The emotional toll, especially for partners

I’d like to share some thoughts on the emotional toll this disorder takes on loved ones. A lot of what concerns us on this forum has to do with the devastation wrought by positive symptoms. A casual observer might get the impression that people with SZ experience almost non-stop psychosis and harmful, even dangerous behavior. It happens all too often, but it’s probably not the day to day most of you experience.

I’m more concerned in this post with negative symptoms, especially flat or absent emotions and apparent self-centeredness. From what I have read, negative symptoms are least likely to be improved by meds and are the ones most likely to create long-term suffering on all sides.

Family members and partners continue to hope against all odds that their loved one will somehow “come around” or “snap out of it” and be fully available emotionally. And yet, from what I have observed, that rarely seems to happen, whether someone is on meds or not. The often profound lack of emotion and empathy can lead to desperation on the part of loved ones, both family and especially romantic partners. So the biggest challenge is to accept that the person (or our perhaps flawed memories of that person pre-psychosis and symptoms) will never be what we once hoped and dreamed. There may be flashes of the “person underneath,” but the disorder has effectively erased any hope of a normal life, for them or for us. So the task is working through grief, gaining acceptance, and moving on, whatever that looks like.

But that road is hard, not least because it can often be that precisely their sociopathy and self-centeredness that keep loved ones bound to them. SZ can evoke an almost childlike state: the universe revolves around the afflicted person. Many withdraw into their own heads, which further wounds loved ones. Sometimes they may seek attention and connection. But if you examine what that looks like, the focus is almost exclusively on themselves. The family and partners are more like an audience for self-focused, often confused thinking. Many learn to fake a degree of normalcy to get what they want or avoid treatment or other things they dislike.

Relationships are almost always fraught. The bond between a child and parent may be unconditional, but it’s not usually that way with partners. A parent does not know how a child will turn out, but a partner usually meets the afflicted partner at an age when some symptoms may already be present but may not be recognized as typical of schizophrenia. The new partner is “different,” has novel, maybe even charming behavior and observations about the world. His/her emotional inconsistency and elusiveness may be part of the attraction. Sex is a big motivation, especially to young people with the disorder, and they may work hard to hide the illness in order to attract a partner. But it usually isn’t long until the cracks appear and it becomes obvious that the person isn’t capable or willing to be a real partner able to give and take emotionally. The “normal” partner ends up drained, with their emotional needs neglected or worse. That kind of situation can’t be sustained forever. But even thinking about abandoning the loved one creates feelings of guilt and conflict. There may be children involved, further complicating the situation. The conventional wisdom is that even if they can’t show it, people with SZ still need love and attention. I have begun to question that. Perhaps some do, but few are able to reciprocate. And that is why so many end up alone.


An excellent post. Thank you. I have been caregiving for my wife for nearly two years. I relate to everything in your post. The one belief I do have is that even if the person suffering from psychosis is not able to return love and affection, I still believe they need it. I still believe that showing love and affection helps both the loved one who has the psychosis and the loved one who is caring for this person. As one person with psychosis shared as a piece of advice to caregivers, “… remember, it’s still me in here.”


Your explanations @kwillkat and @KevinSkilton help me to understand more the trials of caregiving to a spouse with schizophrenia. I believe that everyone needs affection. You made me feel lucky that my husband’s problem is only alcohol, as his emotional roller coaster is much less severe, and he is able to give love and affection on his good days.