How can he appear “fine” to others?

Hi there. My first post. I’m a mama of a 35 yr old son. Dr diagnosed with paranoid schizophrenia despite his lack of cooperation with a diagnosis. She diagnosed him based upon our relay of symptoms. He has isolated himself and will not respond to family.We have not had more than a brief convo in 3 years. What confuses me is how those few folks he does interact with thinks he’s “fine.” They don’t seem to be able to understand anything is wrong with himThose folks who have spent significant time with him do however. His ex wife, live-in roommates ans, and us, his parents. How can that be? His delusions and false beliefs reveal he is very sick. But he has kept2 PT jobs for a year now. How can this be? How can he be so sick, yet appear so “fine” to others not “in the know.”


I don’t know, I guess because they don’t know them, how they were,
and perhaps there are so may wierd o’s, and people who may have illness
that don’t know it, so they compare and maybe thinks it’s a normal attitude.
I had same thing with all people, for about 7 years, Now they believe me, they didnt believe me unless they saw an episode, of paranoia, or a psychotic episode which are farther between once their on medication.

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Hi Bucky, welcome to the forum. My son’s scz is also in the paranoid category and he has anosognosia (he is unaware of his situation). Our family members with the strongly paranoid version are often highly capable and like your son, can often move around in society without people
easily recognizing that they aren’t “fine”.

Years ago, on this forum, because of my son’s capabilities, I even had people here questioning whether or not my doctor diagnosed son had scz. Our family members can present so differently.

Since we didn’t know anything about scz, we didn’t recognize what was going on with our son until our Family to Family teacher enlightened us and our son was diagnosed by a psychiatrist that specializes in mental illnesses. Now that we are familiar with scz, it is easier to recognize it - it’s like having seen it, we can’t unsee it. My older son has autism and we realized it when he was an infant. Same thing, knowing it and being familiar with it, we can easily see it.

Our son’s scz lightened somewhat in his late 30’s, I hope the same happens for your family.


It is true that those with schizophrenia sometimes appear fine to others. They can even appear fine to their doctors. Weird, confusing, but true.


When hospitalized in a mixed care short term facility, I would play a little game… how long could I talk to somebody before I could figure out their diagnosis and/or trigger observable symptoms. Bear in mind these were people in crisis who’d either checked in voluntarily or involuntarily. Sometimes it was obvious and other times very subtle or not discernible at all.

I’ve also hid symptoms and behaviors from psychiatrists and psychologists for long stretches of time and afterwards revealed deceptions and they said they couldn’t tell. The reality is, many delusions are highly context and environmentally specific and outside of loved-ones and close friends much of conversation and social interactions are surface-level, and conflict/drama adverse. Being hospitalized sensitizes you to situations and topics that may have led you there, so just as with any social interaction you’re incentivized to avoid behaviors that might get you into trouble.

People who know you and your illness better interact with you significantly longer, more intensely and carry more historical and emotional baggage, and have a history of being far more tolerant of adverse behavior. So it shouldn’t be a surprise that they behave differently around you, because if you’re honest with yourself, your behavior and conversations with strangers, casual acquaintances, colleagues and distant and close family and friends varies widely. My psychologist taught me social facades are a necessary self-preservation tool for everyone and telling everyone your innermost thoughts is a sign of poor mental health, so to be safe and healthy it’s an extremely bad idea to spill internal turmoil.

Edit: in short, his withdrawal is his form of self-regulation. With medication and/or other therapies he might recover to a broader life with a larger social footprint. Recovery is very much a fake-it-til-you-make-it process, so I see this as a positive. My biggest fear in recovery was blowing-my-cover, certainly not that I wasn’t the same for everyone.


Thank you so much for this s reply and such insightful info. I really appreciate it. This condition is so confusing.

Thank you for taking the time to confirm. I start to question myself and my own judgement, but I do know he’s not well. I saw the psychosis that others did not. I appreciate your response so much.

Thank you. I’m reading through replies now and getting a better understanding of how he disguises his symptoms. I appreciate you taking the time to respond.

@Bucky I feel like I understand some of what you’re going through, although my son (25 years old) isn’t functioning as highly; I can’t imagine him working PT jobs outside of the home. However, my son does have the ability to act how he thinks is socially acceptable at certain times even though as his mom I can tell he’s not being himself at all. He would even hug my mother-in-law, and I can’t even remember when he last showed affection or emotion. My son just knows that’s what he’s “supposed” to do, so he can sometimes.
He basically can’t pretend at home around his dad, me, and his sisters, at all, though. But he has even pretended to have insight into his illness just to try to get out of the hospital, when he doesn’t believe he’s ill at all.
He tells me that he can do it on purpose. He’s been diagnosed as having schizophrenia by at least 2 different psychiatrists (I say at least, because he saw more than we talked to when he was hospitalized).

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