How to Communicate with Someone with Schizophrenia

Schizophrenia is a severe brain disorder that can significantly impact cognitive functions and a person's health. People with schizophrenia may experience auditory hallucinations, emotional disturbances, and sometimes speak in confusing or meaningless ways. However, there are a few things you can do to communicate better with someone who has schizophrenia.

Recognize the Symptoms of Schizophrenia. Some symptoms are more obvious than others, but by learning to recognize the less visible ones, you will gain a deeper understanding of what someone you're talking to may be experiencing. Symptoms can include:

• Unfounded suspicions.
• Abnormal or strange fears, such as believing that someone is trying to harm them.
• Hallucinations or altered sensory experiences, such as seeing, tasting, smelling, hearing, or feeling things that others do not.
• Disorganized speech or writing. Associating unrelated events. Drawing conclusions that do not align with available facts.
• "Negative" symptoms (deterioration in typical behavior or brain function) like lack of emotion (sometimes called anhedonia), avoiding eye contact, lack of facial expressions, poor hygiene, or social withdrawal.
• Unusual clothing choices, such as strange outfits or disheveled attire (like one sleeve or pant leg rolled up for no apparent reason, mismatched colors, etc.).
• Unusual motor behaviors, such as making odd postures or engaging in meaningless repetitive actions like buttoning and unbuttoning, or zipping and unzipping a jacket.

Compare the Symptoms with Schizotypal Personality Disorder. Schizotypal personality disorder is a condition within the schizophrenia spectrum - both of these disorders share difficulties in emotional expression and social connection; however, there are some important differences. Individuals with schizotypal personality disorder remain connected to reality and do not experience constant hallucinations or delusions. Their speech is also normal and easily understood. People with schizotypal personality disorder often prefer solitude, have little or no sexual desire, and may be confused by social conventions or interactions.

• Although it is part of the schizophrenia spectrum, this condition is not schizophrenia, so the behaviors described for people with schizophrenia do not apply to individuals with schizotypal personality disorder.

Do not assume you are dealing with someone with schizophrenia. Even if a person shows symptoms of schizophrenia, you should not automatically assume they have this disorder. You certainly wouldn't want to make the mistake of diagnosing someone as schizophrenic without certainty.

• If you are unsure, you can ask their friends or family.
• Ask in a delicate manner, for example, "I want to make sure I don't say or do anything wrong, so may I ask: does X have any kind of mental health disorder like schizophrenia? I am sorry if I’m mistaken, but I’ve noticed some signs, and I want to treat him with respect."

Adopt an empathetic perspective. Once you understand the symptoms of schizophrenia, try your best to put yourself in the patient's shoes. Feeling their perspective with empathy or understanding is key to establishing a good relationship, as it helps you become less critical, more patient, and better able to comprehend the patient’s needs.

• Though it may be hard to imagine some of the symptoms of schizophrenia, you can still picture what it might be like to lose control of your mind and be unaware of the loss of control or not fully grasp the actual situation.

Speak slowly, but do not sound condescending. Remember that they might be hearing other noises or voices as background sounds while you speak, which makes it harder for them to understand what you're saying. Therefore, it’s important to speak clearly, calmly, and softly, as their nerves might be overwhelmed by all the sounds they are hearing.

• Those voices could be criticizing them while you speak.

Be aware of hallucinations. Four out of five people with schizophrenia experience hallucinations, so you should be mindful that the person you are speaking to may be going through such an experience while you talk to them. They might believe that you, a neighbor, or an external entity such as the CIA is controlling their thoughts, or they may see you as a messenger from God or something else entirely.

• Recognize the specific types of hallucinations to understand which information to filter out during your conversation.
• Keep an open mind. Remember, you’re speaking with someone who may think of themselves as a famous person, someone with power, or above regular reasoning.
• Try to empathize with them, but avoid indulging them excessively or flattering them with excessive praise.

Never speak as though they aren’t present. Never exclude them from the conversation, even if they are experiencing hallucinations or delusions. Usually, they can still be aware of what’s happening and may feel hurt if they hear you speaking as though they aren't there.

• If you need to discuss the person with schizophrenia with others, make sure to do so in a way that doesn’t upset them if they overhear or talk privately at another time.

Ask people who know the person with schizophrenia. You can learn how to communicate with the person most effectively by asking their friends, family, or caregivers (if possible). You might ask questions like:

• Do they have a history of aggression?
• Have they ever been arrested?
• Are there any specific hallucinations or delusions I should be aware of?
• Are there any special approaches I should follow in situations involving this person?

Have an exit plan. Know when to leave the room if the conversation shows signs of going badly or if you feel unsafe.

• Try to anticipate when you might need to calm the person down or gently convince them to calm down or break free from delusions. You might do things to help them relax, like suggesting that they close the window if they believe the government is watching them.

Be ready to accept unusual things. Stay calm and do not react. A person with schizophrenia will have behavior and speech that is different from what is typical. Do not laugh, belittle, or mock their mistaken reasoning or arguments. Call the police if you truly feel threatened or find yourself in a dangerous situation.

• If you can imagine living with someone with this disorder, you’ll understand the seriousness of the situation and realize these issues cannot be taken lightly.

Encourage them to continue taking their medication. Individuals with schizophrenia often want to stop their medication. However, it is crucial to keep taking the medication. If they mention stopping, you can respond in the following ways:

• Suggest consulting a doctor before making such an important decision.
• Remind them that the reason they feel better now is due to the medication, and they need to continue to maintain that improvement.

Do not reinforce their delusions. If the person begins to have delusions and claims that you are conspiring against them, avoid direct eye contact, as it could intensify their delusion.

• If they believe you are writing something about them, refrain from texting anyone while they are watching.
• If they suspect you are planning to steal, avoid staying alone in the room or the house for too long.

• A great resource is the book The Day the Voices Stopped by Ken Steele, which can help you understand what someone with schizophrenia goes through, as well as the contrasts when they have recovered.
• Visit the person and talk to them as you would any other individual, no matter their current condition.
• Do not adopt a condescending attitude or use language like you would with a child. An adult with schizophrenia is still an adult.
• Do not assume that someone will become violent or threatening. Most people with schizophrenia or other mental health conditions are no more violent than the general population.
• Do not show panic or fear when symptoms appear.

• If you need to call the police, be sure to inform them about the individual's mental health condition so they can handle the situation appropriately.
• Schizophrenia carries a higher suicide risk compared to the general population. If the person mentions suicidal thoughts, you must seek immediate support by calling the police or a suicide prevention hotline.
• Always prioritize your safety when someone with schizophrenia is experiencing hallucinations. Remember that this is a condition involving delusions and hallucinations, and even if the person seems entirely friendly, they may suddenly become aggressive.