@Lirik Thank you for your encouraging post about working. My son will be starting a new job in June and his counselor is working with him and giving him exercises to do to help with future triggers and delusional thoughts while under stress. Is there anything you would go back and do for yourself in preparation for when you first started working again after your diagnosis?
Meditation has helped me immensely in becoming less easily stressed and anxious. I have also become a kinder more compassionate person as a result. I would highly encourage your son to practice meditation. There are free ones but there are also apps. Some of the ones I use are Insight Timer, Headspace and Simple Habit. Any of those are great. I quit work many times before because I was too anxious all the time. I think meditation will help your son immensely. Very successful people even like Bill Gates meditate.
With regards to delusions, I always get the feeling others are looking at me or talking about me. I have learned to ignore them. If your son gets these thoughts too, he has to look to the evidence around him. He has to actually look at other people that he believes are looking or talking about him. Once he sees other people are minding their own business and they are not actually talking, I hope he can realize he is having delusions. I have learned to look at the actual evidence around me and analyze whether there is any merit to my delusions and hallucinations. In fact, I still actively felt people looking at me and talking behind my back when outside recently so I upped my Latuda dosage. However, I realize all these are delusions and hallucinations through my years of dealing with them.
Depending on the job, also make sure to take notes of every single procedure. I forget easily so I write everything down.
Good luck.
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@Lirik Thank you, thatās a big help. Yes, he is aware they are delusions and has VERY similar ones including number, letter and sound references. Weāre all hoping for the best.
Thanks again
My daughter could NEVER hold a work from home job now, there just isnāt enough motivation or cognitive function left for her to successfully monitor herself work-wise. It is so different, her life now and her life before the illness. She cannot handle any type of stress at all. She is very successfully medicated, but her ānew normalā is not really at all like her āold normalā. Her positive symptoms are well managed (hallucinations and delusions and non-sense talk are gone), however, her negative symptoms have remained strong.
āNegative symptoms include blunting of affect, poverty of speech and thought, apathy, anhedonia, reduced social drive, loss of motivation, lack of social interest, and inattention to social or cognitive input.ā
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Hi Lirik, thank you so much for sharing! Your insight is helpful and seems sound. Iām curious, have you ever worked with a therapist and used CBT (cognitive behavior therapy)? It sounds as if youāre using some of the techniques to identify when you are suffering delusions and to work through them and Iām just wondering if those are self-taught through life experience or like I said learned from CBT as well. My partner suffers anosognosia and shuts down at even the slightest suggestion of a therapist but Iāve been trying for years to teach him the techniques passively myself.
Itās really great to hear your story and I appreciate your contribution here! Please keep sharing
Your are describing my son. I agree, working from home would be a real challenge. He needs to be instructed and guided to perform his work. Working as a cashier may not be glamorous for now but it does provide structure. I know he will eventually quit - I will not force him to do anything. The negative symptoms are really the main issue with my son. He no longer hears voices or have suicidal thoughts. The lack of motivation and self drive is virtually gone. Not until that recovers, if ever, can I ever see my son moving out on his own and going back to his career. I always thought the problem was the medication doing all of this. I might be wrong.
Hi there, I developed these cognitive strategies on my own. For the first two years of my illness, I had thought broadcasting and believed I was talking to myself in public all the time. I ignored all those thoughts whenever outside. I still donāt know whether I did that or not. It went away with switching of medications and time. I personally had not found psychologist or social worker I saw to be of help with regards to therapy, but then maybe I have bad ones. I donāt suffer from anosognoia though so canāt comment on that. If you got any questions feel free to ask.
I have a bad memory but I think I read Abilify is supposed to help with negative symptoms the most. Latuda which I take also helps with it. I do really believe switching to Latuda has helped with my negative symptoms. I recall me actually trying to study and work when I started taking Latuda. Maybe you can ask your psychiatrist. Also, not all psychiatrists are equally knowledgeable. For example, my old one believed I had bipolar with psychosis. It is ridiculous because he only looked briefly at my behaviour and judged me so. He was the one who asked my parents to apply for mental incompetence. My current psychiatrist looks at the real underlying root cause of the behaviour and symptoms. I recovered greatly because of him.
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Thanks Lirik! Do you think youād mind describing your experiences with thought broadcasting specifically and what that looks like? Thank you in advance for your responses. Itās good to have you here!
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I believe I used to have an extreme form of thought broadcasting. Typically thought broadcasting is like your thoughts are known to everyone else and everyone can read your thoughts. I believe everyone can read my thoughts to the degree where I believe I am talking to myself out loud. Whenever I go outside, I would have this delusion. When I had psychosis in the first month, I was at a gym and I saw some staff there looking and talking about me. I believe I was really talking to myself out loud back then cause I approached one of them and asked him whether I was talking to myself. He did not answer me directly, perhaps out of fear. I still do not know whether I talked to myself in public during those periods.
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Thank you for that. My partner with anosognosia who, general consensus from close family and friends who are practicing mental health professionals have agreed, likely suffers from disorganized SZ. He suffers delusions but itās never been completely evidenced that he suffers auditory or visual hallucinations and has never said so. His behaviors though are often him acting out at beliefs of situations and scenarios that are just absolutely not true or happening at all in reality. Conversation can be difficult at times as he has a hard time staying on topic and will answer questions with long ambiguous statements that have little or nothing to do with the question or topic. He is often if not always socially awkward but on good days he just comes off a bit eccentric.
So on the topic of work however, he has been working regularly for at least the last ten years albeit for his family (which had it been anywhere else not sure if he would have made it). Initially, during what I call his constant crisis years, he only drove a truck which didnāt require much social engagement which worked well at the time. I think the minimal responsibility and the routine and the fact that he was simply told what to do and where to be was good for him. Eventually his episodes became more spread out.
At some point it was decided that he would be moved into a position that would require him to engage closely with a handful of other workers out in the field and required taking classes. We held our breathā¦ oddly, it seems that having to focus on something more challenging and structured as the classes suited him extremely well and he has managed to function mostly in the position at work as long as heās getting some instruction from his instructor throughout the day. He does get visibly agitated and I think he cares what his coworkers think and can get insecure and uncomfortable in his skin, so often it seems he will get quiet and start to shut down. But all in all it has been a success story and I think the challenges that require focus actually help him. His worst episodes are at home, where he knows heās safeā¦
My brother also, though not SZ, will be the first to tell you itās likely heās on the spectrum. Extremely high functioning Aspbergers. Never officially diagnosed, but similar in his social awkwardness, tendency to not process emotional or situational stress in a generally acceptable social way, and a genius, has worked effectively in computer technology and support for more than fifteen years. Heās very good at his job and I think he finds that self esteem rewarding. He does interact socially with clients but from the safety of his computer desk and phones. He does travel some, and has learned to do that effectively independently over the years as he got older. Note: he does still live at home with my parents, with his wife and two young children. Win some loose some.
Vvicin01, hi there. I also wanted to comment on the fact that as a graphic designer your son may not only be a good fit for his prior job as it was something that utilized his natural talents, but that he may be using his drawing as a comfortable healthy way for him to therapeutically process what heās going through internally. It might be something that feels familiar when he feels within himself things are out of control. Strong creative types, in my own experience and me being one as well, I believe can often find grounding and outlet and focus in these acts of creating. Like a meditationā¦ I wouldnāt worry about it or discourage it, in my own unprofessional opinion
All of my work experience in Science and Technology was after I developed SZA. I worked in retail and food service and other temporary jobs in my prodrome. In a study associated with Elyn Saks, high functioning people with SZ cited work as an important factor in their recovery, and I agree. Ultimately the best job for anyone offers good work/life balance and personal growth. People with SZ are often at a disadvantage, because their on-the-job or formal training was interrupted by illness or theyāre unable to tolerate certain work environments due to adverse changes in their cognitive and emotional makeup.
Each person has their own talents and varying degrees of symptoms, so no job is suitable for everyone. I think some work environment and task qualities matter more to people with SZ than any specific job. A caveat to this is some jobs inherently have work environments and activities less suited to people with SZ and some more so.
Iāll list these important workspace qualities and explain their impact:
Lower degrees of expressed (especially negative) emotionā This goes for both home and work environments. People with SZ are other confused and threatened by too much expressed emotion-- especially anger, fear, and hate. Itās toxic to them, and can cause them to shutdown or lash out. So high drama work environments are toxic and should be avoided.
Control over environment (especially background noise)ā a quiet tranquil environment or one where you can wear headphones or play background music, makes it easier to concentrate and can block out stimulus that can feed paranoiac delusions. A full office where you can close your door, or a lab or shop or library limited to a small number of quiet people is ideal, but can be hard to find.
Controlled interaction with the public/coworkersā Direct interaction with the public is risky, because it leads to lack of control over the above. Predictable and controlled interaction is best. Slow introduction to new people and nuances of their personalities is better, otherwise you can become overwhelmed and become stressed or paranoid and can project insecurities onto customers or coworkers.
Gradual changes in work environment and tasksā At times people with SZ are like cats-- they notice any small change in their environment and seem irritated by it. Or also like cats, they can seem completely oblivious to it. Generally, people with SZ donāt like change-- especially if they arenāt prepared for it. They can deal with it, if they are kept informed and constantly reminded of it, but they mostly hate surprises.
Smoke, Drug and Alcohol Free Work Culturesā I think we all recognise smoking, drug and alcohol use is detrimental to people with SZ and especially SZA. So working in bars, restaurants and cannabis dispensaries are all bad ideas. Some professions attract folks who use recreational drugs. Best to avoid these if possible so temptations to self-medicate are kept to a minimum,
Job and schedule flexibilityā people with SZ have good days and bad days, and sometimes need to stay at home to limit stress or need to shift to different tasks because symptoms or their cognitive functioning limits them. Shift work with irregular schedules or long hours can disrupt sleep patterns and throw them out of balance.
Flexible procedures and deadlinesā people with SZ often have idiosyncratic or ācreativeā ways of doing things, and donāt always work well with rigid processes and procedures. They also can be less efficient because of organizational and cognitive deficits, so they may need more time to complete tasks. Iāve mostly worked salary exempt and often worked extra hours without overtime to make up for my inefficiencies. Piece or āgigā work is also a way to make up for lack of productivity.
Tolerance of aberrant behavior, absenteeism and tardinessā much of my work and recreational life straddles Nerd and Artistic circles, and both are faitly tolerant of excentric and āflakeyā behaviors. In fact nowadays Iām viewed as highly reliable and steady within both cultures. Everything is relative, but I didnāt start out that way. But over time, I learned I gained credibility and status as i seemed more ānormalā and steady. But Iām grateful that both cultures were more forgiving of eccentricities and foibles.
Gradual acquisition of skills, responsibilities and social standingā Some jobs nowadays adopt a sink or swim philosophy with minimal training and supervision and maximum responsibility and stress. These are generally unsuitable for people with SZ/SZA. Typical warning signs are phrases like āself-starterā or ābe your own bossā or āmake your own hoursā in job descriptions, or commission-based pay. These types of jobs are commonly advertised and people with SZ with little work or world experience may fall prey to such promises. Apprentice or on-the-job training positions where experience is slowly acquired and gradual advancement is possible are better fits. The tale of the tortoise and the hare is an appropriate lesson to stress here.
Understanding, patient and tolerant managersā people with SZ require patient and understanding managers. For years I was insecure in my job and needed constant reassurance. Like many new and inexperienced employees, I made many mistakes and often was self-conscious of them. With SZ you are prone to confusion about work situations and work instructions and can require additional supervision so reality-checking and clarification can occur.
Clear and consistent communication of goalsā People with SZ donāt do well with ambiguous or vague direction. They experience enough of this with hallucinations, misperceptions and delusional thoughts, and usually with unfortuate results. I do best when I have clear goals, but the freedom to find my own way to achieve them. Certainly coaching and brainstorming help, but the ultimate goal should be to point workers to self-sufficiency.
A few more points before finishing this overly long postā¦ I donāt think solitary or remote or āgigā or piece work is healthy in the long run for people with SZ. While it may pay some bills, humans are social animals and encouraging a lifetime on COVID-19 lockdown exacerbates the crippling nature of the disease. Coddling or babying someone by removing all stressors can create fragile brittle and dependent āunicornsā like Laura from The Glass Menagerie, or Travis Bickel type Uber drivers. I believe a certain degree of āgoodā stress or challenges lead to growth when presented gradually and in moderation, and can lead to more self-sufficient recoveries with supportive services like CBT or other talk therapies. If thatās all that can be found or tolerated, itās better than nothing, but I think this sort of work should be a temporary bridge to something else, rather than a destination.
Better alternatives might be work with animals or plants or trees if human contact is difficult, or work as an artisan or in a trade like drywall or painting etc. If entry level work is all that can be found, consider off-hour stockroom work or cleaning crews etc. I think itās better to be part of a smaller team with minimal contact with the public, as it can be quieter and less stressful, but still mix in a little social contact and teamwork. I also think apprenticeships or family or friend owned slower-paced small businesses might be a good fit, because they typically offer better work environments. Academic and civil service jobs can offer these sorts of environments too. And if nothing can be found, volunteer work or clubs may be a bridge to employment. Regardless, I think itās better to attempt a certain amount of outside the home activity to help develop coping skills even if itās not remunerative and build from there. There will of course be discomfort and stress and setbacksā you canāt grow or succeed without them.
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I know the guilt can be huge. Our son abused drugs and alcohol for a year when we were trying to figure out what was going on. We even had to kick him out of our home at that time which caused a lot of guilt but we were doing what we thought best at the time. He used to be on risperidone but has been very stable on Invega injection once a month for the past 2 years. I feel pacing is part of both meds and schizophrenia. It is calming in some ways. Propranolol helps for some to calm that restlessness. Donāt give up on his future, our son takes one college class at a time. It really helps self esteem and gives him a goal and hope. We help him study but are proud of how he is trying!
Wow, @Maggotbrane, thanks so much for the thoughtful, organized and detailed reflections on job elements that can help or hinder.
In reading your post, the āhigh expressed emotionā as your number one trigger really jumped out at me.
Itās funny, because I have been very aware of the research going back decades suggesting this as a trigger for relapse in the family setting, but somehow I never extrapolated this to the workplace (perhaps because the research literature tends to ignore work as well).
I have always suspected that a work promotion (which put him on the front lines of dealing with co-worker distress) was associated with my husbandās initial break, and that some later changes in the overall atmosphere in his workplace contributed to his recent relapse.
I think you have absolutely hit the nail on the head in the high expressed emotion in the workplace factor. His job is perfect for him along pretty much all of your other dimensions, but there is a huge degree of strongly expressed negative emotion in his workplace, and that is very hard for him.
Yes, as I recall your husband is high-functioning and well regarded in the workplace and thereās a tendency to thrust such people into managerial roles they arenāt well suited for, because management doesnāt understand this.
My solution when pushed into these roles is to alternately do a poor job to discourage assigning more such responsibilities, or bending the role into more of a detached mentoring or consulting supervisor/manager. It can be a precarious balancing act. Another tack is to use other aspects of a favorable work environment to avoid such pressures, like retreating to a lab or studio or closing an office door or taking a mental health day in hopes such tensions blow-over. You can only get away with such antics if you are valuable in other ways to colleagues.
Often organizations intuitively sense that certain ācreative typesā are special cases and develop mechanisms to protect them. Think, Don Draper in Mad Men. But turnover or mergers can bring people into managerial roles who donāt understand or respect their special status and tear down these protections with disastrous consequences.
High functioning employees with SMI tend to entrench themselves at their jobs, because it takes time to build protective systems and human networks that allow them to function. Thereās a huge social cost for them to look for a new job, so its hard sometimes to forcefully push back or leave when management makes such fateful decisions.
Thank you MB, that āoverly long postā was 100% and if I could press the ālikeā button five more times I would. One. Hundred. Percent. Detailed everything nicely as far as the reality of life with my SZ partner exists and with excellent suggestions. Thank you!
Your son is so lucky! My son couldnāt finish High School. He paces all the time. Canāt work. Canāt focus on watching a movieā¦ Worries about gaining weight and always thirsty. 26 yrs old and he doesnāt have a life. We are in our mid 50ās trying to keep his safe. We love him to death, but itās so hard not to get frustrated.
@gijane there are some cognitive techniques that can help with concentration and focus. Iāve had a psychiatrist who suggested I might be borderline ADD along with my SZA and considered medication to help with it, but I focused on CBT style approaches instead. Iāve also served as a mock client at a Occupational Therapy college and it was interesting to see creative approaches that OT students suggested to help organize work and study habits. OT is often thought more as remedy to physical deficits, but thereās cognitive approaches as well.
My suggestion to you and your son is to start with a little psychosocial therapy. Try to find activities that he still can handle and enjoy, preferably in one on one or small social groups and branch out from there. I hear Clubhouse settings can be good for this, but I have no experience with them.
Time boxing or Pomodoro techniques may be helpful. The standard time interval of 25 minutes is probably too long, but he could start with shorter intervals and work his way up. Pomodoro Technique - Wikipedia
Improved concentration can be achieved with some practice and motivation. Meditation may help too. If thereās something that captures his focus and attention like video games and the like, try to leverage that improved focus elsewhere. I think itās a bit like teaching ADD and autistic children to find ways to complete schoolwork. You have to help them find their own way of doing things if you can. Good luck.
I know I am replying to this after 3 years. I have copied your comment and saved it. My family member is going through this now; will be finishing up college in May-2024, in Management Information Systems Major ( obviously it has taken an extra 1 year, with all the struggles associated with SZ ). With our ( parents ) help, he has applied to many many internships and jobs. We are looking into āsupported employmentā now. Pretty sad and broken to watch his cognitive / understanding / creative abilities very subtly deteriorating for the past 5 years and we all could sense that this year with his last few subjects. Thanks for your detailed post. BTW, he is almost on the max dose of Olanzapine.