments are available so you can be there for the people you care about.

Experiencing a different reality: signs and symptoms

There are frequent misconceptions about schizophrenia, including that people with the condition have “split personalities.” This is not true, explains Dr. Wu.

“For people with schizophrenia, the disconnect isn’t between separate identities. It’s between the outside world and how they experience it,” Dr. Wu said.

Schizophrenia is characterized by the presence of multiple, complex symptoms:

  • Hallucinations. These include a person hearing voices or seeing, smelling or feeling things others can’t. People with schizophrenia perceive the hallucination as very real and can describe it as running commentary or criticizing remarks.
  • Delusions. These false beliefs may include fears that others are “out to get them” or that the TV or radio is broadcasting special messages just for them.
  • Negative symptoms. These can include difficulty showing emotions (such as having “flat affect” or interacting with others in a disconnected manner), reduced motivation, and lack of interest in daily activities or social interactions.
  • Cognitive issues/disorganized thinking. These can include problems with attention, concentration and memory. People may have trouble following conversations, turning silent midway through and then not responding.

Less than 1 percent of the U.S. population has schizophrenia, with males usually diagnosed in their late teens to early 20s and females in their mid-20s to 30s. Individuals in their early to mid-teens are not usually diagnosed with this condition, although it’s possible if they are diagnosed with schizophrenia when they’re older to look back and notice something was going on, Dr. Wu said.

“There may have been slips in academic performance. Or they stopped enjoying sports or hanging out with friends. Little hints that not everything was going normally,” Dr. Wu said.

Schizophrenia treatments: from antipsychotics to support groups

The first step to treating schizophrenia is getting an accurate diagnosis, Dr. Wu said. That’s because the condition can often be confused with many other mental illnesses, such as bipolar disorder or even a substance use disorder.

With the right diagnosis in hand, treatment can begin sooner. “The earlier an intervention, the better the outcomes,” Dr. Wu said. An accurate diagnosis also allows a person’s doctor to choose the best therapies, which usually involve antipsychotic medications.

These drugs can reduce how severe and how often people may experience hallucinations and delusions, but they can come with side effects that may include increased risk of weight gain and high cholesterol. That’s why people using these medications should be monitored frequently by a doctor to ensure that the treatment is effectively addressing the symptoms and that they’re not developing side effects such as diabetes-like symptoms or heart problems.

“It’s always a balancing act to prescribe a medication that’s effective while minimizing the side effects,” Dr. Wu said.

Treatment also may include psychotherapy, such as a form called cognitive behavioral therapy (CBT). This can help a person “reshape their thinking,” so they can better respond when their symptoms arise.

“If they hear voices or feel that the radio is sending them messages, with CBT training, they can question whether these symptoms are reality-based or part of the illness,” Dr. Wu said.

Behavior skills and employment training can also be helpful for people with schizophrenia to improve their interactions with others and lead a more fruitful life. “Depending on the severity of the illness, it can be difficult for them to manage everyday things or hold a job,” Dr. Wu said.

Families, too, have a role to play in caring for their loved ones with schizophrenia. It can be difficult to know how to support or respond to a person experiencing the symptoms of schizophrenia. Here are some tips people can use to help:

  • Educate yourself. Schizophrenia is a complicated disease. Consult trusted resources or talk to a treatment provider to learn more. “It’s hard to do it by yourself,” Dr. Wu said.
  • Be involved as possible. Help your loved ones keep track of their appointments and daily medications. This can help a family member stay in treatment.
  • Learn how to respond. People with schizophrenia truly believe what they’re seeing and hearing is real. Don’t immediately challenge their beliefs by saying it’s not. Instead, be respectful that everyone can see things in their own way.
  • Check out support groups. Sharing experiences with others can be therapeutic – both for people with schizophrenia and their caregivers.