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.


More "Survival Kit" postings

Grief Survival Kit

I'm replaying this popular posting from December 2017 because I've added new writing, indented, towards the end.


This works for all forms of grieving - not just for departed loved ones. Feel free to pass it on to someone in need, or bookmark for a future moment. See also the Depression Resuscitation Kit.


To be clear, it's ok to feel sad. Grieving is natural. I'm not suggesting that we should be cold, emotionless robots. But I write this with one important assumption: that you aren't trying to fall in love with your pain. You're not using this sad moment to milk drama and stoke self-pity. You feel bad...and you'd honestly like to feel better. If so, this will help. If not, the following will upset you by minimizing exactly what you're trying to maximize! So consider carefully before proceeding.

Here's the question which you must ask yourself - relentlessly, again and again: What is real, and what isn't? Keep shaving off all the layers of untruth and drama. Slice away until you get to the real part, and then let that hurt (open yourself all the way to this pain; don't deflect it). You do not need to find fake reasons for heightening your pain. Deal with what's real.

Below are a few typical falsehoods (there are many more). They're things we've seen people saying in movies, so we have an unconscious urge to say them, ourselves. But they're just empty memes:

"Poor him/her!"
Whatever you believe regarding afterlife, your dearly departed is certainly not hurting. You can repeat "Poor him/her" ad infinitum, making yourself more and more miserable, but it's not a real thing. You're just hypnotizing yourself, and that's self-indulgence, not grief. "Poor him/her" is not true. Slice it off.

"She/he will never get to see/do X"
We, the living, miss out on things all the time. I'll never play quarterback for the Jets, and most likely none of us will celebrate our grandchildren's 75th birthdays. So what? This isn't the sort of thing we particularly sweat, so why would it be any more so for the dead? And if someone checks out at a low point, missing the happy turnaround, well, that's just normal odds! How many ecstatic peaks have you experienced? And would you have been particularly happy to have died during one them?

So young!
We all die young (at heart, we're the same person we were since we first opened our eyes; we only pretend to be grown-up). This meme, too, has to do with a person's "story", not the actual person. It's not real. Beneath the story-telling, we are ageless presences who watch stuff unfold. This, from their point of view, was just another thing that unfolded - and unfolds for each of us. It's not dramatic in any way. Don't try to make it so.

What a lousy way to go!
Accounts of gristly deaths used to really upset me. But I'm old enough now to have actually lived through some gristly stuff, and you know what? It was all just stuff. Broken bones and root canals seriously hurt! But such things don't ruin our lives. We get through them, and relief follows. Rest assured all suffering's over. It's natural to sympathize with pain, but, question: Did you sob for days when your cousin broke her ankle skiing?

I'll miss him/her.
Ok, now that's real. And that's all that's real. Everything else is just stuff you're telling yourself to heighten the drama and pain. Stay with what's real, open up to it, and let it subside, gradually, to a more manageable level. That's actual grieving, not cinema. Stay with the true!

A couple of years after I first published this, and having lost my mother in the interim, I see that there's still more falsehood to be shaved off. Even "missing" isn't entirely real.

I find myself missing her in instances where I could use guidance or an opinion...and then I remember that I can no longer turn to her for that, and feel a sense of loss and disconnection. Very sad, no? But here's the bizarre thing: I never sought out my mother's guidance. That wasn't her thing (she had other good attributes). She was never that sort of mother, even in her prime, and she hadn't been in her prime for a quarter century. Yet, every few days, I find myself crestfallen about losing something I never actually had!

We all hold a "Mother" idea (in an apron, with cherry pie cheeks and benevolent, nurturing smile) deep in the recesses of our imagination. And a "Father" and a "Child" and a "Husband" and a "Wife". They're images/ideals which may resemble the actual person only coincidentally, if at all. And since an imaginary image never dies, there's no reason to miss it. Deal with the loss of the actual person!

The impulse to torture ourselves with dramatized falsehoods has nothing to do with the departed. It's entirely about our own internal issues. Consider this: If you're this phenomenally upset about death, that can only mean life is truly amazing. So why ruin so much precious alive time with unnecessary drama? If the departed saw you doing this, they'd slap their foreheads and holler "Stop! That's just crazy! Don't do that!! Especially not in my name!" They'd want you to mourn for a while, and then go out there and kick ass, relishing every moment.


Resilience is related.

Resilience Means Giving Serendipity a Chance

Great Amazon reviews for Navy Seal Eric Greitens' new book, "Resilience":

If there's one thing special services soldiers know about, it's resilience, and Greitens, a Rhodes Scholar and Oxford PhD, is said to have created an elegantly insightful work.

I haven't read the book yet, but I feel prompted to try once again to explain my own resilience trick. It's such a simple thing, yet unbelievably hard to explain*. I've torn up many sheets of paper trying, but let's see if I can manage it this time. If you're in a hurry, skip to the condensed version just above the illustration, below!

Have you noticed that problems and setbacks often turn out, in the long run, to have been not so bad...or even positive? A wrenching break-up with a romantic partner allowed you to meet your one true love. A debilitating illness gave you time to read and think and work out deep problems. Your house burned down, and, with nothing to lose, you found the courage to make life changes your previous complacency would never have allowed.

As I recall dips that transformed into swells, I regret the time I wasted lamenting bad results before the game was over (and the game's never over until hearts stop beating!). Rather than wallowing in bad outcomes long after the actual injury, the smart move is to direct attention sooner toward the next scene.

Any point in time may later be recognized as having been the turnaround point. So why wait for future retrospection? Why not inhabit that outlook immediately? It's just a matter of shifting perspective.

It's always an option to release your grip on whatever just happened, and embark on the twisty, unknowable path to the next thing. Of course, that next thing may be another bad result. In that case, simply repeat. Aggregated failure can't weigh you down, only aggregated lamentation of failure. The problem's not the problem!

Rather than courageously hope for remote brighter future to arrive, the trick is to amiably shift focus forward; to let difficult moments be step one of the next chapter rather than step two of the previous one.

I'm not suggesting a heroic push toward victory from the pits of aggrieved desperation. For one thing, that's just another way to over-dramatize the situation, and I'm more interested in quashing my dramatic impulses. For another, you don't know what to push for, or what victory would look like. Situations where things worked out for the best always yield outcomes which couldn't have been predicted, much less pursued, at the time. It's all about the serendipity, baby, and serendipity works best if you simply make yourself receptive and responsive to its subtle machinations. Trying to force serendipity is like pushing a string.

Admittedly, it's an unnatural shift. Remaining receptive to serendipity is hardly a natural stance in the wake of bad news. We're conditioned to respond to disaster and disappointment by closing and clenching - the posture least expedient to turnarounds and most impervious to serendipity. That's why it often takes so long for disaster to morph into success. It's not that serendipity works slowly, it's that we are slow to embrace it, thereby failing to notice and engage with tide-turning micro-opportunities as they present themselves.

Happily, we humans can be trained to respond in counterintuitive ways. We can learn to steer, against instinct, into a skid. If you can train yourself to respond to adversity and setback with an open, loose attitude, redirecting attention forward rather than obsessively locking attention on previous injury, life transforms miraculously. Just from that one tiny adjustment.

It takes practice. But even by deciding to practice this, you'll be 95% of the way there. When a student driver seeks out icy surfaces to practice skid recovery, that very act of cheerfully seeking out the Scary Thing transforms her attitude toward ice. When the slings and arrows of outrageous fortune become an opportunity to practice "skid recovery", you've mostly completed the shift, before practice has even begun!

I'm no Navy Seal, but I've learned resilience via other channels. And while I'll enjoy reading Greitens' book, I'm nearly certain it will amount to some version of the above. Because the only way to overcome the pain and trauma of grippy attachment to some bit of drama is to steer into the skid; to open wide, embrace the winds of fate, and bemusedly let serendipity carry you to the next scene and its infinite opportunity. Serendipity's the ever-willing rescuer, and resisting one's rescuer is never helpful!


Shorter version:
The longer you wallow in whatever just happened, the greater the probability you'll miss out on noticing and engaging with the opportunities which would have turned the tide.

Disaster and disappointment aren't the tombstones of hopes and dreams. Rather, they're the launchpad of all that's to follow.


It's easiest to express this visually:

Esoteric addendum: Nothing ever actually happens to you. Stuff happens around you. The awareness at your core - which has blithely hummed as it has peered, since early childhood, outward from your eyes - has never wavered amid the ever-changing plot points of your life.

Feel free to pass this on to anyone you know in the midst of Bad Scenes.


* - here are my previous efforts to express this: Perils Are Not Infinite; The Stories We Tell Ourselves; Ants v Humans; "So That Happened"; "Oh Shit" Antidote; The Real Secret

Depression Resuscitation Kit

I have a friend whose circumstances are, to all outward appearances, not very encouraging. Understandably, he's fallen into a deep depression. I just sent him the following. You may want to save it to read if you're ever severely depressed (or to forward to friends):

I've known severe depression. But there's one thing I've come to notice, which you may have noticed, too: Depression is what happens when you think about it; when you obsessively tell yourself sad stories about what's happening.

In terms of reality - what's actually happening at any given moment - there's only one thing to say: "Here I am!" Just like always, right here with your eyes blinking and shining, taking it all in. That "here I am" feeling has existed for as long as you can remember. It's never varied. Everything else changes around that.

Sometimes events spur you to tell yourself happy stories, and sometimes they spur you to tell yourself sad ones. But there you are, either way. Same you. Same aliveness. Same "here I am", regardless of the story.

Nothing really changes but the stories you tell yourself about what's happening. But the stories aren't you. You, at your heart, are constant. You're awareness, softly humming. Feel the hum! It's been there for your entire life; the same hum as when you were five years old. That's what's real. The stories are arbitrary. They're a caprice. Any life circumstance can be interpreted a thousand different ways, as you know. Go ahead and choose whichever interpretation you'd like; that's your prerogative. Sad's fine! Just don't forget you're the storyteller, not the story.

Further reading:
A Unique Perspective on Depression
A Surprisingly Uplifting Examination of Suicide
The Evolution of a Perspective
Framing as Hilarious or as Catastrophe
Previous writings on depression