Counseling relatives of schizophrenic patients on all issues – how to behave

What to do if there is a mentally ill person in the family – and he denies treatment

In the world, about 15% of people need psychiatric care, in Russia – 25%. At the same time, every fifth psychiatric patient interrupts treatment too early, and every twelfth refuses treatment altogether. The lack of criticism of their health condition in medicine is called anosognosia. Patients deny their problems and the need for treatment, condemning their environment to suffering and themselves to an even greater deterioration of their health. Let’s look at why people don’t want treatment, how to help them and what to do if you don’t want treatment.

Why do not want treatment, but the refusal of medication only makes it worse

Often people with severe mental disorders do not follow the doctor’s recommendations, do not take medications and do not comply with the recommended regime. This occurs, firstly, because of an underestimation of one’s condition: it seems that if there is no pain – then everything seems to be fine. Secondly, some medications have side effects: drowsiness, tendency to gain body weight and other troubles – this really interferes with a full life, so many tend to refuse medication. Third, no one wants to take medication for life or for long periods of time: not only does it cause existential sadness, but it is also expensive and inconvenient.

In addition, the stigmatization of mental disorders in Russia plays an important role: people seek psychiatric help only in the most extreme cases, so a huge number of patients remain without examination and treatment.

More than 11% of those in need of psychiatric care in the first two years of illness do not receive it, because they are unsuccessfully “treated” by other specialists.

In mental illness, anosognosia leads to deplorable consequences, first and foremost for the sufferer: deterioration of health, untimely treatment and complications. At the same time, the severe condition is very slow and difficult to correct, and each breakdown leads to a decrease in adaptation and to a deterioration in the quality of life, and relatives often have to “clean up” difficult situations: loans taken in a state of aggravation, severe conflicts with those around them.

The most dangerous consequence of not receiving treatment is suicide. The suffering person is consumed by painful experiences and, without the help of medication, often ends up self-harming or attempting suicide.

The biggest problem is that the ill person may shut himself off from the world, withdraw into self-isolation and underestimate his condition: he may think he is strong and can handle himself – but the disease often turns out to be stronger.

What kind of situation the patient’s relatives find themselves in

It is not easy for relatives as well. There are two typical poles of worry for the person’s relatives.

One pole is guilt for the behavior of the ill person, shame about what is going on in the family and, as a consequence of this guilt, full adjustment for the illness. This is the reason for the hyperprotection that is especially characteristic of the families of alcoholics and drug addicts.

The other pole is, on the contrary, detachment. People choose to ignore the problem not because they are violent, but because they are misunderstood, confused, and afraid. In both cases, relatives often try to hide the fact that there is a disease in the family and are afraid that someone will find out about it.

This can gradually lead to social isolation for the whole family, which can also be a consequence of stigmatization – negative social attitudes toward the mentally ill.

People lack clear ideas about what exactly to do if a seriously ill person refuses treatment. Many people helplessly turn to forums, medical websites: “help, my mother abuses alcohol and does not want to go to the doctor…”, “what to do in the situation when my daughter suffers from schizophrenia and does not want to take medications prescribed by the doctor…”, “it is difficult to live with her, but she does not want to go to the doctor….”.

These questions can be confusing, because you can’t take an adult by the hand and take her to the doctor by force if she doesn’t want to.

What the law says about involuntary hospitalization

“A person suffering from a mental disorder may be hospitalized in a medical organization providing inpatient psychiatric care without his consent or without the consent of a parent or other legal representative before a judge order, if his psychiatric examination or treatment is possible only in inpatient conditions, and the mental disorder is severe and causes:

(a) his immediate danger to himself or others, or

(b) His helplessness, that is, inability to independently satisfy the basic necessities of life, or

(c) Substantial harm to his health due to deterioration of his mental condition, if the person would be left without psychiatric care.”

– The Federal Law “About Psychiatric Assistance and Guarantees of the Rights of Citizens at its Provision” from 02.07.1992 № 3185-1 article 29 (ed. from 19.07.2018), article 29: “Grounds for hospitalization in a medical organization providing psychiatric care on an involuntary basis”.

Only in these cases it is possible to hospitalize a person involuntarily: by decision of the court or the prosecutor’s office. In other situations, hospitalization is carried out only with the consent of the person, at the doctor’s recommendation.

Forced hospitalization is always not the best option. Any violence is accompanied by mental traumatization.

As a result, the patient will lose trust in his relatives, their relationship will become hostile, which will not help the sufferer in any way, but only aggravate his condition.

How to behave with a person suffering from mental disorders

According to the chief freelance specialist psychiatrist of the Department of Health of Moscow and chief physician of the Psychiatric Clinical Hospital № 1 G. P. Kostyuk. P. Kostyuk, with patients who do not succumb to persuasion, “the main thing is not to argue, but also not to agree …”.

In no case should relatives threaten, blackmail, criticize or intimidate the person. It is important to remain calm and kind to the sufferer, to be patient.

The sick person may be fickle, first needing someone else, his love and warmth, then being withdrawn, pushing away and demanding that he not be disturbed. You should not be offended by a sick person. We don’t resent people who can’t speak because of their illness.

If the patient has delusional fantasies, it is recommended to listen to them calmly and not show that you are upset or distressed, worried about something, it is even possible to play along in such a situation.

For relatives of the mentally ill to feel more confident, they need information about their loved one’s illness, treatment methods and forms of help directly from the community of people with similar problems. They can receive this information at special psychoeducation courses, which are regularly held at the PND.

What attitude should be developed toward what is going on

The relatives of the patient should be aware that if mental illness is treated, seek help from specialists in a timely manner, do not hesitate to talk about it with people who have suffered a similar fate and take a comprehensive approach to treatment and rehabilitation issues, good results can be achieved.

It is important to understand that an acute condition is not forever, you can survive, endure and treat it. The main thing is to believe in the best and to seek help.

Naturally, negative impressions and frightening emotions cannot be avoided. The thing is that help in such a situation is required not only for the patient, but also for his environment. Use relaxation, listen to calm favorite music, take the opportunity to take a walk alone, meditate.

About his anxiety is also important to talk to the doctor and agree to supportive therapy: the situation in the family, where the sick person lives, can be psychotraumatic for its other members.

It helps a lot to treat what happened to a loved one as a test or lesson that teaches you to be more tolerant, learn to be caring, be strong, wise and courageous. Yes, illness can cause shame, fear or pain – but knowing that you can deal with it together gives hope for well-being and improves the psychological situation in the family.

Be sure to give everyone time, especially after the acute phase of the illness. Don’t wait impatiently for a “quick leap forward,” but facilitate the small steps of your loved one with a mental disorder – and enjoy them.

How to help the person with a mental disorder accept the need for treatment

If the person is stubbornly resistant to contact and does not want treatment, you can look for information about private clinics, discuss the situation with the doctor and come up with a competent way out.

Wake up the person with the fact that he needs to go to the hospital urgently, it is not necessary. If the person is competent, he is partly aware that something wrong is happening to him, but perhaps he is afraid to go to a psychiatric hospital, having seen enough scary movies or heard enough stories. And the subject of psychiatry itself is very stigmatized in Russia, which reduces the confidence of patients in psychiatrists.

It is possible to call a doctor at home or to present him as a psychologist or psychotherapist, who “will just talk” – this will be perceived less painfully by the patient.

A psychiatrist can help convince the person to start taking medication.

If the mentally ill person does not agree in any way to be hospitalized, and he or she really needs it, it is possible to take a trick and say that he or she needs to go to the hospital for an examination to prove that he or she is absolutely healthy and that the doctor’s diagnosis is incorrect. Or to explain that it is necessary to take tests to cancel the diagnosis, and this can only be done in the hospital.

Modern psychiatry is slowly transitioning to an outpatient form in the “Western manner,” when hospitalization is not required.

Treatment takes place at home rather than in an inpatient facility, which promotes the adjustment of people with mental disorders and does not stigmatize them. This results in a positive impact on quick recovery and socialization.

What you should not tell the patient

According to psychotherapist Mikhail Burdin, when talking to a patient, you should not use prediction phrases, predictions:

“You’ll get sober!”

“You’ll get fired from your job!”

“You’ll ruin your liver!”

“The kids won’t respect you!”

“You’ll end up like your father!”

“You’ll drive us into the coffin!”

These are all predictions. They can be as fair as they want, but these words won’t do any good: the sick person will immediately become defensive. You have to be able to separate real events from your generalizations.

What to say to the sick person

People with a variety of mental disorders (alcoholism, schizophrenia, depression) can be very sensitive to the behavior of others.

The behavior of those close to them should be based on care and a desire to help. Standard phrases such as “calm down…”, “everything will be all right…”, “pull yourself together…” are not suitable for everyone. – They often do not work at all.

The mentally ill person lives in his own world, and sensitivity of relatives to his condition is needed. You can gently ask, “How are you feeling?” Try to ask open questions in an unobtrusive way: “Tell me… What did you eat (eat) for breakfast? What are you thinking about?” It is important to stimulate the patient to talk and answer in detail – this will help him to understand better. If he does not want to talk, there is no point in making him do it – it is better to try and talk again later.

Your own openness about yourself will help the sick person to open up too.

Try to remain calm and friendly.

What if relatives make mistakes

Unfortunately, relatives do not always understand the strangeness of a loved one and may panic in vain. Panic is often a projection of one’s own difficulties or problems onto another (anxiety, anger, aggression). Such a person may not accept that he or she has problems, deny them, suppress them, and blame them on the other person.

Situations of unreasonable anxiety in the family can be rather various.

The young man may be told by his parents that he is crazy and they want to transfer him to a psychiatric hospital. He is just an artist who was unlucky enough to be born in the provinces, where people don’t understand his quirks, his paintings, his reticence or his eccentric behavior. Does the law protect him in this situation?

Yes, the law on psychiatric care protects him: he has the right to refuse treatment, in which case there are no grounds for involuntary hospitalization, and no one will take him anywhere.

How to check for yourself if everything is all right

If you refuse to eat, sleep badly, have nightmares in your dreams, feel broken, notice strange things, thoughts flow quickly in your head or, conversely, feel sluggish, sluggish; you cannot go to work or school, you feel mental pain and hopelessness, you hear a voice in your head; if people seem persecuting and hostile to you, if you suspect that they want to poison you, if you feel strong anxiety, and all this interferes with your normal full life – then it is really time to see a doctor.

If you are quite content with your life, and only conflicts in the family and at work spoil it, then you can try to see a psychologist to solve difficulties in interpersonal relations – you probably don’t have any disorder.

Because of the rapid development of pharmacology in psychiatry, we often want to send someone to a psychiatrist, but there are only very limited conditions for doing so. A psychiatric hospital or a private psychiatric clinic should be consulted only when necessary.

For everyone, from the jealous to the melancholic and from the creative to the common asshole, the option of seeing a psychiatrist is not an option!

Some may need behavioral correction, but a psychologist or psychotherapist is enough for that.

Treatment of schizophrenia: how to make friends with the disease

Schizophrenia does not choose gender, age or social status. Among its owners – and children, and the world’s famous figures. It is undoubtedly a specific, symptom-rich and vividly experienced disorder that requires increased attention and intensive therapy. Nevertheless, timely and correct treatment of schizophrenia enables its carriers to exist in society calmly and confidently on a par with ordinary people.

Is it possible to get rid of schizophrenia cardinally?

Unfortunately, it is impossible to get rid of the disorder forever. At any “convenient” moment, the process can worsen. This is due, first of all, to the fact that scientists have not definitively established the cause of the disease, and if it is unknown, it is not clear what to fight. But with the right therapy, it is possible to achieve a fairly long remission. That is, a state in which the main symptoms of the disorder go away or are reduced to the extent that they do not interfere with the patient’s behavior and activities.

Recovery is said to occur when the patient’s condition returns to a pre-disease state. But how can this condition be defined, if, for example, the disease started at a young age, manifested itself systematically during 20 years, and suddenly subsided at the age of 40? With age, the emotional background in principle undergoes changes. How to understand that a person’s behavior is not a symptom of the disease, but a character trait? In this regard, there may be some misunderstandings about the condition of the patient. But the fact remains that so far you can not get rid of the disorder definitively.

Scientists are still actively searching for a “magic” way to eradicate the disease. For example, in the United States of America, research is being carried out on stem cells. As we know, they are capable of replacing the damaged cells of any tissue. It is assumed that in schizophrenia, they will be able to replace the altered cell elements of the brain.

A postmortem microscopic study of brain tissue of people who had schizophrenia during their lifetime revealed some dispositions of brain cells, and changes in their structure. However, further study showed that these abnormalities occurred as early as prenatal, i.e. intrauterine development, because these cellular elements lacked glial cells. And they appear in brain damage after birth. These intrauterine-altered cells disrupt nerve communication, but it manifests itself in adolescence, when the body begins to burst into a violent upsurge.

An experiment on rats showed that the stem cells transplanted to them were able to restore in them exactly those cellular structures that suffer from schizophrenia. Confirmation of this theory would be a major breakthrough in the treatment of the disorder.

The whole world is involved in the study of the disease and the search for effective treatments. The National Institute of Mental Health in Maryland has a schizophrenia research program. Anyone, whether a patient or a relative, is welcome to participate. In some cases, participants are paid for travel and participation in experiments.

Problems in schizophrenia therapy

As a rule, the disease draws attention to itself when productive symptoms appear. Recall that these include, first of all, delusions and hallucinations, as well as disconnected thinking and incoherent speech.

Hallucinations are most often vocal. They cause the patient to perform certain actions, sometimes of a negative nature. Hallucinations induce the person to act inappropriately or threaten himself or others.

Of the delusions, delusions of jealousy and persecution are common. At times the statements of such patients can be so plausible that it is very difficult to believe that they are not true.

Disconnected thinking is manifested by incoherent utterances. Here is an example of a dialogue with a girl with schizophrenia:

– My mother has a disability in neurology, and this is already cobalt.

– Nastya, what cobalt, is it metal?

– Metal is not metal, but that’s the ceiling.

The disease has other signs relating to negative symptoms: apathy, lack of willpower, aloofness, etc. But these in isolation rarely suggest schizophrenic disorder.

So, the patient enters the hospital in the acute period of the disease with delusional speech, supported by unrealistic images and with a violation of self-identity. Medications help to relieve the exacerbation. They are the first medical aid in such a situation, stabilizing the patient’s condition.

But this is not the end of the treatment. Ahead of the patient is a long period of medication treatment. The first means of therapy for schizophrenia are neuroleptics, which eliminate psychopositive symptoms, as well as antidepressants and other antipsychotics.

There are some problems associated with taking these medications that delay the onset of remission.

Firstly, it happens that, it is necessary to try several treatment regimens and go through more than one medication before it is possible to achieve the desired results. Antipsychotics are quite effective at treating hallucinations (they dissolve after only a couple of days) and delusions, which can take several weeks to resolve. On the whole, it takes up to 6 weeks for the patient’s condition to normalize.

Secondly, side effects often occur with antipsychotic medications. These may include dizziness, somnolence, visual disturbances, tachycardia, photosensitivity. These usually go away within a few weeks.

More serious effects include seizures, weight gain, and heart attacks.

Since schizophrenia is a chronic disease, a person has to take such drugs throughout their life. If you stop taking them on your own, the psychotic episodes will recur. The decision to stop taking medication should only be made by a doctor, adjusting the treatment.

It should be noted that the doctor should listen to the feelings expressed by the patient about taking antipsychotics. In case of intolerance, he will try to select a more appropriate remedy.

Unfortunately, many patients do not understand the seriousness of the situation and refuse to take the medication. There may be different reasons for this:

  • disbelief in the existence of the disease;
  • duration of ingestion;
  • severity of side effects;
  • Lack of rapid results;
  • Disorganization of thinking, when the patient simply forgets to take the pill.

Medication therapy is the main step on the way to the successful treatment of the disorder. It is necessary to convey to the patient the seriousness and necessity of the use of medication. Specialists are developing new ways to make it easier to take them.

One of these ways is the emergence of a new generation of antipsychotics. They greatly reduce the degree of side effects, which makes them much better tolerated by patients. Among them are drugs of prolonged, that is, long action. You don’t need to use them every day. Only a few doses a week are enough.

In addition, there are injectables that also replace the daily “swallowing” of pills.

As a reminder for these patients, special medical calendars have been developed where the days of taking medications are marked, as well as boxes-organizers in which medications are placed by day of use. This is not only convenient for the patients themselves, but also for their relatives who monitor the treatment.

An electronic timer, which signals when it is time to drink the medicine, is also a common way of reminding.

Here is the story of a woman who recounts the development of her husband’s disorder. For her, it’s been a living hell. From a caring and kind spouse, he turned into an aggressive and rude paranoid: breaking phones and a laptop, claiming he was being bugged by the FSB, and his neighbors were nothing but agents. The man claimed that his wife was possessed by demons and aliens. He was awake at night, wandering the rooms, talking and laughing to himself.

The disease accompanied him for several years. His symptoms worsened when he quit taking pills. Once again, the woman tried to convince her husband to take them. He survived the full course, which lasted a year, and achieved a stable remission.

Stories like this once again prove the necessity of taking antipsychotic medications. It is time to realize that they are as indispensable for schizophrenia as insulin is for diabetes.

The Second Step to Success

Antipsychotics and psychotherapy are a standard combination in the treatment of schizophrenic disorder. Psychotherapy is usually used during a period of quiescence when the patient’s consciousness is clear and sane.

Among its methods, cognitive-behavioral therapy has been used successfully to treat schizophrenia. Because it is believed that incorrect beliefs can lead to the disorder, this method focuses on working with the patient’s cognitions–the thoughts, attitudes, and priorities of life. It fundamentally changes a person’s thinking, helping them to perceive reality more adequately.

A schizophrenic patient is prone to pathological fantasizing. Gradually his fantasies become reality for him, due to which he begins to behave inadequately, talking to voices or imaginary characters that arise in his head.

The task of the psychotherapist is to explain to the patient the absurdity of his or her thoughts and the unreality of the images that arise. For this purpose, the therapist uses various ways to confirm the facts – theses from scientific literature, photographs, video recordings, as well as judgments of people authoritative for the patient.

Group psychotherapy plays a huge role in the treatment of schizophrenia after individual sessions. It is especially effective with pronounced negative symptomatology: depression, apathy, isolation from others.

In this case, group sessions allow the patient to realize that he or she is not alone, that there are many people with the same problem around him or her; they help him or her accept the diagnosis.

Group psychotherapy gives support to its participants, teaches interaction with people and development of adequate ways of behavior. The patient learns to recognize and assess his own emotions. At the sessions, participants discuss the problems they have and look for ways to deal with them.

The group usually consists of 8 to 16 people. The session can begin with a warm-up session with art therapy, psychogymnastic exercises, and simulated situations. After that, participants move on to a discussion of existing questions and problems. It is directed at active involvement of all members of the group in the discussion.

Not every patient can become a participant of such a group. It is undesirable to include patients in the midst of productive symptomatology, as bustle and crowding will intensify manifestations of delirium and hallucinations. Patients in an excited, aggressive condition and with anxious manifestations are also not admitted to sessions.

Particular attention is paid to participants with depressive and suicidal tendencies, since they can “infect” others with them.

Before inclusion of the patient in the circle of other patients, the psychotherapist can check the patient’s readiness for group psychotherapy. Since a significant number of patients participate, the therapist needs to be sure that all of them will have only positive effects on each other.

Schizophrenic patients are a specific population. Sometimes it is difficult for them to formulate their thoughts or understand what the doctor wants to convey to them. Their abstract thinking is poorly developed, they do not understand humor and react strongly to remarks. It happens that therapy soon becomes boring to them. This is why patients in this category require special attention and great patience. Work with them continues for a long time. The task of the specialist is to keep the patient interested, but on the other hand, not to exert strong pressure, so as not to scare him/her off definitively.

The choice of therapy for each patient is chosen individually, taking into account his or her condition, the form of the illness and the set of symptoms. The conversation should be conducted in a concise, easy to understand manner for the patient.

Schizophrenia – not a sentence

Many patients, learning about his diagnosis, put a cross on themselves, their dreams and goals, believing that the full value of life with this impossible.

This is a huge misconception. There are many examples of people who have achieved much more than the average person by living “cooperatively” with their disease.

Law professor Elin Sachs has lived hand in hand with schizophrenia for 30 years.

She had her first attack when she was 16, coming home from school. The houses around her became somehow animated, giving her verbal cues. Then the psychotic episodes recurred at the university. A speechlessness suddenly came over her: Conclusion suggests presence. And therein lies the salt. The salt is on the nightstand. Sam said. Did you kill someone?

She was haunted by delusions of having killed many people, she was haunted by terrifying hallucinations, her thoughts were confused and incoherent. Elin characterized this period as a nightmare dream, but could not wake up. She was terrified and confused. But classical therapies helped her: psychoanalytic approach and medication.

Her relationship with medication did not improve immediately. For a time, Ellyn believed that the less medication the better. Her therapist tried to convince her otherwise, but she was resistant. She reduced the dosages until, during another visit to the therapist, she fell to the floor and began thrashing about convulsively. It seemed to her that she was being attacked by strange creatures with knives and chopped her into small pieces. As a result, she did go back on the prescribed medication, and she hasn’t parted with it to this day.

When Elin once again started raving in the psychiatrist’s office, the psychiatrist offered her hospitalization, which she had to accept.

Ellyn is currently a professor at the University of South Carolina Law School and a member of the Department of Psychiatry at the University of California, San Diego. In the past, despite her illness, she has been the recipient of a MacArthur Foundation Fellowship, one of the most prestigious charitable organizations. The disorder did not prevent her from marrying successfully at age 40.

Her case proves that schizophrenia is not a reason to isolate yourself and the world. The disease can be kept under control, just need to work on himself.

With her colleagues, Elin is doing research on schizophrenia. They’ve been able to study 20 people who are also living with the illness. Most of them have been through more than one hospitalization, and most have a high school or college degree. Among them are masters, psychologists and lawyers, doctors, technologists and managers, and CEOs. All of them live active lives and are not used to being discouraged.

Little tricks

People suffering from schizophrenic disorder say that to cope with the disease along with medication and psychotherapy, they are helped by their own special techniques. For each, they are individual. Some look toward sanity when they hallucinate. They ask themselves if it really exists, maybe it’s an illusion, a mirage. Others banish the voices in a crude way.

There are people who are able to anticipate the onset of an attack. In this case, they try to seclude themselves.

However, many note that work helps them to reduce the sequence of negative episodes. Some are capable of working the entire day. This is a great way to distract and occupy the mind with something useful. In addition, the feeling of their importance and usefulness, as well as respect from others gives them strength and a positive charge.

In everyday life, such people strive to maintain a harmonious internal state, avoid stress, overstrain and upheaval. Harmony and calmness – the best way to prevent the aggravation of the disease. They try to do favorite, useful work and avoid activities that are unacceptable for them. They communicate with people who are pleasant to them. They consume food that suits them and choose entertainment to suit their tastes. Their task is to minimize their exposure to negative stimuli.

But the main and necessary means to keep the disease under control is, of course, the care and support of those closest to them. The person needs to know that he or she is not alone and that there is someone to turn to. That there are people around who are able to help him at a critical moment. This gives confidence and strength.

Schizophrenia – this is no reason to fall into despair. Real stories are a great example of this. However, this illness requires patience and control. Proper treatment allows one to live life to the fullest.

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