The Family and the Schizophrenic
Blame and shame
"People do not cause schizophrenia; they merely blame each other for doing so." This blame can come from both sides, patient and family. Family education, including brothers and sisters, which encourages the expression of beliefs, fears, and feelings help reduce the blame-and-shame syndrome. As a result, schizophrenia becomes easier for all to live with.
Anger and depression
Families of schizophrenics often feel anger toward the schizophrenic member for being ill, then with fate, the universe, or God for allowing this illness. Unexpressed anger turns inward to emerge as depression.
Where should he/she live?
The majority of people with schizophrenia do better living away from home - as do most adults who are not schizophrenic - and coming home only for visits. Living at home creates an atmosphere of unpredictability and tension. The family fears imminent relapse, perhaps through their fault. The patient fears that everything he/she says or does may be misconstrued as a symptom. Consequently, minor frictions and incidents can easily grow out of proportion.
How to behave
The way to behave toward a schizophrenic person is naturally, simply, and with the respect due another human beings, adult or child. Intense emotion can be overwhelming and should be avoided, as should arguing about delusions. Humor, especially sarcasm, is difficult for the schizophrenic to understand. Two-way communication, expression of emotion, and interpersonal relations can be difficult for the schizophrenic, especially in group social events. Schizophrenics like to be around people, but they also need time and space to be alone quietly. An atmosphere of calm and confidence is important to them. Predictable, simple routine, which structures activity and time in everyday living, helps to counteract hallucinations, delusions, and sensory overload.
Independence
The basic guideline for increasing the independence of a patient is to do so in increments based on his/her demonstrated responsibility and competence in household chores. Responsibility for medication is another more difficult issue.
Violence, suicide, homicide
The schizophrenic is rarely violent or homicidal, and, moreover, these acts are invariably by threats or delusional statements. This allows the family time to consult with the treating psychiatrist to assess the seriousness of the situation. The estimated suicide rate varies from 2% to 10% in the schizophrenia population - and many of these suicides are the accidental result of delusional thinking.
Expectations for the future
Keep expectations realistic and within realization, even if this means lowering them. The resulting positive benefit enables the family and its schizophrenic member to share and to enjoy the activities and accomplishments that are within his/her capability.
Brothers and sisters
Siblings, often forgotten, share the guilt and fear experienced by parents. They also worry that they too may become ill, or perhaps are jealous that their problems have been given secondary consideration. One must remember to include them in family education since "it is they, after all, who are likely to have long-term responsibility for their schizophrenic brother or sister after the mother and father have died,..."
Family and support groups
These have proliferated since the mid-70's. All of them include mutual support and education on the subject of psychiatrists, problems of living, housing, patient finances, and patient advocacy. Their most important function is to provide a forum for sharing common experiences and problems. Most are affiliated with the National Alliance for the Mentally Ill (National AMI), founded in 1979, and now numbering over 300 chapters across the U.S.A. Some are an outgrowth of community mental health centers or the American Schizophrenic Association. The latter promotes an orthomolecular approach to the treatment of schizophrenia.
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