Family and Caregiver Schizophrenia Discussion Forum

Lack of Empathy

Hi all. So I was just wondering if any of you have observed difficulty showing empathy in your family member/loved one with schizophrenia? My brother, who has schizoaffective disorder, seems to have little capacity for empathy; he only thinks about himself and seemingly cannot see things from the perspectives of others, even when we try to explain things to him simply. Consequently, it makes living with him quite the challenge. He does take his medication (sometimes) but otherwise is receiving no treatment. How should my family and I deal with this lack of empathy?

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It’s very emotionally hard to deal with their lack of empathy and compassion. My son once was so loving and thoughtful but now he can watch me lugging heavy sacks of groceries or trying to move furniture etc and simply walk away It’s hard not to get upset and realizing that it’s his illness that causes this. At times I think he is just ignoring me but have come to realize that he just doesn’t understand anymore that I need his help at times . I also think that he only thinks of himself not others. In his world as I call it, he is busy doing things in his mind and cannot focus in the real world. He openly talks to me about his world where his life is filled being a CIA agent, the king of his realm, his children which he doesn’t have, his wife and no he really doesn’t have one, friends he thinks betrayed him and many other things that simply are not real. But to him they are and I listen and respond back which has kept our relationship intact It’s been a hard road that I deal with daily with no end in sight but I’m lucky he is safe with me, that he tells me he loves me everyday, and that he is not on the streets or in jail. Sometimes my heart shatters at his lack of empathy and at times I just break down and cry. I guess all we can do is talk about it, see a therapist if needed and stay strong for both them and ourself

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I believe that a lack of empathy is very common with schizophrenia. My own experience is that as the months (1.5 years now) go by on a medication that helps her, my daughter’s empathy keeps improving. It is much better than it was a year ago, and light years ahead of where it was when she was unmedicated or on a medicine that didn’t work well. While there were active hallucinations/delusions, her empathy was almost non-existent.

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Glad to hear that your daughter’s empathy is improving. The medication that my brother is on right now, although it’s keeping his head above water, does not seem to be having the efficacy it should be. He also has anosognosia, which makes it difficult for him to take his situation seriously. Thanks for sharing.

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@Maggotbrane addressed this subject recently - sadly I can’t find the post.

What resonated with me in my experience was that my son’s struggle to do the simple tasks of living his life day to day while dealing with voices, paranoia and delusions was a challenge that often didn’t allow enough energy for empathy for others.

At Family to Family they told us we could expect for our family member to be able to accomplish one thing a day. Sometimes my son’s one thing is just the thing he needs to do most and he is worn out after doing it. Sometimes he has to wait quite a while for a lighter cycle of psychosis to come around so he can do something he needs to do, like shop for groceries.

For others not as far along in their coping skills, and starting from ground zero, the one thing they accomplish might be a shower.

Some people in the past have expressed frustrations that their family members seem to expect support and didn’t offer gratitude. I used to think that way about my own son. Over time I have come to feel quite differently. I now see his requests as needs instead of expectations. I can also see that he is frustrated when he asks for things he needs and I suspect it’s more about him being frustrated that he can’t do these things for himself.

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Since I have SZA and possess more empathy in some contexts and less so in others, I have a more nuanced view and have hypotheses on caregivers’ observations and can offer possible explanations and clarifications on empathy and SZ/SZA.

First, I’d consider observations of capacity for empathy prior to the onset of the illness. Certainly if a person had little expressed empathy prior to illness, I wouldn’t expect much improvement. I don’t believe there’s a correlation between lack of empathy and developing SZ, but my experience is people with SZ/SZA tend toward introversion often intensified by the disease—at least those with paranoia such as myself—and as such may be reticent to act on or express feelings of empathy. I wouldn’t assume empathy is completely absent. I’ll offer various reasons why this may be the case.

Empathy is in large part a learned social response to shared experience. In a typical prodrome, a person with SZ/SZA will withdraw from society, often reactively to avoid overstimulation, but also defensively as you start to feel misunderstood and devalued by society. This alienation robs you of experiences and resultant emotions at thresholds of adulthood. And it can handicap you of relating to others due to a simple lack of a shared context. Couple this with impaired social skills and avolition and in many contexts you have trouble relating or expressing emotion.

For example my first ‘date’ was in my late-mid 20’s, my first ‘career’ job was the year before and my first ‘relationship’ was ten years later. I’ve never married nor had children. If I didn’t have work or theatre and other hobbies, I’d have little shared experiences to empathize with most people. And I’m a near best-case scenario. My brother speaks almost entirely about his past prior to developing bipolar disorder, or engages in fabrications and delusions—his empathy and social development is noticeably stunted as a result.

This situation only gets worse when hallucinations and thought disorders and delusions take hold. You perceive the world differently, and find it harder and harder to relate to others, because they do not share the same experiences of reality. Furthermore, caregivers and the rest of the society often invalidate and contradict resultant aberrant thoughts and feelings which are quite real to the sufferer. And unless caregivers practice LEAP methods, they can be guilty of a similar “lack of empathy” from the sufferer’s perspective. In many ways it’s harder for caregivers to relate/empathize, because they haven’t experienced these thoughts and feelings, while the sufferer typically remembers shared “normal” experiences before onset of their illness. Hallucinations and delusionary thinking can be quite complex, individualistic and difficult to explain. This is especially true when paranoid delusional systems are in play. It can take hours and hours or days of exposition to fully explain their world view and often a rational person still doesn’t ‘get’ thought processes that are alien to them. I sometimes tell people when explaining delusions, “you had to be there”, knowing full well they couldn’t possibly understand. It’s a little “meta” joke I tell myself.

Caregivers are often told to take care of themselves first using the metaphor of putting on their oxygen masks first before assisting others. Please remember, people with SZ/SZA are those others. They may have trouble breathing from their metaphorical oxygen on good days, much less when the cabin pressure is low. They may be preoccupied with the flashing lights or whistling wind from the gaping hole in the plane or numbing paralysis of fear that the plane is about to crash or many voices shouting that “we’re all going to die!” And the hypoxia from lack of oxygen is dulling their cognition, so maybe you should forgive them if they leave their luggage behind in the aisle when they rush to slide down the chute of their imaginary crash-landed plane. I’m being melodramatic here to make a point: you’re the one breathing oxygen here, your brain is functioning, yet you’re asking the person you are assisting to think about other people when by definition you consider them impaired.

Schizophrenia is a disorder of thought AND emotion. Most people forget this and focus on the thought disorders and resultant behaviors. Look up the definition to refresh your understanding if you’re unaware of this. The ‘split’ is between thought and emotion-- not 'personality’. Anti psychotic drugs work largely on the thought side of matters or “positive” symptoms, and less so on “negative” symptoms. And what are those negative symptoms that those drugs don’t work well on?: poverty of speech, flat affect, lack of friending skills and socialization and avolition. These all have to do with expressing and acting on emotions, so to me it’s small wonder there’d be a perception of a lack of empathy.

In my experience, negative symptoms are the last to leave— if at all. In my case I had about a decade of talk therapy, voice lessons and acting experience to tackle mine— most people aren’t nearly so lucky aside from the few who convince a doctor to prescribe Clozapine. For me that split between thought and emotion was very real and palpable, and I was acutely aware of it because of insight. It cost me those ten years between a first date and a ‘real’ relationship.

Endless practice in gradually more challenging roles got me out of my head to stop ‘performing’ my emotions and instead ‘acting’ on them— in-the-moment — as actors say. Voice helped me focus on presentation and affect. But make no mistake, before my training, I had emotions and empathy, often strong and overpowering. They came out alone in my apartment after I thought about events that I appeared numb to in-the-moment. Maybe I didn’t fully understand what was going on until I thought about event, or talked to my therapist, or listened to music or watched a movie or read something that helped me relate, and gradually the lag between thought and emotion lessened as I grew to experience new things and was better able to relate to others. Yet through through the veil of stigma it was often impossible for them to relate to my experience.

So as @oldladyblue implies, have patience. Empathy is a tough nut. It can take years or a lifetime to emerge. This is very much a marathon, not a sprint. And we with with SZ/SZA always feel behind, bringing in the rear. Hoping they don’t shut down the race before we get to the finish line.

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.

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I’m wondering if it was in a thread about perceptions of “narcissism” which is a related topic. I was overlong composing the previous post, so didn’t see this first.

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I am so glad you did respond in detail - thank you.

Yes, this was the post from the other thread-

“ A person with active SZ is too preoccupied and disabled by hallucinations and thought disorders to interact socially in meaningful or thoughtful ways, and may act out in elemental ways to get their needs met. Whereas someone with a narcissistic disorder views social interaction and society in general as a game to be played, exploited and won at all costs to their sole benefit.”

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Wow, what a thoughtful response @Maggotbrane --this is incredibly helpful. Thank you for sharing your insight!

This was very helpful for me to understand from a different perspective. Thank you for taking the time to write this!

I find that when my son wasn’t on medication he had little empathy. He would see me dragging groceries upstairs, pass me by and not even notice. I had the flu at the end of last year so bad and it was like I didn’t exist, nor did he care or asked about his two brothers that were trying to reach him by phone. His room looked like a tornado went in and destroyed it. But I don’t think my son ignored me or just didn’t care because that’s how he felt. I think when they are in phychosis they are in a world of there own, I remember having to call my son 4 or 5 times and he was right in front of me, he definitely was oblivious to everything.

He is now on medications that are working for him and and now he will help me with the groceries as soon as i come in the door. He has more empathy then before. I kiss him and tell him I love him and at least now he is responding. Before he wasn’t very happy when I tried to hug him or tried having him talk to me, actuallyhe never spoke completely ignored me. This is a horrible illness, it robs them of everything, my son is very good and loving. But when he gets ill, he is a totally different person. It breaks my heart because he is not violent or gets into trouble he is just being tortured by voices and conspiracy theories, it makes him be a different person.

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Well said. Lots of insight I will capture for my son. Thank you