Dealing with Severe Symptoms
Tips for parents when symptoms are severe
As the parents above can attest, it can difficult and sometimes impossible to know the exact right thing to do when symptoms of psychosis cause young people distress. Generally speaking, the best approach is to keep the person safe, acknowledge the distress and let him know that he is supported. Other family members should be discouraged from trying to argue the person out of her delusions or convince him that his hallucinations are unreal. A short list of do’s or don’ts can help to keep everyone stay on track when symptoms temporarily escalate. The acronym SAND can remind you of the following 4 basic tips:
STAY CALM. If parents can remain calm when their children are upset, children tend to have an easier time calming down. This fundamental principle of parenting applies to children when they are young and even when they are older. The same principle can be applied to parents who want to help a child distressed by acute symptoms of psychosis. Before taking immediate steps to deescalate, parents are encouraged to check in with their own stress level, take deep breaths and try to calm themselves first. Young adults in recovery from a history of psychosis often recall being helped most by people who were able stay grounded and calm when symptoms were bad. Of course, remaining calm when your child is distressed can be challenging. Know your limits, take breaks when possible, and get support when you need it. When you take good care of yourself, you will take better care of others.
AVOID ARGUMENTS. When we say that someone has mild to moderate symptoms of psychosis, we mean that the person is experiencing symptoms (e.g., hearing sounds that are not there) while continuing to recognize that these experiences are not real. When we say that someone’s symptoms are severe, we mean that the person is temporarily convinced that these experiences are, or may be, real. This does not mean that the person’s personality or world view has fundamentally changed. It means instead that temporary changes in the brain’s chemistry are interfering with that person’s ability to reason or distinguish what is real from what is unreal. Family members should never try to argue a person back to health when symptoms of psychosis are severe. Reason and insight will eventually return when the person’s symptoms settle back down. The better course of action when symptoms are severe is to focus the person away from topics that trouble them, engage that person in pleasant activities, or move to a room with less stimulation.
NEITHER CHALLENGE NOR PLAY ALONG. While it is mostly unproductive to challenge the veracity of hallucinations or delusions (e.g., “I do not see it.”), it is equally unhelpful to play along and confirm that these visions, voices, or beliefs are real (e.g., “I see it too.”). Confronting the person with psychosis tends to be unhelpful and usually leads to more upset and confusion. Playing along is also unhelpful, tends to reinforce symptoms, and runs the risk of convincing that person to take actions that may be dangerous. So what options do you have? One approach is to acknowledge the reality of the person’s distress (e.g., “I can see how upset you are.”) and take attention away from symptoms altogether. Connecting with the person on an emotional level allows you to be helpful without getting bogged down in questions about what that person actually sees, hears, or believes.
DO NOT TAKE IT PERSONALLY. A child distressed by symptoms of psychosis may, on occasion, make unkind remarks or accuse the very people trying to help her. It is impossible not to feel some anger, surprise or hurt when such statements catch us by surprise, but it is important not to prolong our gut reactions by taking what is said personally. To keep perspective, we can remind ourselves that a person with severe symptoms of psychosis is no longer responding to the real us, but they are responding to a false perception of us that is caused by temporary changes in their brain chemistry. It may also help to remember that these unkind remarks will eventually pass as the person recovers, especially if the comments were uncharacteristic of the person before the illness. Of course, deflecting unkind words can be challenging in the moment. Once again, know your limits and give yourself space when needed. Managing someone with severe symptoms is taxing, so do not be shy about reaching out for any support you can get. You deserve it. And a final note: tolerating misguided criticisms and accusations does not mean condoning personal threats or verbal attacks. It is still appropriate to set limits on aggressive behavior. Safety is always first.