Practicing Compassion: How To Help Someone With Schizophrenia Who Refuses Treatment
Schizophrenia is a relatively uncommon disorder, affecting roughly 0.32% of individuals worldwide in 2022. It typically involves symptoms like delusions, hallucinations, and dramatic mood swings, which can be distressing for those who have it and the friends, peers, and loved ones who experience it secondhand.
A combination of therapeutic interventions, like medication, online or in-person psychotherapy, and other psychosocial programs, can be highly effective in reducing such symptoms and helping people manage them to live productively.
However, despite its effectiveness, people with schizophrenia don't always accept treatment. Those who experience delusions might develop a mistrust of doctors, psychologists, and even their closest friends and relatives. Hallucinations can further contribute to the distrust and fear of getting treatment, and, in some cases, people with schizophrenia may not believe they have a problem at all.
These factors, plus mood-related and cognitive symptoms, difficulty functioning in daily life, and problems with interpersonal relationships, can create significant challenges when a loved one with schizophrenia refuses treatment. It may be helpful to listen without judgment, provide encouragement, and ask them how you can help. Seeking support for yourself can also be beneficial.
Why do some people with schizophrenia resist treatment?
Schizophrenia can present differently between various individuals. Some people may avoid intervention while others are more receptive. There can be several reasons why someone with schizophrenia may show resistance when approached for treatment, many of which tend to be rooted in the disorder's characteristics and complications.
Schizophrenia symptoms
The Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR) classifies schizophrenia within the umbrella of schizophrenia spectrum, other psychotic disorders, and schizotypal disorder.
All these disorders tend to be defined by symptoms in one or more of five domains:
- Delusions: Delusions can be defined as unusual, irrational, or illogical ideas and beliefs. Often, the individual holding these beliefs continues to assert them in the face of reality-based, rational facts to the contrary. These delusions can manifest as paranoia in some individuals, potentially creating the belief that others want to harm them.
- Hallucinations: Hallucinations can be thought of as sensory experiences that aren't real but may seem extremely real to the individual experiencing them. Schizophrenic hallucinations are typically auditory or visual.
- Disorganized thinking and speech: These can range from difficulty organizing thoughts to disjointed, chaotic thought patterns typically presenting as odd or incoherent speech. This is sometimes colloquially referred to as "word salad."
- Disorganized or abnormal behavior (including catatonia): This may involve repetitive or sporadic movements. In cases of catatonia, individuals may cease moving and speaking entirely.
- Negative symptoms: Negative symptoms may include the neglect of personal hygiene, flat affect, diminished motivation, or lack of ability to experience pleasure.
Schizophrenia often appears early in adulthood. Symptoms typically persist for at least one month without treatment and tend to wax and wane throughout a person’s lifespan.
Anosognosia
Defined as "a neurological condition in which the patient is unaware of their neurological deficit or psychiatric condition," anosognosia can diminish an individual's awareness of symptoms that disrupt their daily function, such as poor judgment, emotional dysfunction, and unusual behavioral and language patterns.
While its etiology isn't fully understood, multiple studies conclude that anosognosia may relate to neurological dysfunction in some regions of the brain, which can be found in some people with neurological and psychiatric conditions like schizophrenia.
Complications with medication
Individuals with schizophrenia may receive treatment but discontinue the plan and refuse to resume it. There are several reasons this may occur, the most common of which tends to be complications with medication. Some people may begin treatment for schizophrenia but have difficulties with the antipsychotic medications typically prescribed to remedy its symptoms. For example, medicines for schizophrenia may have unpleasant side effects ranging from minor (dry mouth, drowsiness) to painful (acute dystonia, or the involuntarily contracting of muscles) to life-threatening (myocarditis, or heart muscle inflammation).
Some newer medications may be much more effective with fewer side effects, but they can come with their own set of challenges when individuals discontinue taking them against the advice of a doctor because they believe they have been "cured."
How to help someone with schizophrenia when they refuse treatment
Regardless of the reasons behind their reluctance, it can be possible to help your friend or loved one with schizophrenia accept, receive, and adhere to a treatment program. Depending on the individual's levels of paranoia and mistrust, it might be preferable to have these interactions one-on-one, so they don't feel threatened or intimidated. If you don't think it would present challenges, having support from a family member or other trusted individuals during the interaction might help both of you feel more at ease.
Learn about schizophrenia and its early warning signs
The process often begins with learning as much as you can about schizophrenia, including its symptoms, causes, and treatment options. This can help you understand what the person is experiencing, how to spot it, and how you can best support them.
Early signs of schizophrenia might include the following:
- Reduced personal hygiene or self-care
- Sudden drop in performance at work or school
- Trouble concentrating or thinking clearly
- Isolation, avoidance of social interaction
- Increasing suspicion of or uneasiness around others
- Strange or inappropriate emotions and behaviors
- Appearing to be "checked out," lack of emotional expression
- Interacting with things you can't see or that aren't based in reality
If you'd like to learn about avenues of treatment or have questions about support resources, you may contact the NAMI Helpline at 1-800-950-NAMI (6264) or a local treatment advocacy center. They can educate you on treatment options, including when it's appropriate to seek assisted outpatient treatment or inpatient care in a psychiatric hospital.
Talk about their experiences
Ask your loved one to share their experiences and feelings. The delusions and hallucinations associated with schizophrenia can be frightening and confusing for those experiencing them and may result in isolation from others. Showing them that you genuinely want to understand might help them feel safer and more connected.
Remember that checking in with your emotions throughout the conversation may be necessary to avoid becoming reactive if things become tense or uneasy. Your loved one's perspective may seem delusional and distorted, but it's most likely rooted in the reality they perceive right now. Listen empathetically and let them know you're there to support them regardless of how they feel about treatment.
Listen actively without judgment or preconception
Establishing trust can be crucial, and the foundation typically lies in listening without judgment. Show your loved one that you're paying attention with your body language and indicate you're hearing them by sharing your understanding of what they've said.
Ask how you can help
Along with any potentially outward symptoms, people sometimes have distressing symptoms that aren't as obvious. Asking straightforwardly what you can do to help may be enough to let them know you understand and have their best interests at heart. If they maintain that they don't want any help, remember to remain respectful of their point of view.
Provide encouragement
Withholding connection, making someone feel guilty, or trying to force someone to get treatment isn't likely to help. Instead, you might encourage them by letting them know they aren't alone and that there are people from all walks of life with the same experiences. If they're open to it, discuss their treatment options and how they are effective in helping others. This might move the process forward, even if they don't believe you or maintain that they don't have a problem in the first place.
What to avoid
While it's often essential to know how to help someone who is resistant to treatment, it can also be beneficial to know what not to do. Try to avoid the following:
- Judging their feelings or behaviors
- Using language like "crazy" or other stigmatizing terms
- Making them feel guilty or ashamed of how their behaviors are affecting others
- Telling them they must think or act in a certain way
- Trying to convince them that their experiences aren't real
- Belittling them by dismissing their experiences or discussing them as if they aren't present
- Telling them they should "get over it"
- Setting unrealistic goals or standards
- Failing to celebrate progress
- Reminding them they'll never entirely "get better," and they'll probably have to take medication and attend therapy for the rest of their life
What to do in an emergency
If symptoms become significant enough that the individual can't function or care for themselves, or they express suicidal ideation or attempt suicide, stay with them and call a mental health professional who can guide you on what to do to ensure their safety at the moment. If your loved one goes missing or lives on the streets, contact the police for help.
If the situation escalates into a crisis, you may need more immediate help. For example, you may consider calling 911 if your loved one is agitated, aggressive, or threatening to harm themselves or others (including you).
If you must call 911, let the dispatcher know your loved one is having a mental health crisis, and share as much information with them as you can. If possible, request them to dispatch a crisis intervention team (CIT) officer.
In some states, you may receive assistance at home from a mobile crisis or psychiatric emergency team (PET or SMART team) with a social worker or psychologist trained to assess and de-escalate the situation and provide resources for schizophrenia treatment.
For more information about what to do during a mental health crisis, visit the National Alliance on Mental Illness (NAMI). You may also contact the Crisis Text Line by texting HOME to 741741.
If you or a loved one are experiencing thoughts of suicide, please know that help is available. You can call the National Suicide Prevention Lifeline anytime, 24/7, at 988.
What happens if schizophrenia is left untreated?
If left untreated, schizophrenia can result in significant problems affecting every area of an individual's life. For example, the individual may become unable to attend work or school, experience financial difficulties or homelessness, or develop health and medical problems.
People with untreated schizophrenia might be socially isolated or experience difficulties in interpersonal relationships. They may develop co-occurring conditions like anxiety, obsessive-compulsive disorder, depression, and substance use disorder.
Seeking help
It can be common for caregivers and family members of people with schizophrenia (and other mental health conditions) to neglect their own mental health despite the physical, financial, and psychological stress they may be experiencing. Studies suggest that, among other things, support groups and individual therapy may help people face these unique challenges and maintain better mental well-being.
However, caring for someone with schizophrenia may create challenges concerning the convenience and accessibility of in-person therapy. The rise in popularity of virtual therapy has given individuals an alternative to in-office treatment, eliminating such barriers and potentially making it easier than ever to get help. You can speak with a therapist online from the comfort of home via video conference, online chat, or phone call on a schedule that's convenient for you.
Online therapy is often more affordable than in-person treatment without insurance, and studies show that it can be just as effective as traditional therapy for helping people with a large variety of mental health challenges, including those related to the stresses of being a caregiver.
Takeaway
Caring for someone with schizophrenia can be stressful, particularly if they refuse help. It might take patience, understanding, encouragement, and emotional resilience on your part, but it can be possible to get them the help they need and begin the process of healing. While it can be vital for your loved one with schizophrenia to receive support, you may also benefit from working with a licensed therapist to address any challenging emotions you may be experiencing.
- Previous Article
- Next Article