Ask the psychologists...

Is there anything I can do to help stop my son (who has schizophrenia) feeling paranoid? He thinks most people he has ever known are plotting together against him.

Suspicious and paranoid thoughts about the intentions of others towards you or those close to you are often a common experience for people with a diagnosis of schizophrenia. As reported on this website, paranoia relates to unfounded fears that something bad will happen and other people are responsible for it occurring. These people may be known or unknown. Paranoid thoughts are often distressing and can include beliefs about organisations undertaking plots to harm (in some circumstances to seriously threaten) the person. 

The experience of paranoia is not specific to people with schizophrenia or mental health problems. We know from the research undertaken by Professor Daniel Freeman and his team at Oxford University and the Institute of Psychiatry, Kings College London, that the experience of paranoia and suspicious thoughts is also common in members of the general population. For many people, paranoid and suspicious thoughts are based upon common social anxieties and concerns.

In response to your question, we don’t believe that you can ‘stop’ your son feeling like this, but you can offer him support, and perhaps try to help him to develop a mixture of short and long-term coping strategies.

You may find it helpful to ask your son whether there are any particular times of the day, settings or situations that he finds act as a trigger to his thoughts or make his thoughts or feelings worse. Your son might welcome some additional support around these times. The type of support offered can vary, and range from a simple offer of a cup of tea to asking how your son is feeling and being empathic about the emotional upset he may experience. Being empathic does not mean that you are agreeing with what your son is saying about events, because you might not, but you can still be sympathetic about his worries.

This means acknowledging and recognising the upset that he might be experiencing and why that might be the case, given his explanation. It would also be good to know whether there are particular things that he does or stops doing that make the experience better or worse. This information, based on the assumption that your son feels able to provide it, should give you both a good idea of what strategies that you might try or start with. Some people have found they are less preoccupied and in turn less distressed with their suspicious thoughts when they are busy and engaged in other activities. Are there any activities or things that your son likes to do, for example, keeping fit, going for long walks, listening to music, seeing a friend? It might be helpful to have a conversation about this and what type of support, if any, that he might work towards engaging with. 

Your enthusiasm and readiness to help your son with his difficulties is commendable, but you don’t need to do this on your own.  It is also worth noting that the NICE (National Institute for Health and Clinical Excellence) schizophrenia guideline recommends that individuals are offered individual cognitive behaviour therapy (CBT). CBT is a talking therapy designed to help people with similar experiences to your son develop a better understanding of their experiences and effective coping strategies. If your son’s care is within a mental health team, his key worker should be able to offer you some information on where your son can access this therapy locally. If your son is not seen by a mental health team, it would be helpful to ask his GP for a referral.

Supporting a relative with paranoia can be difficult. It is important that you also make sure that you have the right support available to you too. Is there someone that you can talk to and share your concerns with? Do you have regular times in your weekly schedule when you allow yourself a break? You may also find it helpful to visit a local carer support group, which can serve as a useful source of social support and opportunity to exchange helpful coping strategies with other carers (see the Support for carers page for more information).

 

I had a lot to do with my friend's son when he was a little boy and then they moved away. I have kept in touch by letter and telephone but haven't seen either my friend or her son for quite a few years now. When he was 20 he had his first episode of psychosis, unexpectedly and out of the blue. He was violent towards her and had to be sectioned. Since then he has been up and down. I've only spoken to him on the phone once since he first became unwell. I'm going to stay with my friend soon and I don't know how to speak to her son. Should I mention his illness? Should I acknowledge things have changed since I last saw him? Should I ask him how he is? I know that he is not working and spends much of the day doing nothing. My friend says he has put on weight because of the drugs he is on. How should I react to all of this when I see him?

It is understandable that you will have some questions on how you should interact with your friend’s son when you next meet and it is helpful to give it some thought beforehand. However, this is not something to be too worried about. He is still your friend’s son and he and you have known each other for a long time, and this is your starting point.

It sounds as if it as been around 15-20 years since you last saw each other, so it is normal to assume that many things will have changed in both of your lives since you last met. This will include how you both look now. You may find it easier to approach the situation with an open mind, and to apply the same rules you would apply to meeting the children of other long lost friends. In these situations, it would be very unlikely that you would ask lots of questions about their health condition, or comment unfavourably on their weight, particularly if you have not seen someone for a long time. Presumably, you are likely to say how nice it is to see him and that it has been a long time. You might ask him how he has been. It can be helpful to mention that you know things have been a bit difficult for him recently, (as when you spoke on the phone) but that you are glad he is doing a bit better now. You can also talk about how things have been for you, if he seems interested to find out. You should bear in mind that he may not be keen to talk to you, and if so, try not to take this personally. It can be embarrassing to chat to friends of one’s parent; he may not remember you as well as you remember him, and he may not feel much like talking. 

Although it can be a natural thing to do, you should be mindful of asking your friend’s son too many questions all in one go. We are assuming that you will be staying a little while, which should give you some time to talk in greater depth, if he seems to want to do this. It is worth bearing in mind that your friend may also be slightly anxious about your stay, and how to explain what has happened to them both, and may be concerned about what you may ask him. Thus, avoiding asking searching questions is likely to be helpful. On the other hand, it is also possible that your friend’s son introduces the subject himself and is comfortable talking about his experiences with you. In this case, listening, being empathic and asking about how he gets on and copes, would be helpful.

Given how close you, your friend and her son were before, he may be looking forward to seeing you and have questions of his own to ask on how you have been, which would be a nice place to start. In the end, it will be important to take your lead from him and from your friend, and to enjoy your stay with them both.

 

My married daughter is sectioned, section 3, in a mother and baby unit. No one will tell me why. She has a new born baby. In the unit, she has a nurse with her 24/7. I presume she's a suicide risk, as she's not allowed anything dangerous. She's receiving a course of ECT at the moment. As she's married, I'm no longer next of kin, and my son-in-law, whilst a lovely caring man who adores her and the baby, rarely keeps in touch. My daughter refuses to let the hospital tell me anything. As her mother I do not know where to turn. Is there any way I can get the hospital to let me know what is happening to her? This all seems just awful, everyone in the family is so worried about her, no-one can understand how the person that gave birth to her cannot be told about her condition.

Is there anything I can do?

We are sorry to hear about such an upsetting situation for you. As you say, you are no longer next of kin, and this is the reason you are not being kept informed. Also, your daughter does not want you to be involved at this time, and so staff have to respect this request. It is the only reason staff are not being communicative. There is nothing immediate that you can do about this.

It is not clear from your description what problems your daughter may have at the moment. The reason she has been admitted with her new baby to a specialised unit will only be that there is concern for her safety and for the safety of the new baby. She will be being monitored 24/7 to ensure that they are both OK and to try to prevent problems. This is meant to be helpful, because if your son-in-law or other family members had to do this, it would be far too exhausting.

While it is obviously very worrying and upsetting to have had this happen, both your daughter and her new baby are in the best place for the moment. She is being closely monitored and receiving active treatment, which hopefully will lead to some changes. We cannot comment on why she is receiving ECT. This would not be being used lightly. It is not currently recommended for problems of psychosis, but can be helpful at times for conditions such as very severe depression.

At the moment, your best course of action is to try to help to support your son-in-law. It sounds as if he is doing his best to cope with all of this. If you are in contact with him, try to ask how he is managing and ask if he needs you to help with any practical issues such as shopping or cooking, or perhaps looking after your other grandchildren. He is in a very difficult situation himself and will be in need of your sympathetic support. Try not to ask just about your daughter. If she does not want you involved at this stage, perhaps say to him that you understand this, but would still like to help in any way you can, or whatever you can manage.

It may be that for the moment, you will have to wait for things to improve and for your daughter to become well enough to resume contact herself. In order not to jeopardise this, your best course of action is to manage your own upset and worry, and to try to be patient and helpful to your son-in-law while the hospital treatment takes its course. Are you able to get some help on your own behalf? Can you talk to friends or perhaps your GP about how difficult this is for you?

While it may not seem reasonable that your daughter is not sharing this with you, as an adult she can make this decision. She may be so distressed and upset she cannot think about anyone else at the moment – she may not be able to think clearly at all. This would be typical of severe mental health problems. It is not your fault and you should not feel that you have to justify or explain this situation to the rest of the family, who are obviously also worried. You might try to say to them that she is being looked after in hospital, and you are hoping to be back in touch with her when she is feeling better.

Your daughter is likely to improve. When she does, and when she feels ready, she will be likely to resume her relationship with yourself and the rest of the family. However, do remember that it will be up to her how this goes. The more you can look after yourself, be supportive but not intrusive, while waiting for this to happen, the more likely it is that this will go well. 

 

I am contacting you to find out how I can access 'family therapy' and what do I need to do for this please? My elder sister was diagnosed with psychosis when she was 18, she is now 43. She lives with my mother in Turkey but I am a British citizen living in London for the past 16 years. It has been a huge stress to deal with the problems due to her condition over the years. I have been supporting my sister as well as my mother. Unfortunately I am finding it extremely difficult to handle the problems lately and it is affecting me to the extent that I find it difficult to deal with the issues in my daily life, most importantly I feel that I am not able give support to my sister and mother anymore. I have been in touch with my local care centre who have been there to listen my problems and help much as they can, but I realise that I need a more substantial support, ie talking to a psychiatrist advising me how to support my sister, my mother and myself on the problems we are facing. Could you please advise what I should do?

In the UK, family interventions are recommended treatments for all people with schizophrenia living with or in regular contact with family members. The interventions should include at least 10 planned sessions and last between three months to one year (National Institute for Health and Clinical Excellence (NICE) guidance on schizophrenia, 2009). Family interventions are designed to support service users and their relatives in coping with the difficulties commonly linked to psychosis. Although family members can be seen on their own, it is often preferable to have meetings with both the service user and relative present. Given your sister’s permanent residence in Turkey, you are unlikely to be eligible for the NICE recommended family interventions in the UK.

Through research evidence, we know that the impact of supporting a family member with schizophrenia can be extremely difficult, irrespective of whether you are living with the service user or apart, and your letter clearly illustrates this. Thus, we recognise the importance of family members making sure they receive the right type and level of support for themselves.

As we read your letter, it is clear that you have done really well in your efforts to provide support to your sister and your mother, but you have reached a stage where you also require some support for yourself. As a first step, can you make a time to visit your GP to let him/her know how things have been for you recently and how you have been coping? They will be able to let you know about the type of individual support that you can access locally to address your own stress levels and the impact it has on your daily functioning.

We are not sure how much you have shared with your sister and mother about how things are affecting you. If you have not had any discussions, we wonder if now might be a good time to let your family know about how things are for you at the moment. Perhaps you could explain your situation in a letter or as part of a phone call, whichever you find the easiest.  It can often be very helpful to let your family know how you are you feeling. For some families, this can act as a trigger to address some of their own difficulties. It is not clear from your letter whether there are other family members available (eg other siblings or your father) who can get involved and provide support to your mother and sister, rather than just yourself.

We are not sure about the exact nature of the support that you provide to your sister and your mother, but we know that relatives will often provide a wide range of supportive interventions including a listening ear, emotional support, financial assistance, and help with a crisis. We wonder if you could encourage your mother and sister to access support locally. For example, do they require information about medication, their side effects, finances, or managing difficult behaviours? Does your sister have a mental health professional such as a psychiatrist or community psychiatric nurse that she has contact with who can also offer your mother and sister advice and help with problem solving specific issues? Is there a support group for families that your mother could visit? Assuming she can read English, or ask for some help to do so, you could also ask your mother to visit our website. Maybe she could look at the different information videos and post her own questions if she would like to.

Finally, for your own sake, you are correct that it would be helpful to try to put your own needs first for a while. In order to do this, you could try to let your family know that you need a break from their difficulties, at least for the moment, while you try to access some help for yourself. Being a carer can be depressing, and raise feelings of guilt and sadness, as well as anger and upset. All of these emotions are common and understandable. If you can find your own help for these, then you can realistically consider how much to become involved again in the future in your sister and mother’s care.

 

My husband's sister has got schizophrenia and has been in and out of hospital since she was a young woman (she is now 45 and still lives with her parents). We don't see her and my husband's parents very often, but we do drive over perhaps once a month, especially now we have a child. He (our son) enjoys seeing his grandparents. His aunt doesn't really engage with him while we are there and I can see that the time will come soon when he will ask me about her (he is 7). What should I tell him? What's the best way to describe schizophrenia to a young child? She is very withdrawn, doesn't work, doesn't go out and hardly talks to anyone, but reading your website makes me realise that this isn't the case for everyone with schizophrenia.

For some people, schizophrenia can be a long-term condition comprising episodes of crisis and relapse. In between relapses, there are some people who find it difficult to spend time and communicate with others, including close family members. These types of problems will often make it difficult for an individual to start work or go back to work, or to establish and maintain relationships outside of their immediate family. Thus your husband’s sister is not unusual in having these kinds of difficulties.

It is helpful to think ahead about what you might want to tell your son when he becomes more curious about his aunt and starts to ask questions. As a basic rule, it is usually helpful to keep your explanations simple, straightforward and sensitive to your child’s age and stage of development. Given the age of your son, it will not be necessary to offer lots of details, but it will be important to respond clearly to any questions he has. Often children just ask one question, so it is helpful to just answer this, honestly, but with a few words. Adults typically try a long explanation, which children do not then really listen to. So, for example, if he asks, ‘why does my aunt stay at home all day?’ the answer might be something like, ‘because she does not feel like going out much’. If he asks why this is, then you could continue with the next answer, and so on. Or not. It is also important however, to be mindful of his emotional reaction to any explanation, and to try to offer simple replies that are not alarming. But you will be a the best judge of whether anything you are saying is upsetting him at all, and you could also ask him if he feels ok about what has been said. Children typically take their emotional cue from you, so if you are calm and matter of fact, this will be helpful. 

As an example, you may find it helpful to talk in terms of his aunt feeling ‘poorly’ or whatever your family’s words are for not being well. You could also say, if asked, that this means that she feels tired all the time, and does not want to do everyday things such as talking for long periods, or going to work. You could mention that she is seen by a doctor who is working hard to help her feel better. It will be important to make it clear to your son that his aunt’s behavior is due to her being poorly and not due to anything that he has said or done, and to offer reassurance about any fears that he may have, for instance about his safety and wellbeing and of yours. It can also be useful to check with your son what he thought the reason was for his aunt’s behaviour – sometimes children develop their own ideas about why things are happening, and a straightforward explanation can often prevent worries from developing.

In addition to this website, you may also find it helpful to look at the Young Minds website and their list of mental health publications such as Mental illness in the family. Young Minds is a charity that provides information and resources to young people, parents and families on issues related to mental health and well being for young children.

 

My husband is 29 years old and just had his first psychotic break. He is a creative musician and his delusions started by him saying he was going to save the world and humanity through his music, despite the efforts 'they' were making to stop him, and he was suffering a lot because he was sure he was being persecuted and that 'they' wanted to hurt me and his family, but he would protect us from everything. He had just released a CD that was having quite an exciting acceptance and the public and the media were really loving it. I don't know if I should talk to him about how good things are still going with his music project, that there are radios broadcasting his music, people buying it on the internet... I'm afraid it will worsen his symptoms but I also know that it would make him really happy and proud about his work. I'm truly desperate to see him like this.

The first episode of psychosis typically occurs in young adulthood and particularly at a time when an individual is likely to be embarking upon a new phase in their life such as starting a new job, college course or relationship. We know the initial episode can be very shocking and stressful for relatives, and your dilemma is not uncommon; it is often a struggle to identify the best way of communicating with someone and support their recovery whilst avoiding the risk of inadvertently causing upset or adding to their worries. Given the unique impact that psychosis can have on individuals, there will often be an element of trial and error in terms of finding out what best suits your husband, given his previous worries about how his work was putting you all at risk.

We are not sure how recent your husband’s breakdown was. Does he continue to have any persecutory beliefs and/or beliefs about the power of his music to save the world? If the beliefs are still present, or the episode has only just passed, it may be worth just holding off for a little while with your attempts to update your husband on the impact of his music, and just talk about day-to-day things for the moment. At this stage, it might be helpful to give your husband some time to recover and to settle his thoughts about his experiences. His experience of psychosis is likely to have been very confusing and upsetting and it can sometimes take people a bit of time to recover and organise their thinking about their experiences. Your plan to help your husband improve his mood and feel better about himself through increasing his awareness of the impact of his work is understandable. However, it might be helpful to approach things at a slow pace.

Perhaps you can take your lead from your husband about finding the best time to update him on his work and how well the CD is doing. For example, your husband may ask about the CD or express an interest in returning to the studio. If he does want to know about this, then this would be a good time to discuss his success with him. Alternatively, however, it is possible that because of the psychosis he may be less interested or preoccupied with his music developments. In this situation, it will be important to balance your efforts in trying to help him feel proud of his work and perhaps reconnect with his previous creative endeavors, with what he feels able to focus on at that time. 

Given the challenges involved in supporting a partner with mental health difficulties, it is important to ensure that you are getting the right amount of support for yourself. Do you have a close friend(s) that you can confide in and share your concerns and worries? There are also a number of support groups for relatives of people with psychosis that are designed to offer support and information. If your partner is being cared for by a mental health team, they may also run their own support group. Do check with the mental health professional working with your partner.