How to Communicate with Someone with Schizophrenia

If someone you care about has schizophrenia, nurturing a relationship can be a challenge. In this PsychCentral article, Mindpath Health’s Rashmi Parmar, MD, offers effective ways to improve trust and keep lines of communication open.

Communication is one of the best ways to keep your relationships strong and healthy. When someone you know lives with schizophrenia, communicating well is still important — but can come with unique challenges. 

“It is very hard to see or understand things from the affected person’s perspective, which creates problems in daily communication,” says Dr. Rashmi Parmar, psychiatrist with Mindpath Health. 

Understanding their condition and knowing what to say — and not say — can help strengthen the lines of communication and your relationships.

How does schizophrenia affect my loved one?

Schizophrenia is a serious mental health condition that can affect the way someone thinks, feels, and acts. Symptoms of schizophrenia may include: 

• Psychotic symptoms, including hallucinations, delusions, and disorganized thinking, speech, and movement 
• Negative symptoms, like lacking emotional expression and social withdrawal 
• Cognitive symptoms, such as difficulty paying attention or challenges using information they’ve learned 

When people with schizophrenia experience a disconnect from reality, it can be hard for both that person and their friends and family. When communicating, your loved one with schizophrenia might: 

• Have difficulty expressing their thoughts or emotions 
• Be unable to understand or process the information presented to them during conversations 
• Experience varying patterns of speech (e.g., speaking either very slow or fast, or using words or phrases unknown to others) 
• Express illogical thought processes or beliefs 
• Appear distracted or preoccupied with their own thoughts 
• See, hear, or perceive things that others cannot 
• Have difficulty remembering things or parts of conversations 

According to a 2015 study, assessing language and communication issues in people with schizophrenia, participants showed difficulties with higher-order language processing, like: 

• Understanding implied information 
• Understanding humor 
• Interpreting metaphors 
• Understanding emotion in language, as well as rhythm and intonation 
• Using language to exchange ideas 
• Withholding inappropriate comments 

“Further, delusions and hallucinations often lead to paranoia and increased anxiety, which leads an affected person to adopt a guarded and closed attitude from the outside world,” says Dr. Parmar. “This often extends to their close friends and family, which adds another layer of complication.” 

What to say to a loved one with schizophrenia

Empathy, support, and a nonjudgmental attitude are important when you’re communicating with a friend or loved one who lives with schizophrenia. 

“They will need your compassion, understanding, and patience while they navigate living with this illness,” says Dr. Parmar. She suggests the following to help enhance communication: 

• Practice active listening. Pay close attention to their body language to better understand their inner feelings, perceptions, and needs. 
• Be patient during conversations. Acknowledge and validate their feelings whenever you can, even if you don’t fully agree with their beliefs. 
• Allow them time to process. They may have trouble staying on track or gathering their thoughts during conversations. Give them time and space to process what you say. 
• Simplify information whenever possible. Break down information or tasks into simpler steps to help them understand what you’re saying. Talk in short, clear sentences. 
• Encourage them. If they experience low motivation (a common symptom), offer encouragement and praise them when they complete tasks. 
• Recognize psychosis and give them space. If they appear to be experiencing an episode of psychosis, allow them enough time and space so they can reasonably recover. Seek help if you recognize safety concerns. 

What not to say to someone with schizophrenia 

There are some things that can make communicating with someone living with schizophrenia more difficult, but if you avoid negative, dismissive, or accusatory communication with them, they’ll be more likely to open up. Dr. Parmar recommends: 

• Avoid dismissing them. Never tell your loved one that their symptoms are “not true,” “not real,” “imaginary,” or all in their head. 
• Aim to be nonjudgmental. Try to avoid judgment or negativity about their experiences or perceptions. 
• Don’t pressure them to talk. If they’re not ready to communicate, give them time and space. 
• Avoid arguments about their beliefs. Rather than start a confrontation, make an effort to understand things from their point of view. 
• Steer clear of accusations. Don’t accuse your loved one of being lazy, blame them for not being willing to change, or insist on “fixing” things for them. 

And if your loved one appears to be in the midst of an episode of psychosis, it’s best to avoid overwhelming them with directions or requests. 

Don’t forget to take care of yourself. If you ever need to talk over issues in a safe space, you can always reach out to a therapist for advice and coping skills. 

Read the full PsychCentral article with sources.