Survival Kit: Coping with Paranoid Schizophrenics

A friend is having problems with a paranoid schizophrenic in his life. I've had a couple of those, plus I've dealt with a broad swathe of mental illness while managing a million people online for a grueling decade (one of Chowhound's moderators was a doctor who'd spent years treating indigent addicts in the South Bronx, who, a few weeks in, was shocked to have observed more twisted and demented behavior than she ever had in her day job. She described it as a "a post-graduate seminar in aberrational psychology.")

I was going to send him a note, but perhaps this will be useful to others. So here you go. I don't know a lot, but I do know some things.

1. It Feels Like Knowing

The kookie untrue beliefs don't feel like beliefs, nor do they feel kookie. They don't feel like propositions that have been considered, accepted, and incorporated into their world view. They're not workshopping new lines of thought. Nothing like that.

Rather, it feels like knowing. Solid, fundamental, unswayable knowing. The way you know you live in a country called America, and have two feet, and that chocolate tastes good. You know these things, and they are not up for argument. That's how their kookie untrue beliefs feel - even if a new set arises every few days/hours/minutes.

And it's not a matter of over-tenacity, any more than you're overly tenacious in knowing the things you know. It's perfectly healthy to remain steadfast in one's fundamental understanding of the world. The infirmity lies not in the tenacity but in the filtering and error-checking.

So don't expect to "talk them out of it". How receptive would you be to being "talked out of" the fact that Neil Armstrong walked on the moon, or that people eat turkey on Thanksgiving? How closely would you listen to someone's arguments to the contrary?

This problem is not confined to schizophrenics. We all "know" plenty of wrong stuff, and it all feels solidly known. Recognize this and let it feed your empathy!

While creating my smart phone app, Eat Everywhere, which I fact-checked to death, terrified of looking like a gringo dilettante, I discovered to my horror that a half dozen or so of my favorite foreign dishes don't exist.

I'd remembered wrong, or made assumptions, or had repeatedly eaten the dish in one single immigrant restaurant which concocted it to pander to clueless American customers. I've evangelized some of these dishes - in print! - for years. They were bedrock to my view of world cuisine. Yet they were ghosts.

That was an eye-opener. Man, I knew they were real! 

So was I "hallucinating" them? Not exactly, no. Just applying good faculties to bad data. The depth of my belief was not the real problem. 

Calm Contradiction May(?) Be Useful

If someone substantial in your life tells you that you do not, in fact, have two feet, the statement will not persuade. Yet it will be tabulated and stored, minutely influencing the greater Well of Conviction. It goes into the pot. If, one day, you look down and see only one foot, you'll remember.

You cannot argue paranoid schizophrenics out of believing the CIA implanted radio transmitters in their dental fillings. But you can register a quiet, mild "no" vote on the proposition. Be confident, be calm, be kind (but not condescending) and accept that you will not change minds. Even without acceptance, you've spoken truth. There is truth in the pot.

This is counterproductive if you can’t manage it calmly, quietly, and without condescension. Parenthetical voice, not confrontational voice. And if, despite best effort, you rile them up, nix it for a while. Stress is counterproductive.

However, along the same lines (and I suggest this part with greater confidence): resist the urge to patronize. Don't lampoon their beliefs to underscore the absurdity. Don't "show them how crazy they look." That might register as a "yes" vote! Schizophrenics, like Twitter users, parse sarcasm poorly.


Permission to Be Generally Dumb and Unpleasant

Paranoid schizophrenics can be very unpleasant. If you love one enough to stick around, it's reasonable to insist that they not burden you with unessential unpleasantness. Don't be problematic in ways you can actually control! Do the dishes! Don't drink milk straight out of the container! Don't use the hot water while I'm in the shower!

But that's not reasonable at all. Humans - even healthy ones - have bad moods, harsh words, behavioral lapses, and poor judgement. It is not fair (though completely understandable) to expect them to be immaculate above/beyond their uncontrollable dysfunction. Factor accordingly (more here).

And, as you do take this into account, note that this is you becoming saner. The situation can leave you saner or it can leave you nuttier. Why not choose sanity?


Autonomy 

People get to be wrong. They're allowed to make horrible decisions and do harmful things, even life-threatening things. This is a lesson learned by everyone who's cared for aging parents (at least those who haven't driven themselves and their parents batshit crazy).

Sure, we draw a sharp distinction for the infirm. They're not in proper control of themselves! But we're all infirm and lack healthy control in some respects at certain moments....and rightfully expect not to be strapped to gurneys until the bad impulses go away. And we mostly don’t strap schizophrenics to gurneys. So we don’t get to control them, even if we decide, with good intentions, that they really need it. 

All human beings get to be stupid and self-destructive. That’s part of the package of basic rights. So unless you're prepared to strap someone to a gurney, you're going to have to respect their autonomy. There's no choice. Short of criminality or mortal self-harm, they get to make their own calls. Even wrong ones. So long as they’re classified as human beings. 

In the end, you'll discover it's largely an issue of your own missplaced sense of control and authority. Your rock-solid certainty of what's best isn't always so solid. You're not THAT sane, either. Releasing your false notion of control can be your own mental health therapy.

Loving and Caring Without Getting Personally Spun

The item above requires developing some detachment. That's a tough call with loved ones, given that love is nothing but attachment.

You need to say "This person is currently in another universe, behaving very poorly, and I'm not coming with them...or bringing them back. They will continue to reject love and effort, and it's not my (or their) fault. It's simply how it is, and I don't need to hold the horror in my corpuscles. I will accept the unacceptable, while unconditionally loving this person, regardless of her current galactic address."

Note: I myself can't do this.

I know how to hold on tenaciously. And I know how to let go completely, dissolving all sense of caring and attachment. But I’m unable to detach selectively.

When I let go, I really let go. I'm terrific with infinity, but pitiful with gradations. It's a terrible shortcoming.

So I have little to offer on the subject of partial detachment - detaching enough to respect the person's autonomy (and preserve one's own mental health) while simultaneously remaining engaged, present, and caring. Find yourself another jnani for that part.

I'll say this, though: It's the same issue I once confronted atop a ladder while trying to quell a rising sense of panic via a holistic (not selective) "letting go". That was, duh, a really bad move, and I've been trying to come to grips with it ever since.


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