Hi everyone, I have a question in regards to my sister who has been diagnosed with schizophrenia and it seems she is currently undergoing a relapse. She is currently under medication (Zyprexa) but due to the changes in her behavior we’ve booked her in for her doctor’s appointment. But the earliest possible time for that is later this week so before then, I wanted to reach out here and ask if anyone had any advice on how I should be interacting with my sister to ensure that she remains feeling safe and supported. Here’s a few scenarios I need some advice on if anyone is able to share anything I will really appreciate it (thank you in advance!):
- There are instances my sister will be laughing uncontrollably or almost hysterically at the things around her. She seems to be amused by the things around her or the things she sees/hears. I’d ask her curiously if she would like to share what she is finding funny as I am interested in what she is experiencing, but she’ll normally answer and say “I’m fine” while continuing to laugh.
I understand it takes time for her to open up to share what she is experience but I was wondering is there anything I can do or try?
- There are moments when she’ll talk about how she is not a human, but an animal. I understand that during the conversation with her, I should be focusing on how she feels, which my family has been doing.
What would be the best way to interact with her about this? Is there anything else we can do?
- There are also instances where she will lock herself in the bedroom or bathroom for long hours. We will check up on her if she stays in the bedroom with her door locked for too long by asking how she is feeling and if she would like to have a chat. But most of the time she insists that she is fine through the locked door. I have noticed when she is in the bathroom she will like to stare at herself in the mirror and say that the one in the mirror is not her.
In the case that she does not come out of her room, I don’t know if it is appropriate to unlock the door to check and see if she is ok as that she might feel it is a breach of her privacy. When we try to ask her how she is feeling she says she is fine. And when we tell her we are worried about her and just want to check up on her she says she’ll open the door but doesn’t.
She seems to like to be alone. We have tried to engage with inviting her out for walks or grocery shopping, but after that she would immediately go lock herself up in a room.
Is it ok of us to open the door to check on her or is there a better approach? I know we have to give her space for her own thoughts, but what is considered enough time by herself in her room?
Kind regards,
Kay
Some thoughts:
Per the laughing, I’d look at this like talking to people who are laughing when they are stoned or after a road trip or party or other shared experience that an outsider has trouble “getting” the joke. Often times they think it’s hilarious, but when they start telling the story, it bombs. The typical response is “you had to be there.” What’s funny often depends on context or experience, and she may realize that you won’t be able to understand and is sparing you and her tedium or embarrassment. Ever been in your room with a friend as kids and your mother comes in and asks why you are carrying on so? Usually you’d either lie or say “oh, nothing” rather than letting her in on the joke. It’s the same dynamic. Also, ever get the giggles and don’t know exactly why and can’t explain it? It’s just easier to say “I’m okay.” If it’s important she’ll let you know. Otherwise it’s best to say something like “sounds like you’re having fun, if you want to tell me about it I’m here.”
I remember when I first got home while I had the delusion that the FBI was following me, and I was amused that seemingly mundane behaviors might be misinterpreted and by the futility of trying to convince my parents I was being surveilled, because the first rule of surveillance is obviously not to be observed. It tickled me, because it was surreal and absurd. I didn’t get into what I found funny, because it would open more cans of worms and might upset people or get me in trouble.
If she thinks she’s an animal, then ask for details and for her to expand on how it feels without judgement. The LEAP method favors the ‘reporter’ approach. Ask who what why where how questions impartially without judgement. The point is to understand her position and experience without contradiction and how these things fit into her experience. The point is for her to build trust and you to build empathy. The two can build on each other. This is essentially how therapy works in many ways.
Per her spending time alone in her room. I recommend either knocking or speaking through the door, but only periodically. If you are going out or on a walk or some other activity, it’s not a bad idea to invite her to come along. Having a schedule for activities is a good idea too. Generally I would spend time in my room because I was overstimulated and it was hard for me to concentrate and the outside world or social situations were overwhelming and difficult. That said, a degree of encouragement toward measured dosages of outside activity or socializing is a good idea, since over time with the help of medication and experience you can build up tolerance and endurance. Initially my prodrome and acute stages made me more introverted/introspective, and later on as I worked things out I gradually learned to trust myself and others more and became more outgoing.
Disclaimer: While I am a part-time caregiver of my brother and father with SMI, I was diagnosed with SZA over thirty years ago. I’m an advocate of appropriate drug treatments for SMI, but I feel they are incomplete treatments and additional CBT, supportive talk and psychosocial therapies are helpful where feasible. Any drug advice is from personal experience or research and not a substitute for qualified Psychiatric care.
I think you should tell her ahead that if she locks herself for a long time and you nock and she does not open you will be unlocking the door. I think this approach lets her a choice and she knows in advanced.
Maybe the question how do you feel is too vague and too easy to dismiss. Maybe more specific questions like tell me what are you seeing, with whom are you talking too, etc.
I know is hard to engage them. But keep trying.
Hi @Maggotbrane, thank you so much for your detailed response in regards to my question and for sharing your experience with me. Your explanation is very helpful and I feel that I am now able to understand a lot more on how I should best interact with my sister and also what she may be feeling.
I will definitely use the LEAP method when asking for detail and ensure keeping a schedule of activity to encourage a balance of indoor and outdoor activities.
I also want to thank you for your various posts and replies in other threads, I have had a chance to read a couple for them and they definitely help and give me insight which I will be able share with my family. Thank you 
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Thank you @hopeisahead! That is a good idea! I will make sure we let her know ahead that if she locks herself in for a prolonged period we’ll have to unlock the door if she does not open it. She tends to be quite forgetful though, so occasional reminders will need to be made. I sometimes get worried that too many reminders for her might seem like I’m pestering her though… so sometimes I just let her know that I’ll come back to check on her after a certain period of time or try to invite her out for exercise since she seems to love going outside.
I have tried to ask more specific questions like: whom are you talking to, and tell me what you’re seeing, but at the moment it seems that she does not want to open up. My family and I will definitely keep trying as we want her to be able to open up to us, thank you for the encouragement.
No problem. Don’t be discouraged if she often turns you down, she’ll have good days and bad. It can take a while for medication to take hold or for her to regain her social confidence. I recall a poster knocking on her daughter’s closed door daily asking if she wanted to eat or go for a walk until one day she did. You are a good sister for taking an extra effort to educate yourself to help your sister. You need to be Anna to her Elsa and keep knocking on her door, and someday maybe you’ll build snowmen together.
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Thank you so much for the encouragement and support! I am so glad I posted in the forum to find more advice on how to help my sister, thank you! 