Family and Caregiver Schizophrenia Discussion Forum

Went back to work now and wants to try no meds!

Sorry to hear that he left through no fault of your own, and you apparently presently don’t have a dialog with him. It’s certainly difficult to impossible to practice LEAP if you have limited contact with your loved one as it’s a very “talky” process. I’m sure it’s very distressing, but likely he will eventually come to an impasse and have imminent wants and needs to rescue him from whatever situation he’s in and that’s a point where LEAP could provide leverage.

I want to reiterate it’s not necessary that your loved one “open up” about their delusions and for you to understand the inner workings of delusions to practice LEAP. It can be useful for background for how and why they feel and think certain things, and to help avoid arguments and reduce conflict. But by definition delusions aren’t real and therefore won’t be a component of any agreement or plan that results. Agreeing with or centering plans around specifics of delusions being “real” could be perilous and escalating and I wouldn’t recommend it.

With paranoias there’s often a phase when delusions or symptoms are new or distressing and that’s all you want to talk about, and reflective listening and reporter style questioning skills are helpful when the subject actually wants to be heard and understood and empathized with, but alternatively they may go straight to being uncomfortable or secretive about delusions or symptoms and being overly prying or intrusive can stifle progress. I liken this to someone you know becoming engrossed in a new relationship, and either can’t shut up about it or are very touchy or even secretive out of fears of vulnerabilities or outside interference.

Believe me, I know my brother’s delusional systems backwards and forwards and having personal experience and a proven track record with dealing with my own delusions helps extremely little as far as progress with LEAP goes. He’ll go over them in great detail over and over again as if I’m learning about them for the first time, instead of the broken greatest hits records that they are and we make very little progress. Knowing about them and listening to them are actually a huge impediment to progress, so be very careful what you wish for. However, acknowledging his feelings surrounding his issues and listening to him without judgement means he’s less angry with me overall than other siblings, and lines of communication stay open. My sister often makes the most progress with him, and I feel her background in sales and marketing is key here. It’s Agreeing and Planning that closes deals, and the rest just gets and keeps your foot in the door while you learn what your client perceives they want and need, and then you can jump in with a proposal and arrive at an agreement on mutually beneficial terms.

So rather than focus on his delusions, I suggest it’s more productive to focus on wants and needs and what terms you are willing to negotiate with him to provide them. Avoid “giving away the farm” when giving room and board or other support. Someone who’s pragmatic enough to hide information to protect themselves, could perhaps be bargained with for food, shelter, money, cigarettes etc in exchange for other things. Love may be unconditional, but support not necessarily so.

In my case, my primary motivator for starting medication was a realization that I would be unemployable without it, and as I recovered I flirted with and experimented with periods off medication, but this was only with various other supportive therapies. Ultimately I would always go back out of fear of losing my job or social status or other hard won gains. My conclusion was medication is cheap insurance and it was risky and reckless to run around “uninsured”.

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Thanks @Maggotbrane. From what you are saying and others have said here LEAP is a long-term process-oriented way of communicating. I won’t expect some quick result from it, especially since he’s not talking.

I agree, the delusions are not really worth knowing or talking about.

I’ve never really thought about this, but it sounds right:

So rather than focus on his delusions, I suggest it’s more productive to focus on wants and needs and what terms you are willing to negotiate with him to provide them. Avoid “giving away the farm” when giving room and board or other support. Someone who’s pragmatic enough to hide information to protect themselves, could perhaps be bargained with for food, shelter, money, cigarettes etc in exchange for other things. Love may be unconditional, but support not necessarily so.

I’m going to run this thought by my wife. We’ve been thinking about creating an agreement for when he comes back from the hospital.

I talked to the hospital shrink yesterday and my son has clammed up there too. He’s been at the facility since yesteray, so he was just seen. I’m sure they will do their best to learn about him and arrive at a treatment plan. We might be headed in the direction of a LAI, which is new for me and more to learn about.

Glad I might be of some help, if only to offer a different point of view. Some thoughts I have on the content of such an agreement:

Consider having him sign a lease. This gives you civil legal leverage to enforce conditions on him. Eventually the COVID restrictions on evictions will lapse, and it’s another legal lever you might have beyond psychiatric holds and restraining orders if there are future conflicts. It also models independent living skills if he hasn’t rented on his own.

Consider charging rent even if a token amount or in exchange for chores or some other gainful or socially therapeutic activity. My mother started charging me rent after I stopped attending school but was working part-time. I resented it, because my brother did not have to pay rent. But then again, I’m now independent and own my own home, and my brother is not.

If you plan to give an allowance see if you can tie it to things that are beneficial or therapeutic. For example, he gets a “bonus” if he goes to the doctor or submits to injection of medication otherwise he may get less or nothing. You want to incentivize activities that are good for him, and find ways if you can to avoid conversion of resources to things that are bad for him like drugs and alcohol. My brother is an alcoholic, so we try very hard to give gifts that are hard to convert or more valuable to him than alcohol.

In my case, my mother required me to work or at least pursue work as a condition of room and board prior to paying rent. They initially paid my medical and therapy bills, provided me with a car and insurance and funded school tuition, so I viewed it a fair exchange. Work may not be possible, but you may consider requiring volunteer work or some other social activities or household chores as a condition of stay.

I’d go easy on punishments and focus more on incentives, and try to be as consistent as possible. Inevitably one parent will be “the heavy” and it will help to get family and possibly friends in agreement on rules of engagement, so your son does not make end-runs around restrictions. Good luck.

Thanks @Maggotbrane. We’ve so far steered away from tough love because of his neurobiological disability. It was so uncharacteristic of him to go off his meds after at least a decade of compliancy. Hopefully when he gets out of the hospital he will start working with his psychiatrist to manage them again. When he gets stable we are going to need to do some of the things you suggest. My wife and I are growing old and he needs to learn how to live independently.

Speaking from a father’s perspective, I am SO thankful that my son has always WANTED to get better since his diagnosis about 7 years ago! The fact that he has avoided illegal drug use has also been an ENORMOUS advantage for what is now a very stable condition.

He also learned early on that STAYING on his meds is a necessity!

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Well he has been going for his injection which Medicaid covered but now he’s back to work and the injection is too expensive. So he’s going to have to go back to taking daily meds which makes me nervous that he will stop.