Marriage and Mental Health: How to Cope When Your Spouse Has Been Diagnosed with Schizophrenia
- What is schizophrenia?
- Signs and symptoms of schizophrenia
- Getting help
- What you can do to support your schizophrenic spouse
- Self care when you have a schizophrenic spouse
- Additional resources
Table of Contents
“For better or for worse, in sickness and in health”. Ten words that really say it all when it comes to being married to someone with a mental illness. Whether you have chosen to marry someone you know suffers from schizophrenia or the disorder developed during your marriage, there are ways you can help yourself, your family, and your spouse cope with the illness.
Schizophrenics, as a rule, don’t do well with relationships. Because their sense of reality is so skewed and often infused with compelling delusions, it’s hard for them to relate to others. Marriage rates, especially for men, who are typically diagnosed at a younger age, are low and divorce rates high, according to the Schizophrenia Society of Canada.” - (Source)
That said, with proper treatment, a person suffering from schizophrenia can lead a relatively normal and enjoyable life, so the key as their helpmate is to not give up on them! Acceptance is important: a diagnosis may leave you feeling baffled and afraid, but learning about the disorder will help you to come to terms with it and then you’ll be better equipped to help your spouse.
What is schizophrenia?
Schizophrenia is “... a severe brain disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior.” (Source) That’s the textbook definition, which almost reads as if a person suffering from the disorder was just a little ‘off’ in their thinking. The reality can be quite different.
Colloquially, schizophrenia is often times referred to as split or multiple personality disorder. It isn’t that at all. While the cause of schizophrenia is unknown, most research points to genetic predisposition in combination with environmental factors, such as the consumption of psychotropic drugs (meth and LSD), which can increase risk as is being exposed to certain viral infections in the womb. There is no one gene that points to a person being susceptible to developing schizophrenia and even people with no family history of the disorder can develop it, which points to a mutation of certain genes.
People with schizophrenia also tend to have differences in the brain chemicals called neurotransmitters. These are responsible for “communicating information” in the brain. Studies of brain tissue in people with schizophrenia after death even show that their brain structure is often different than it was at birth” - (Source)
More recent studies, using neuroimaging, show that schizophrenics have different structures in the brain and central nervous system. The impact of those differences is still being researched.
Schizophrenia cannot be cured, but rather it is managed as a chronic condition for life.
Signs and symptoms of schizophrenia
Typically, the disorder develops in men in their early twenties, later for women (late twenties). It can run in families; if a primary relation (parent / child) has it, there is increased likelihood of suffering from the disorder. Overall, schizophrenia is characterized by the following three categories of symptoms:
Positive symptoms - psychotic behaviors not seen in healthy individuals.
- Delusions - paranoid beliefs that are not consistent with reality and that the sufferer maintains as being true despite all evidence to the contrary. Examples? That the person is being controlled, their minds read, being plotted against; it’s as if the person is losing touch with all reality. Some even exhibit the belief that they are someone else.
- Hallucinations - hearing voices and seeing things that aren’t actually there. These are sensory experiences that the person experiences, that have no basis in reality. Hearing of voices is the most common hallucination and can be internal (coming from their own mind) or external (coming from someone else). The voices may talk to the person and instruct them on their behavior, commanding them to engage in certain acts. The voices can also talk to each other. This is where the notion of ‘split personality’ has been confused with schizophrenia, in the past.
- Disorganized thinking - strange, delusional ideas and thoughts, which make it difficult to carry on a simple conversation. The thoughts don’t follow a logical sequence, or at least, not logical to those around the person suffering from schizophrenia. They may also stop speaking entirely, mid-thought, or invent words and a language of their own.
- Abnormal motor behavior - this can include sitting without moving for hours, almost in a catatonic state, or body movements that are very agitated, or wildly repetitive.
Negative symptoms - behaviors that are easily confused with other disorders like depression.
- Lack of emotion / enthusiasm for daily activities.
- Limited facial expressions or vocal tone - also known as ‘flat affect’, it is where the person speaks without inflection or facial changes, things that most people come to expect in the course of normal conversation.
- Limited speech - this is characterized by a person not speaking very much, as opposed to the quality of their speech abilities.
- Inability to sustain activity - one very frequent manifestation of this is the inability to manage personal hygiene.
Cognitive symptoms - like negative symptoms, these are easily confused with other disorders unless specific testing is applied. These symptoms create the most difficulty in social / employment functions.
- Lack of ability to take in information and use it to make decisions.
- Lack of ability to focus.
- Problems with short term, working memory.
Any combination of these signs or symptoms can lead to an impaired ability to function, but it is the positive symptoms that cause the most distress and dysfunction for a person coping with a spouse who has schizophrenia.
It is not uncommon for people with schizophrenia to be reluctant to get help or take medication, as part of the their treatment. In fact, the notion of treatment plays right into the paranoid delusions of many schizophrenics: that they are being controlled by someone, that they are being harassed. Alternatively, many believe that they don’t require treatment because the voices and conspiracies that they are anxious about are real to them, and not related to any delusion whatsoever.
Your concern, first and foremost, has to be your safety and that of your children. If your spouse is refusing treatment and is being overcome by psychotic episodes, they risk becoming violent. In that case, you will need to call in a crisis team or the police to help you deal with the situation. Thankfully, violent behavior is not a hallmark of schizophrenia: if anything, a person suffering from the disorder is more likely to harm themselves than anyone else. But physical violence is only one concern.
Verbal and emotional abuse, property destruction (example, punching holes in walls), creating hazards such as the setting of fires, substance abuse, despotic behavior (example, not letting people in the home use the phone) are all possible behaviors that fall within the scope of schizophrenia but which, at the risk of harm to yourself and your family, cannot be tolerated. It creates a ‘walking on eggshells’ environment where all members of the family become afraid to do something that will trigger an outburst; an exhausting and debilitating way of life for those who surround the sufferer.
Setting limits on behavior that your spouse cannot control is not easy but it’s necessary for your protection and that of your family.
The outcome of treatment and how your spouse will function, eventually, will depend on several things including: the severity of their illness, the age when symptoms started (younger start = more severe illness), how well they are responding to treatment and therapy and how cooperative they are in recognizing that they have a mental illness and in dealing with it. Your spouse may never return to a full time job but they may be able to go back to their pre-diagnosis life in some capacity. People who were well adjusted, employed and a committed partner in all sense of the notion, prior to the onset of schizophrenia, have a greater chance of returning to a good level of functioning once treatment is in place.
What you can do to support your schizophrenic spouse
Do what you can to encourage your spouse to seek treatment
This might involve different techniques, including providing options that give your spouse a measure of control. For example, offer them the option of being accompanied to the appointment by someone other than yourself, if they are suspicious of your motives (paranoid delusion).
Many people are worried about being labeled ‘crazy’ and keeping in mind that most schizophrenics see their delusions as real and normal, they may not understand your concerns. Focus on a specific element of their behavior that can be characterized as ‘treatable’ and generic, like insomnia, as the reason for the visit.
Once they accept their diagnosis, you can play a strong role in ensuring that they remain involved in their treatment plan.
Keeping the lines of communication open, as opposed to putting up walls or shutting down in the face of the diagnosis, will help both of you to cope. Remember that a recent diagnosis might leave your spouse afraid and worried, in addition to the other symptoms that are manifesting, so clear communication about expectations within the relationship and the family unit are important. Consider therapy, both individually or as a couple, to help you both to navigate this new reality.
Part of communicating is ensuring that you do what you can to reduce stress in your everyday living. That includes taking over things that your spouse can no longer accomplish, such as paying the bills or managing the insurance forms, but also encouraging your spouse to be as independent as possible. This helps to create the supportive environment that you can both find peace in.
Ultimately, if your schizophrenic spouse says things that are clearly false but which they believe wholeheartedly, communication has to remain positive. You don’t need to go along with with they are saying, perpetuating their delusion, but you should also not state that they are wrong or, worse, deluded. It’s best to frame a positive statement along the lines that every person has the right to believe what they want, and it’s okay for people to have different points of view.
Monitor their treatment / medications
Side effects that might occur while your medical team is trying to find the right dosage / drug combinations that will be most effective for your spouse, might create a situation where your spouse stops taking them. These side effects must be reported to your spouse’s doctor immediately.
As with all treatments, once your spouse’s behavior begins to stabilize, he or she might then not see the point of taking the medication anymore, or may not remember to take them. Using a calendar or digital reminder system will help in this regard. You might also want to keep a mood journal, a regular record of your spouse’s behavior and moods, that you can share with the doctor should you have any concerns. It’s hard to remember the details in the heat of the moment!
Be wary of your spouse consuming alcohol or other drugs, as interactions with antipsychotic medications can be very dangerous.
Watch for signs of side effects / relapses
The most common cause of a relapse is when the sufferer stops taking their medication, though it can happen even if they are following the regimen closely.
Commons signs of relapse:
- Change in routine behaviors, like personal hygiene
- Paranoia returning
- Confusing speech patterns or inability to carry on a simple conversation
- Confusion and hostility
If you suspect a relapse, call their doctor immediately.
Prepare for a crisis
With relapses in mind, it’s best to have a plan in the case of a full on psychotic crisis. The point where your spouse is destroying the house is not the time to start looking for phone numbers or finding their medications.
- Have all phone numbers for the medical team, including therapists on hand at all times.
- Have the address of the hospital that will do a psychiatric admission, preferably one that is connected to your spouse’s primary care physician.
- Have a plan for the care of children during a crisis, people you can call upon at moment’s notice. And keep the kids in the loop on the plan: if they need to go over to a neighbor’s house or down the street to a friend’s house quickly, they need to know that this is your expectation in a crisis.
The important thing to remember in a crisis is to act to defuse it, not inflame it. Limiting visual distractions, noise, contact with other people (ask guests to leave, for example) are all important steps in calming the situation. Don’t engage your spouse’s behavior directly but instead do everything you can to bring a sense of calm to the environment.
Self care when you have a schizophrenic spouse
Don’t argue with delusions: you won’t win
A key to dealing with your schizophrenic spouse is to accept the disorder and educate yourself on it. You cannot argue with it. You cannot reason with it. There is no value in expressing anger or irritation when your spouse is dealing with their symptoms. It will not help you or them. Remember that you are dealing with their illness, not them.
Knowing what you are dealing with and how you can best advocate and help your spouse is satisfying in and of itself.
Create a support system for yourself
You need to recognize what you can and can’t do in dealing with your spouse and their illness. Respite care is an option for situations where the spouse is not able to be left alone and it’s an important one to consider, as a primary caregiver. You cannot possibly help your spouse or be present and available for the rest of your family if you are exhausted to the point of a breakdown.
Find support where you can, which might be a group of spouses of schizophrenia sufferers. Your shared experiences and the ability to talk about your situation freely, without fear of judgement, is invaluable to your own self care. Despite the limitations that schizophrenia can pose on your life, you have to take care to keep up relationships with family and friends. They are a comfort and a link to a world that doesn’t include mental illness, which can in and of itself, create the respite you need.
Take care of the everyday
Ensure that you take other steps in self care including eating properly, getting rest and exercise. It’s perhaps easy to say, but ultimately, your life cannot be subsumed by the illness that your spouse is suffering. You need to make sure that you have a life too.
Every case of schizophrenia is different and it’s impossible to know whether the person you married will return to being a functioning and contributing family member. Routines and achievable tasks are helpful for both you and your spouse. There is comfort in knowing what is expected of both of you and attaining those goals is rewarding. Marriage is all about compromise and give and take. Schizophrenia can make it feel like there’s a lot more take than give but it’s important to always remember that your spouse is not their illness. They are a person who needs love and care, just as you do. Take the time to learn what you can do to help them and keep the lines of communication open to keep your relationship healthy and happy.
Don’t be afraid, don’t put up a defense against us, don’t brace yourself for something bad. Be there to talk and support. It may not be pleasant, personally I can be downright mean when in a bad frame of mind. But you’ll both be glad you were there. (Source)
Listen attentively and laugh as often as you can — we often hear when people are speaking but are we always listening? There’s a difference. Often, that is all a person who is suffering needs: to know that someone is listening to them. Not making suggestions, not always trying to fix things. Just being there.
Humor is said to be the best medicine, and it’s true that it can help to loosen anxiety’s grip on us: “Laughter dissolves tension, stress, anxiety, irritation, anger, grief, and depression…” (Source)
Keep track of medications and appointments — as we said earlier, a bipolar sufferer who is feeling better might be inclined to drop their medications or skip therapy appointments. Don’t let them. Taking an active role in helping your spouse manage the disorder is appropriate and possibly even necessary.
Develop coping mechanisms and rules — find ways to cope with the results of the symptoms. For example, if your spouse tends to go on spending sprees while in a manic episode, you might need to keep hold of the credit cards. If their driving becomes erratic or overly aggressive, it’s time to keep hold of the car keys. Establishing some rules when they are in a calm state can help you both deal with the times when the disorder takes over. For example, you could have the rule that two successive days of refusing to get out of bed means that your spouse needs to call their doctor. It sounds a bit ‘mechanical’ but having processes in place can help you go into reactive mode rather than trying to reason with the illness. (Source)
Part of these processes needs to be planning for an emergency. If your spouse’s behavior suddenly becomes unmanageable, even life threatening, you need to have a plan in place: who to call, after hours numbers, which hospital to go to that is connected with your psychiatrist, the terms of your medical coverage and so on. Scrambling for this information in the middle of a crisis will only aggravate the situation, so like the boy scouts say: be prepared!