I have a friend with paranoid schizophrenia. He suffers from it for 10 years and is on meds all the time. He lives with his sister and her family with few social contacts, more or less isolated. His mother died and his father doesn’t want to see him much due to the fact he’s so ill.

Ever since I’ve met him I saw the relationships in the family are rather bad. He’s subjected to mockery and is getting scolded fairly often. I’ve never felt much – if any – support from them. He usually does nothing at all just to minimise the possibility of spoiling something. He’s unkempt, not able to keep his room clean, doesn’t care about his grooming and neither do his family. He only keeps painting all the time. But I know he’s capable of a difference as he e.g. shaves when I’m about to visit. He can talk about many things just fine, at least with me, and it is clear that behind the disease there’s a very clever person.

It pains me to see he could possibly get better if treated differently or living in a better environment that would support him and lead him to being more independent. But what can I do? He’s legally competent and adult. Talking about changes frightens him. And I can’t take him to my house and I can’t talk to his family members. I’m not a part of his family and they wouldn’t listen anyway.

Should I really try to let it be as it’s not in my capacity to change it? Sometimes it gets so painful to watch and the helplessness is the worst part…Thanks so much for any advice!

A. You said that he takes medication which means that he sees a mental health professional. You can encourage him to speak to his doctor about independent living arrangements; however, if he’s not ready, then you must respect his wishes.

As you suspect, your power is limited in this situation. You’ve tried to talk to him about moving and the idea of change frightens him. His family won’t listen. You’ve really done all that you can.

Many people with schizophrenia are frightened of change. In some cases, too much change, too quickly can lead to a psychotic episode. Even knowing that he is not living in the ideal set of circumstances, it may be in his best interest to simply leave him be. He may someday be ready to move out but now doesn’t seem like the right time.

You are his friend when no one else seems to be. You care about him even when it seems that no one else does. You may think that you are not doing enough for him but your friendship undoubtedly means a great deal. Perhaps in time, he will lean on your caring and support to become independent. Research has consistently shown that having strong social support significantly improves the outcomes of people with schizophrenia. Your relationship with him has the potential to create strong positive change.

Continue to be a friend and an advocate and maybe in the future, he will be ready for independence. He may never be ready but should he be, your relationship will have served as an important lifeline. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog