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Coping With Schizophrenia Requires Effort...

The following is an adaptation by the Menninger Letter of ?Twelve Aspects of Coping for Persons with Schizophrenia? by Frederick J. Frese, Ph.D. (Innovations and Research, Vol 2., No. 3, 1993, pp. 39-46.)

I am a person with schizophrenia. I am not currently psychotic, but I have been in the state of psychosis often enough to be somewhat familiar with the trips there and back.

A few years ago I decided to talk openly about my experiences with schizophrenia. My initial talks on the theory and politics of caring for the mentally ill were well received.

But I soon learned that most nonprofessional audiences prefer to learn how families can cope with the condition. I now focus on 12 aspects of coping with schizophrenia: denial, knowledge , medication, delusional thinking, social deficits, replaying, expressed emotion, stress, music and hobbies, stigma, revealing, and networking.

Denial and acceptance

I can?t tell you how difficult it is to accept a diagnosis of schizophrenia. Humans are governed by logic and reason: the unreasonable is unacceptable. But this disorder disrupts brain chemistry and fools you into believing that your thoughts are rational when other people can usually tell that they?re not.

Psychosis is a ?catch-22.? If you understand that you are insane, then you?re thinking properly and are therefore not insane. You can be psychotic only if you believe you are not. It is generally best not to confront denial outright, but rather to chip away at it. Acceptance of the diagnosis can help motivate us to learn more about the disorder.

With people who deny that they have the disorder, it is helpful to point out to them that they are being treated by others as though they have a mental illness. Once they concede this point, they may be more willing to seek medical treatment.

Knowledge of the disorder

Schizophrenia is now widely accepted as a brain-based imbalance in the biochemistry of the neurotransmitting systems. On a practical level, it disturbs thought and belief systems and affects confidence in what is truthful. It can even evoke mystical experiences that seem very real, but which mus be viewed as a symptom of an illness that requires treatment.


People who are physically disabled can be helped by artificial supports such as seeing eye dogs, hearing aids, or crutches. Schizophrenia requires the chemical ?crutch? of neuroleptic medication. Without it, I would not be able to function as I do today. True, some medications have serious side effects, but new drugs are constantly being developed, and many of them are more effective with fewer side effects.

Delusional Thinking

Our psychological systems were designed to protect us from reasonable amounts of stress. Stress affects everyone, but different individuals react in different ways, and sustained stress affects various physiological functions and thought patterns.

When normal brain functioning is disrupted, our brains revert to responding from our emotional center rather than from our center for rational thought processing. It is important for us to recognize that stress can overload our rational capacities and make us react in an overly defensive, vigilant, or delusional way.

Social deficits

People with schizophrenia tend not to look at the person they?re conversing with. There is a good reason for this avoidance of eye contact. We?re more easily distracted, and the other person?s facial expressions can make it difficult to focus on what we are trying to say. Because we?re slower to process information our recognition of what the other person says is often delayed.

These tendencies throw off the rhythm of conversation because they disconcert other people. We also have trouble knowing when and how to end a conversation. But, if we can get other people to understand these social deficits, then we can work together to overcome them.


In psychiatric hospitals patients often appear to be talking to people who aren?t really there. Sometimes these patients are responding to voices, but not always.

Those of us with schizophrenia are quite sensitive to having our feelings hurt. We may seek to protect ourselves by replaying past painful experiences and then rehearsing responses (often out loud) that might be useful in the future.

But we need to recognize this tendency and understand that it may upset other people. Since my own inclination to talk out loud annoys my wife, I try to confine myself to doing so only in the shower of while mowing the yard.

Expressed emotion (EE)

The EE concept focuses on the relationship between family and other environmental characteristics and the likelihood of relapse by persons recently released from hospital treatment. Researchers have found that patients who go back to live with family members who frequently express emotional over-involvement or negative emotions (resentment, hostility) are much more likely to relapse than those who live with families who are les emotionally expressive.

Those of us with schizophrenia need to avoid persons, place, and activities where we are likely to encounter high expressed emotion. We also need to learn how to let others know something about the nature of our disability and what triggers a relapse.

Stress and excitement.

Stressful and stimulating situations tend to cause relapses. My own breakdowns often occur while I am attending conferences or shortly thereafter. Even visits to s shopping mall can be too stressful. I find it helpful to limit my exposure to, or withdraw slightly from, such situations. Adjusting medication dosage might also be made in consultation with one?s doctor.

Music and hobbies

Because the ability of persons with schizophrenia to sustain rational processes is damaged, activities that do not tax logical abilities are often helpful. Music, art, and poetic forms can all be used as a way to communicate.

These aesthetic expressions can release pressures and be most and be most therapeutic. Such activity has been called ?woodshedding,? from the jazz musician?s custom of experimenting in isolation until the sounds form patterns that others can appreciate. Woodshedding in any expressive art can build bridges back to the world of normality.


Traditionally, persons judged ?insane? were summarily dismissed as unimportant by the general population. When we started returning to society, we were often unwelcome. The media have mostly portrayed mentally ill persons as monsters. Although such conditions as cancer and heart disease can be openly discussed, the topic of schizophrenia elicits emotional reactions of fear or derisive humor.

Those of us who find ourselves unwelcome in what I sometimes call ?the chronically normal community? must work together to change our image. We can promote greater understanding and acceptance by being open about the nature of mental illness.


Recovered mentally ill persons often contact me about whether to reveal their condition to others, especially employers. I usually encourage them to show their boss an article about me or another recovered person as a way to gauge that person?s receptivity?and then to be guided by the reaction they elicit.

As a practical matter, however, many people should probably not be too open about their past. ?You can usually account for time spent in the hospital or spells of unemployment in creative ways that involve no real falsehood?such as by indicating you were doing freelance work, consulting, or writing.


When I was released from the hospital, I had trouble connecting with other former patients. But that?s changing because organizations such as the National Alliance for the Mentally Ill (NAMI) have established a national network with groups in all large cities and many smaller ones nationwide. It has been my experience that recovering persons benefit greatly from associating with others with similar disabilities.
To locate a NAMI affiliate in your area, call their national office at 1-800-950-6264.

Frederick Frese, Ph.D. is coordinator of Recovery Services for Summit County, Ohio. He has a website: and can be reached online at
Article source is from Dr Frese's website here:


I really like this one too, Dr Baxter. The most helpful information for me always comes from the people who are actually living with the diagnosis of schizophrenia.


new here and i'm not too good on computers - great reading but can someone tell me how to deal with schizophrenia and drug abuse together - family member in hospital at present. thanks

David Baxter PhD

Late Founder
Sadly, that's not an uncommon combination for people with schhizophrenia, CM. People with schizophrenia tend (1) to have limited insight into their illness, often believing that the problem is other people or things; (2) to either not believe they need medication or be reluctant for various reasons to take it; and (3) to "self-medicate" using street drugs like cannabis, LSD, etc.

That presents the great challenge of trying to treat both schizophrenia (starting with medication compliance strategies) and possible addictions issues.

The fact that your relative is in hospital currently is a good thing, although they may not be able to keep the individual against his/her will for very long.


as you can tell i'm hopeless on computers so if i don't reply its because I have lost my way on the board. back to my relative (young adult). He is in hospital involuntarily (I'm from Down Under) and seems to be using weed whilst still in there. don't know how to get through to him and if and when he gets his head together what to do next. he was going to NA for 12 months and then started using weed again which then went on to everything else. five years ago he was on weed,amphetamines, LSD, alcohol - when well he was going to Uni but finding it hard to hope with stress,OCD, panic attack, anxiety.

David Baxter PhD

Late Founder
Your reply came through just fine :)

I'm not sure NA is going to do it for him if the diagnosis of schizophrenia is accurate. He is going to need a real addictions treatment program, likely residential to keep him away from drugs while he learns reasons why returning is a bad idea and where he can develop some relapse prevention strategies. But all of this needs to be coordinated with his doctors who are treating the schizophrenia.

I know nothing about the Australian health care system, however, so I have no idea how feasible this is.


Welcome CM,

Here are some words that can become confusing when talking about mental illness and addictions combined:

In Canada we call this combination concurrent disorders. The USA uses the words dual diagnosis but in Canada dual diagnosis means a developmental disorder with mental illness or other condition.

Like Dr Baxter says, it is quite common for someone with schizophrenia to also have addiction problems. People with schizophrenia have a 10.1 % higher risk of substance abuse than the general population.

The Schizophrenia Society of Canada has developed a 10 wk course for friends and caregivers of people with mental illness and it's called Strengthening Families Together (SFT). NAMI also has a similar 12 wk course titled Family-To-Family and it is worth your time to take one of these.

Some helpful information on concurrent disorders from the SFT course:

~Treat both the addiction and mental illness as a disease.

~The best treatment for concurrent disorders is to have integrated treatment (the mental illness and addiction is treated simultaneously versus separately).

~Show support and understanding.

~Seek out support for yourself with other families who are dealing with concurrent disorders in a support group.

~Acknowledge your family members acomplishments.

~Don't blame, shame, nag, preach or lecture. Let go of past mistakes.

~Set boundaries when needed to ensure yours and other family members safety.

~Don't rescue someone from the consequences of their actions.

~Expect relapses of addiction and aknowledge the difficulty of recovering from addiction. Remain supportive and encouraging.


thanks for listening Dr Baxter and HeartArt and for your helpful info. I was wondering if
the residental farm programs here would be of assistance. However I do worry that once there he might end up making even more contacts as he has done in hospital. Also where i come from there is not much available as far as concurrent disorders. By the way just want to let you know most of the information I seem to get on the net is from Canada. I was interested in Orthomolecular psychiatry and relative was going to a nutritionist as well as psychiatrist and doing well for 3 years until he abruptly stopped meds rather than taper off. Not sure whether self medicated with drugs or drugs came first, then illness. As far as myself goes I am seeing a psycologist, going to a parent structed group and am on anti-depressants which has recently been increased. They have just kicked in and I am able to cope just a little better.

We also have something here called ARAFMI which is for friends and relatives, however all our groups here only seem to deal with either mental illness or alcohol and drugs. 7 years ago when I was trying to get help and he was 17 then we had no facilities for anyone under 18. NOW WE HAVE. there are more people now with dual diagnosis but I dont want it to be too late. What makes things worse is that I know how he feels (his low self esteem). I am 50 years old and just learning to like myself. only recently I wanted to take all of my meds at once and end the pain (don't worry - I need to be here and couldn't put my family through the pain I am going through. thanks for listening. CM



These family education courses cover anxiety disorders and mood disorders as well, so you will get a clearer picture of what you are seeing in your young relative and how to support them.

Here is a link to a group in Australia who would be able to direct you to support groups and hopefully a *family education* course close to where you live.

Just click on the above link and you will find articles to read and more importantly. phone numbers to start calling. Sometimes you have to talk to many people before you get answers to your questions so don't give up. If someone says they don't know where there is a family education course or support group for families coping with concurrent disorders then ask them to give you a number of someone who may know.


Oops should have read your reply before posting. You have already linked to the group I found.

I would still say to keep asking about support groups for concuurent disorders and a course, CM. It is worth travelling if that's the only way to get to them.

Orthomolecular psychiatry's claims to cure schizophrenia with mega doses of vitamins is not supported by research and it is irresponsible of these nutritional psychiatrists to make such claims, CM.

The danger is that people do stop their meds as that is the usual strategy with this treatment approach. The less relapses a person has with schizophrenia the better the outcome, CM. The best approach to treating psychosis in youth is through the Early Intervention Programs and it is supported by research.

Wishing you and your family the best.


thank you for your help. I will pop in again. I think talking is keeping me 'sane'. take care everyone. CM


Good luck with your relative, CM. You are dealing with a very difficult situation so please remember to take care of yourself as best as possible. Sounds like you are doing that with counselling, meds and support....good for you.

Things will get better, they always do.
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