Improving communication

One of the best things you can do for a relative or friend with schizophrenia is to have a good relationship with them. Besides helping to counter the isolation of schizophrenia, it also helps to anchor them to reality and boosts their self-esteem.

Good communication improves any relationship, and communicating with someone who has schizophrenia can be very difficult, for example, how do you talk to someone who thinks they are God. And what do you do when they do not want to talk?

Reading the guidelines below will help to make this easier. Remember to talk to someone with schizophrenia in much the same way as you did before they became ill. Although you have to make allowances, you are not talking to a child. Put yourself in their position. Which would you prefer, someone who is condescending or someone who treats you with respect and makes you feel you are a worthwhile human being?

Talking to someone with delusions
When someone insists they are Jesus Christ or that the CIA is after them, don't say they are talking rubbish. It is important to recognise that these ideas and fears are very real to the person, but at the same time you wish to show that you do not agree with them.

This means calmly saying things like: "I know you can hear voices talking to you, but there really isn't anyone else in this room". Or, "I know you really believe you are Jesus Christ, but you are not. You are Michael Smith".

Once you have made your point, don't become involved in an argument. Try and move on to some other topic. This is often easier said than done, of course. It is very tempting sometimes to give in and say, "Okay, you are Jesus Christ". This will only feed the delusion. If you have schizophrenia and a hundred people insist you are not Jesus and one person says you are, you will believe the person who agrees with you.

Keeping your cool
Schizophrenia can make people irritable and aggressive. Staying calm in the face of this is easier when you understand why.

People with schizophrenia are sometimes very sensitive and have low self-esteem. These things combined with their delusions mean they may easily take offence and feel they are being criticised unfairly. If the person is being irritable and unreasonable, do not shout or storm off. Try instead to explain calmly why you feel angry.

Give a clear reason, such as "I'm upset that you left the door open when you came in last night. We have had a number of burglaries in this area and I don't want us to be burgled to". When you want the person to stop doing something annoying, always give a reason. Saying "Don't do that" is not enough.

If you have a row and the person becomes withdrawn
People with schizophrenia often leave the room during an argument and the family's natural reaction is to go after them. The best approach is to back off and leave them some privacy and still show you care. You could say something like, "I'm really sorry you are upset - let's talk about it later".

Think before you speak
You cannot always be spontaneous when you are talking o someone with schizophrenia. The paranoia and sensitivity that go with the disorder can make people misinterpret what you say. A casual remark like "I hear your mother has been sick lately", can be translated into "Your mother has been sick because you make life so difficult". It pays to say something more specific like " hear your mother has been sick with the flu".

Again, when you get angry, avoid generalisations like "It's all' your fault" or "You are nothing but trouble". A more specific "I wish you hadn't done that because ......." is better. Remember to keep the person informed about things that are coming up in the future, a visit from relatives, for instance. Spring the news on them suddenly and you risk making them suspicious, and they will think something like, "they have been keeping this from me for weeks ......"

Keep sentences clear
Anyone under stress but especially someone suffering from schizophrenia can be confused by complicated instructions. Here is an example: "Could you put the garbage and milk bottles out and when you have done that, the garden needs hosing, but don't water the plants on the table because I have already done them". It is better to say "Could you please put the garbage and milk bottles out" and, when they have finished that, say, "Could you please water the garden, but you don't need to water the plants on the table".

The same goes for giving choices. Do not bombard someone with lots of options like "There is egg and lettuce sandwiches, cheese and pickle, ham and salad or would you rather have tuna?", narrow it down to two or possibly three choices.

,b>Bizarre words, unfinished sentences and other conversation quirks
Some people with schizophrenia use made up words (neologisms). If you do not understand them it is more useful to say "I don't really understand what that word means" rather than saying "Don't talk rubbish". Also be prepared for the person to either refuse to explain or give an explanation you do not understand.

When this happens, it is a good idea to change the subject, otherwise you end up in a conversational stalemate and if the person insists in continuing a conversation you cannot comprehend, it could mean they are becoming psychotic. Again, make it clear you do not understand and either talk about something else or offer a distraction.

Some people also suddenly stop what they are saying in mid- sentence (this is called thought blocking). What you do here is remind them of what they were saying before "Jill, we were talking about..." The same goes for times when the conversation suddenly switches to a completely different topic (this is called tangential thought). Again, lead them back gently: "Jill, we haven't finished talking about..."

If the person does not want to talk
If you are trying to talk and the person seems distant, do not take it personally. It is because the person cannot process what you are saying - you are probably competing with a cacophony of other voices in his or her head. There will be times when the person needs to withdraw. You can try saying "Is there some reason why you do not want to talk to me?" When the person does not want to talk, accept it.

You may not be able to keep them in the 'real world' all the time. Remember too that people with schizophrenia often have a strong desire for privacy. Ask too many questions and they may think you are prying. You need to respect their need for privacy while at the same time showing that you care. You can do this by saying something like "I see you do not want to talk right now and that is OK. If you want to talk later on, I will be here".


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