How to Talk to a Schizophrenic

Co-authored by Trudi Griffin, LPC, MS

Last Updated: January 28, 2023 References Approved

Schizophrenia is a serious brain disorder that can significantly impact the mental functioning and well-being of those who suffer from it. People who have schizophrenia may hear voices, have disordered emotions, and may sometimes talk in ways that are difficult to understand or that do not make sense. Still, there are a number of things that can be done to improve your conversations with someone with schizophrenia.

Method 1

Method 1 of 2:

Learning about Schizophrenia

1
Recognize symptoms of schizophrenia. Some signs are more noticeable than others, but by getting a sense of even the symptoms you don't observe, you will have a better sense of what the person you are talking to may be going through. ^{[1]
X
Trustworthy Source
Mayo Clinic
Educational website from one of the world's leading hospitals
Go to source}^{[2]
X
Research source} Signs of schizophrenia can include^{[3]
X
Trustworthy Source
Mayo Clinic
Educational website from one of the world's leading hospitals
Go to source}:
- Unfounded expressions of suspicion.
- Unusual or strange fears, such as saying someone wants to harm them.
- Evidence of hallucinations, or changes in sensory experiences; for example: seeing, tasting, smelling, hearing, or feeling things that others at the same time and place, in that same situation, don’t experience.^{[4]
  X
  Research source}
- Disorganized writing or speech. Mismatching facts that don't relate to one another. Conclusions that don't follow the facts.
- "Negative" symptoms (i.e., reductions of typical behavior or mental functioning) such as a lack of emotion (sometimes called anhedonia), no eye contact, no facial expressions, neglect of hygiene, or social withdrawal.
- Unusual adornment, such as offbeat clothing, worn in a crooked, or otherwise inappropriate manner (one sleeve or pant leg rolled up for no apparent reason, mismatched colors, etc.).
- Disorganized or abnormal motor behavior, such as putting one's body into weird postures, or engaging in pointless excessive/repeated movements such as buttoning/zipping up and down one's jacket.
2
Compare symptoms with schizoid personality disorder. Schizoid personality disorder is part of the schizophrenic spectrum of disorders — both disorders are characterized by difficulty in expressing emotion or making social connections; however, there are some notable differences. The person with schizoid personality disorder is in touch with reality and does not experience hallucinations or continual paranoia, and their conversational speech patterns are normal and easy to follow.^{[5]
X
Trustworthy Source
Mayo Clinic
Educational website from one of the world's leading hospitals
Go to source} A person with schizoid personality disorder develops and displays a preference for solitude, has little or no sexual desire, and may be confused by normal social cues and interactions.^{[6]
X
Trustworthy Source
Mayo Clinic
Educational website from one of the world's leading hospitals
Go to source}
- Though part of the schizophrenia spectrum, this is not schizophrenia, so the methods of relating described here for the person with schizophrenia won't apply to the individual with schizoid personality disorder.
Advertisement
3
Do not assume you are dealing with a person with schizophrenia. Even if the person displays symptoms of schizophrenia, don't automatically assume schizophrenia. You definitely don't want to get it wrong by deciding the individual has or does not have schizophrenia.
- If you are unsure, try to ask friends and family of the individual in question.
- Do so tactfully, by saying something like "I want to make sure I don't say the wrong thing or do something wrong, so I wanted to ask: does X have a mental disorder, perhaps schizophrenia? So sorry if I'm wrong, it's just that I see some of the symptoms and still wish to treat them respectfully."
4
Take an empathic perspective. Once you have learned about the symptoms of schizophrenia, do your best to step into the shoes of the individual suffering from this debilitating disorder. Taking the person's perspective, by empathy or cognitive empathy, is a key factor in successful relationships because it helps one to be less judgmental, more patient, and allows a better sense of the other person's needs.^{[7]
X
Trustworthy Source
Greater Good Magazine
Journal published by UC Berkeley's Greater Good Science Center, which uses scientific research to promote happier living
Go to source}
- Although it may be difficult to imagine some of the symptoms of schizophrenia, you can still imagine what it is like to be out of control of your own mind and possibly to not be aware of this loss of control or to not fully grasp the real situation.

Method 2

Method 2 of 2:

Having a Conversation

1
Speak to the individual the way you would to anyone else, making allowances for anything unusual that is said. Remember that they may hear noises or voices in the background while you are talking, making it difficult to understand you. It is therefore essential that you talk clearly, calmly, and rather quietly, as their nerves may be frazzled from hearing voices.^{[8]
X
Research source}
- These voices may be criticizing them as you talk.
2
Be aware of delusions. Delusions occur in as many as four out of five people with schizophrenia, so be aware that the person may experience these while you are talking.^{[9]
X
Trustworthy Source
Mayo Clinic
Educational website from one of the world's leading hospitals
Go to source}These may be delusions that you or some outside entity such as the CIA or a neighbor is controlling their mind, or viewing you as an angel of the Lord, or anything else, really.
- Get a sense of the specific delusions so you know what information to filter through in the conversation.
- Keep possible grandiosity in mind. Remember that you are talking to someone who may think as if a famous person, authority or ascended beyond the realm of ordinary logic.
- Try to be as agreeable as possible while talking. Don't be overly flowery or flattering with many compliments, though.
3
Never speak as if the person isn't there. Don't exclude them, even if there is an ongoing delusion or hallucination. Typically there will still be a sense of what is going on; that includes being hurt by your talking as though the person is not around.^{[10]
X
Research source}
- If you need to talk to someone else about them, say it in a way that one wouldn't mind hearing, or take a moment to speak in private.
4
Check with other people who know this person. You may learn a lot about how best to talk to this particular person by asking the friends and family or (if applicable) care-taker. There are a number of questions you might want to ask these people, such as:
- Is there a history of hostility?
- Has there ever been an arrest?
- Are there any delusions or hallucinations in particular that I should be aware of?
- Are there any specific ways I should react to any situations you think I might find myself in with this person?
5
Have a back-up plan. Know how you will leave the room, if the conversation goes badly or if you feel that your safety is threatened.
- Do your best to think ahead of time about how you'll calmly reassure and gently talk the person out of anger or paranoia. Maybe there is something you can do to make the person feel at ease. If, for instance, they feel the government is spying on them, offer to cover the windows with aluminum foil to be safe and protected from any scanning/spying devices.
6
Be prepared to accept unusual things. Keep an even keel and don't react. A person with schizophrenia will likely behave and speak differently than someone without the disorder. Don't laugh at, mock or make fun of any faulty reasoning or logic. If you feel reasonably threatened or in imminent harm, as if threats might be carried out, call the police, but stay there as interactions with the police have too frequently resulted in the death of the patient at the hands of the police.^{[11]
X
Research source}
- If you imagine what it must be like to live with such a problematic disorder, you will realize the gravity of the situation and that such problems are nothing to mock.
7
Encourage continued use of medication. It is common for individuals who suffer from schizophrenia to want to get off of medications. However, it is very important that medication use continue. If there are mentions of coming off their medication in conversation you can: ^{[12]
X
Research source}
- Suggest to check in with the doctor first before making such a serious decision.
- Remind that if one feels better now, it may be because of medication use, but that continuing to feel better may require continued use of those medications.
8
Avoid feeding delusions. If they become paranoid and mention that you are plotting against them, avoid making too much bold eye contact, as this might increase the paranoia.^{[13]
X
Research source}
- If they think you are writing things about them, don't text anyone while being watched.
- If they think you are stealing, avoid being by yourself in the room or house for long periods of time.

Warnings

If you call the police, be sure to mention the individual's mental health diagnosis so the officers know who they are dealing with. Oftentimes many situations become dangerous because the officers are not informed that the person they are responding to has a mental disorder and may respond negatively to police presence.

⧼thumbs_response⧽
Helpful 3 Not Helpful 0
Keep your own safety in mind if the person with schizophrenia is hallucinating, having delusions or otherwise exhibiting psychotic symptoms. Remember that this is a disease that can involve paranoia and delusions, and even if this person seems perfectly friendly, unexpected lashing out may occur or sudden changes in behaviors are also possible.

⧼thumbs_response⧽
Helpful 10 Not Helpful 5
Schizophrenia is linked to high rates of suicide relative to the general population. If the person you are talking to seems like they might be considering suicide, it is important to get help right away by calling the emergency services or a suicide hotline such as the Suicide and Crisis Lifeline: 988 (you can also text this number)

⧼thumbs_response⧽
Helpful 2 Not Helpful 0