Sooner or later, when a family member has schizophrenia or a major affective disorder, a serious crisis will occur. When this happens there are some actions you can take to reduce or avoid the potential for disaster.
Ideally, you need to reverse any worsening of the psychotic symptoms (psychotic means out of touch with reality) as well as reducing the delusional thinking (believing you have millions in the bank or that you have powers from God are two examples of delusional thinking). At this time you need to provide immediate protection and support to the ill person.
Seldom, if ever, will a person suddenly lose total control of thoughts, feelings and behaviour. Family members or close friends will generally become aware of a variety of behaviour which gives rise to mounting concern: sleeplessness, ritualistic preoccupation with certain activities, being suspicious, unpredictable outbursts, very bizarre behaviour, etc.
Also read: The importance of mental well being of the elderly
During these early stages, a full-blown crisis can sometimes be averted. Often the person has ceased taking medication. If you suspect this, try to encourage a visit to the physician. If this is not successful (and the more psychotic the person the less likely it is to be so) you should contact the physician by telephone or by a note dropped off at his office in order to get advice.
You must also learn to trust your intuitive feelings. If you are truly frightened, the situation calls for immediate action. Remember, your primary task is to help the patient regain control. Do nothing to further agitate the scene.
It may help you to know that the person is probably terrified by his/her own feelings of loss of control over thoughts and feelings. Further, the “voices” may be giving life-threatening commands. In the person’s mind messages may be coming from light fixtures; the room may be filled with poisonous fumes; snakes may be crawling on the window.
Accept the fact that the person is in an “altered reality state”. In extreme situations, the person may “act out” the hallucinations, e.g. shatter the window to destroy the snakes. It is imperative that you remain calm. It is also imperative that your relative gets medical treatment.
While waiting for medical help to arrive (or before attempting to take your relative to the hospital) the following suggestions may prove helpful.
- Remember that you cannot reason with acute psychosis.
- Do not express irritation or anger.
- Don’t threaten. This may be interpreted as a power play and increase assaultive behaviour by the person.
- Don’t shout. If the psychotic person seems not be listening, it isn’t because he or she is hard of hearing. “Voices” or deluded thoughts are interfering.
- Don’t criticize. It will only make matters worse; it cannot possibly make things better.
- Don’t squabble with other family members over “best strategies” or allocations of blame. This is no time to prove a point.
- Don’t bait the person into acting out wild threats; the consequences could be tragic.
- Don’t stand over the person if he/she is seated. Instead, seat yourself.
- Avoid direct, continuous eye contact or touching the person.
- Comply with requests that are neither endangering nor beyond reason. This provides the person with an opportunity to feel somewhat “in control”.
- Don’t block the doorway. However, do try to keep yourself between your relative and an exit.
- Decrease other distractions immediately – turn of the TV, radio.
- Express understanding for what your friend or relative is going through.
- Speak quietly, firmly and simply.
Also read: Role of mental health awareness
Sometimes you may feel you are walking on broken glass when your relative or someone you know is having a particularly difficult time. At that time you have to summon up all your energy so that you can maintain their trust while at the same time maintaining equilibrium at home. Here are some ideas towards that goal.
- Be friendly
- Be accepting
- Be encouraging
- Make time to listen
- Include them
- Treat them with respect
These behaviours should also be adopted by the general public.
Avoid the following:
- Being patronizing
- Being critical
- Pushing them into situations they are not comfortable with
- Being gloomy
- Arguing with them, or with others while they are present
- Giving them a lecture or talking too much
- Getting yourself into difficult situations with them.
When a crisis comes
Sooner or later when a person has Schizophrenia a crisis will occur. When this happens there are some things you can do to reduce or avoid the potential for disaster. Here are a few pointers:
- Remember that you cannot reason with acute psychosis.
- Remember that the persons may be terrified by his/her own feelings of loss of control.
- Do not express irritation or anger.
- Don’t shout.
- Don’t use sarcasm as a weapon.
- Decrease distractions – turn off TV, radio, dishwasher, etc.
- Ask any casual visitors to leave – the fewer people the better.
- Avoid direct continuous eye contact.
- Avoid touching the person.
- Sit down and ask the person to sit down also.