Social isolation has got to be one of the greatest losses in schizophrenia. People with schizophrenia can have no friends, no spouse, and sometimes no family. Two thirds of patients with schizophrenia return to their parents house after discharge from a hospital the first psychosis. Family members generally receive very little education as to what they can expect. They may not know the importance of medication compliance. There could be number of major disturbances before they make a rule "that you can only stay at this house if you take your medication". It's a pretty sensible rule.Family members are the primary victims of violence from psychotic individuals, usually their own son or daughter, and most families cannot believe their own son or daughter would be capable of such a thing. Although families are usually the main care givers at the beginning of schizophrenia they often find their experience very frustrating for a number of reasons, and relationships suffer. Family education and support has been shown to improve outcomes considerably and family education is the second strongest factor in relapse prevention. Without education and good relapse prevention families often burn out. Most of the homeless mentally ill in downtown city cores have lost their family relationships. It is not a reflection on their families so much as the lack of adequate treatment and support. The families tried and tried and lost their ill relative.
My father took his own life in early 2005. He was becoming increasingly blind and didn't think he would continue to enjoy life as a blind man. My mother developed Alzheimer's years ago but died within a few years because of the mini strokes she experienced. She actually refused food and starved to death, but at that point she didn't even recognize my father. My father died the same wat his brother died when they were teenagers, by hanging, something my father never shared with my sister or me. I haven't really seen either of them very much in the last twenty five years. My sister saw more of them partly because she also lived on the west coast. I lost virtually all my human relationships over the years I was untreated, and since my illness extends back to late adolescence, I haven't had any close human relationships for many years. When you have schizophrenia, that just comes with the territory.
Enter the quasi friend, the case manager, usually in cases where the individual is at considerable risk of relapse, and usually when the individual has lost most of their community relationships. I had a case manager for several years and always looked forward to her visits. Case managers help negotiate compliance to medication, housing, meaningful activity, substance abuse, poverty, isolation, and everything else living in the community can throw at you.
Without a spouse you tend to spend a lot of time alone. One of the main reasons Rosemary and I moved in with each other was that neither of us was enjoying living alone. It was very romantic at first but now we are just friends who see less and less of each other. I suspect schizophrenia interferes with the quality and depth of relationships you have with other people. Amongst the people I know, schizophrenia has meant a pretty solitary life of poverty. I have a lot of acquaintances, and colleagues, but few close friends when not at work. Over the last seventeen years of living with schizophrenia on medication it is celibacy that has hurt the most. It saps the life out of you, your self confidence, your self esteem. I don't understand why I'm celibate. I never seem to meet anyone who is attracted to me. I've had over 500,000 people visit this web site and nobody has asked me out on a date. In some Scandinavian countries and Holland disabled people are allowed monthly visits by state approved sex workers. To me that is only common sense. To live without sex is unnatural and can only cause emotional suffering. We don't recognize the importance of quality sexual experience in keeping people healthy and happy in North America. That doesn't mean it isn't. The women with schizophrenia are more focussed on love rather than celibacy, and having children. It is the loss of that enduring romantic relationship they miss the most, and that can lead to a lot of trouble as they develop relationships with men with substance abuse issues, and get pregnant without adequate financial resources to raise children.
I have a pretty high profile in my community through the meaningful acclivity I do. From having a half dozen names and faces to remember, I now have what seems like hundreds. I have a lot of trouble remembering people's names and faces. I am still meeting new people but I'm rarely invited to socialize with any after work. They have families, full time jobs, kids, cars, cottages, etc. My life at home is pretty solitary. It's a nuisance to travel across the city to visit people. There are few people that I share a similar background with. Since people with schizophrenia tend to have trouble learning new things, and change very little as a result, we tend to have trouble making new friends. People with schizophrenia can come alive talking about things in the past before they became ill. It's as if their life ground to halt when they became sick. I'm stuck in the mid seventies, ln the post hippie era when anything was possible, and thats the music I like.
Rosemary's experience is similar. She has much stronger family relationships. She met her first major love at age sixteen. Seven years later he "moved on" as she developed schizophrenia. She knows he married a physician and has three blonde kids and she still talks about him. She was an executive secretary to the deputy chief of police in Sudbury at the time and her developing schizophrenia prompted her to quit and within a year she was in a psychiatric hospital.
Everybody I know with schizophrenia is quite isolated socially and I don't really know why. That is especially true for the older people in my age group. Younger people seem to be doing much better. Many still live with their parents. Most older people live alone. There is also the odd person who recovers well, returns to a career, and marries someone without schizophrenia. In cases where marriage predates the onset of schizophrenia, the outcome is often divorce although women are more likely to stick with their husbands with schizophrenia than vice versa, especially if there are already children. Women with schizophrenia often lose their children. The powers that be don't believe women with schizophrenia are able to raise children. I hope the next generation who appear to be less disabled survives better than people my age with schizophrenia. The goal of community integration is one that requires: more effective treatments and/or more financial support and/or a compassionate nondiscriminating community. The combination of early diagnosis and atypical medications will change the face of schizophrenia. I'm not expecting more financial support from the government, but many more people with schizophrenia will start working again instead. Their social networks will develop but social networks are probably the hardest hit in schizophrenia. It's better that you never lose your friends in the first place.
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