I'm not sure. Most are harmless and just need to have a lifestyle and type of work that reduces all stresses as much as possible. I knew of one such who had difficulty coping with people and relationships. On a whim, he decided to clean up every scrap of litter in a public park. Then he began weeding, mowing, pruning and planting. The formerly abandoned park became so lovely that families started picnicking there. After two years, the neighbours appealed to the council and he was given a job as the permanent caretaker.
I think it depends on what condition they're in at the time and the particular variation of schizophrenia they have. During normal periods, one can treat them the same as anyone else, but during episodes one has to be extra careful not to trigger their patterns of reactive fears, and that means one needs to know the person quite well.
When they are talking in word-salad, there is usually a central theme, and if one can pick it, there is some meaning there. If you can pick it and respond to what they intend, then it's possible to communicate. For instance, in Lucky's central soliloquy in Waiting for Godot, if you eliminate every word that doesn't make sense you get this: Given the existence... of a personal God... who... suffers... for reasons unknown... it is established... beyond all doubt that... man... is seen to waste and pine.... for reasons unknown. In the midst of all the absurdity, it sums up the essential meaning of the entire play. In my view, (entirely non-professional,) schizophrenics are often experiencing an existential breakdown of this order, and it makes them anxious and frightened. They need soothing and gentleness.
Occasionally, some are dangerous, and then I think it's best to get out fast or ensure that they can't come in.
R. D. Liang was famous for his technique of talking to a person on exactly their level, as if what they are saying or perceiving is real. From there, he would slowly suggest alternatives that helped shift their perspective.
A shrink I once interviewed had developed a remarkable technique using the Tibetan pantheon of "idams" or abstract personifications. When a schizophrenic was hallucinating demons sending compulsive messages to do destructive acts, she would help her client to counter with visualisations of an angel or god-like entity who was sending stronger messages of benevolent actions. She found it worked.
Of course, if the person trusts you, you could ask them if they've remembered to take their medication. If they've abandoned it for a specific reason, it may be that it doesn't suit them in some way - like making them feel like a half-dead zombie. Then you could ask them if they'd like you to take them back to their MD. Sometimes an adjustment of the dosage or a change in the meds can make them feel a whole lot better.
If you have someone like this who is close in your life, you have my sympathies. It is never easy.
This post was edited by Benedict Arnold at January 15, 2018 8:11 AM MST
Thank you for such a thoughtful response. I do know someone like this- they’ve invented imaginary people. They’re not diagnosed at this point. I’m going to research some of the things you mentioned when I’m not using my phone and will respond better later.
Your info on Laing is what intrigued me most- I wasn't familiar with his work. I'm only just now scratching the surface.
One of the things I just caught was that Laing described psychosis as "a special strategy that a person invented in order to live in an unlivable situation."
I think that could well be spot on. In "my" situation, the individual has some issues that are easily identified, even by someone without a psychology background, and they don't have anything going for them in real life, largely as a result of untreated conditions, both medical and mental. And, I could totally see how the person would create this alternate reality because, if real, would actually normalize them. I cannot, however, determine whether the person knows they're making up the stories or believes them to be true.
At this point, I'm only associated with the individual by proxy. That's probably the best way to explain it... I'm being vague here because I don't know who will read this thread and don't want to provide info that could identify anyone. But, I do see the individual regularly- at least several times per week. At this point, I would rather call BS on the stories. I don't think we're doing the person any favors by going along with it. And, we have urged the person to get help, even volunteering to take them to a doctor, and they refuse. Others in my circle disagree with me and think this imaginary world the person has created is what's keeping them going, and poking holes in it will either result in the person losing it and becoming combative or the person could fall apart entirely and become suicidal. So, we're all at odds here. I can't get medical professionals on board without the person's buy-in, and my circle just wants to let the person be.
Your story about the person with the park is heartwarming. I think something like that would help this person immensely. I may try to help them find some kind of volunteer opportunities. The individual has been bounced around for years and hasn't worked- either relied on the kindness of others or been in really bad situations. If their current living situation were to become not an option, I have little doubt the individual would have no choice but to live on the streets or go to a shelter. Their current state makes them totally unemployable.
So, right now, I'm still deciding how to best help this person- if we should clear it up with the person that we think these people don't exist or if we should just keep trying to redirect them to healthier things and let them have their alternate reality.
Our society tends to pathologise any condition that we consider antisocial or less than optimally functional, and then the professionals attach labels, some without doing blood tests or background checks.
If the labels are wrong, that person can end up suffering years or a lifetime of mistreatments that make the condition worse. But on the other hand, research into brain function and psycho-social issues is rapidly improving all the time, as is the training and supervision of professionals - so finding the right professional is better than none.
It's easy to understand the person's fear of being institutionalised. In Australia the laws on this are the same as you have in Arizona. Laing was a master of deep listening, hearing the truth in a person's subjective reality, and responding with empathy. To help that person say yes to meeting a professional, Laing's strategies could probably help. It might also be possible to get a well-connected counsellor to meet your acquaintance in his or her normal setting, without knowing that the counsellor's role. They usually have good skills in helping a person decide to ask for help.
I agree about not supporting the BS. Reality checks like, "(such and such evidence) shows that this did not happen/ could not possibly have happened," or, "if (this,) then how (that?)" can help.
I also agree with your concerns about the person's trajectory; it could become tragic without an intervention.
My admiration for you, for your caring approach to the others around you, as just shot up even higher. I'm guessing you must have an abundance of energy to cope with such huge demands in your life.
The guidelines are different by state. Here, it does require a threat to others or suicide risk. I believe a parent or a spouse can also have someone committed for up to 48 hours for observation too. I don't think the hospital has the right to make that call, barring the aforementioned circumstances.
I have mentioned to this person that they can't be forced into treatment, but they distrust the system. I haven't really pushed the issue though. At the time, they were ignoring a really bad infection, and I felt like there was a chance they'd involuntarily commit them because their lack of self-care made them a risk to themselves. Right now, I think a hospital would have less grounds, though that's not something I would say to them, lest it give them other notions about getting committed.
Are you talking about me? Excuse me, I rather think she is talking about ME! Who on Earth would want to talk about someone who could be totally annihilated with a few pills.
This post was edited by Stemmata949 at January 14, 2018 7:39 PM MST
You don't deal with someone who is schizo. You get him/her a LOT of help. And if they won't accept help, they will wind up on the streets or totally wrecking lives around them. They have a disease that you have no more ability to cure than you do cancer.
There is not much you can do if they are not a danger to themselves or others and refuse to seek help themselves. It is a sad situation. If they are refusing to seek any medical attention out of fear of the hospital....they know there is something wrong. And they are probably right to worry. In my experience, it is better to humor them. I don't know IF this is possible, for you or another in your circle to talk to the psychologist first about trying to get this person in just to talk under the promise of no hospitalization as long as the person remained non-violent. (Don't know that a psychologist would/could make that promise but maybe a start) I know one who had this for decades untreated, was never violent who had a large tumor which they refused to go to Dr for...said the Dr just poison you and call it medicine. I never thought about it but it could have been fear of the mental hospital. If possible stay away from Lithium. It will cause kidney failure after long term use.
I think you may be right on humoring them. I just realized I already do the same with my mom. I may glaze over the delusions and have a heart-to-heart with this person about their general mental health and be firm about them getting treatment.
I'd be wary of making any promises about commitment. If it doesn't go down that way, and the person is committed, then they'd never trust any of us again. I do think they're a good candidate for rigorous outpatient treatment, though, and I can certainly promise them that I'd be an advocate when it comes to talking to the care team- that I'd fight for them to get outpatient care if it came to it.
You are right promising is going to far. Promising to fight for the outpatient care etc is the way to go. That very good of you to step up like that, it can be very stressful.
Benedict Arnold 