Why are some people with schizophrenia able to live alone and others can’t? Why do some seem to recover while others have symptoms that persist for their entire lives? Why is suicide the leading cause of premature death in people with schizophrenia?

Many people say the answer lies in psychological resilience. So, does that mean some people have more psychological resilience than others? Does having a mental disorder mean your brain is less resilient to start with?

Hosts Rachel Star Withers and Gabe Howard explore the concept of psychological resilience and how it is connected to living with schizophrenia.

Dr. Nicole Washington, a psychiatrist and the co-host of Healthline’s Inside Bipolar, joins to give a medical perspective on psychological resilience.

Dr. Nicole Washington

Dr. Nicole Washington is an ABMS board certified psychiatrist and the chief medical officer of Elocin Psychiatric Services, a primarily virtual practice where she focuses on the mental health needs of the busy professional. Dr. Washington has spent most of her career caring and advocating for people who aren’t typically consumers of mental health services, namely underserved communities and high-performing professionals.

Rachel Star Withers

Rachel Star Withers creates videos documenting her schizophrenia, ways to manage and let others like her know they are not alone and can still live an amazing life. She has written Lil Broken Star: Understanding Schizophrenia for Kids and a tool for schizophrenics, To See in the Dark: Hallucination and Delusion Journal. Fun Fact: She has wrestled alligators.

To learn more about Rachel, please visit her website, RachelStarLive.com.

Gabe Howard

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without. To learn more about Gabe, please visit his website, gabehoward.com.

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Schizophrenia. Hosted by Rachel Star Withers, an advocate who lives openly with Schizophrenia. We’re talking to experts about all aspects of life with this condition. Welcome to the show!

Rachel Star Withers: Welcome to Inside Schizophrenia, a Healthline Media podcast. I’m your host, Rachel Star Withers here with my great co-host, Gabe Howard. Why are some people with schizophrenia able to live alone and others cannot? Why does it seem that some people fully recover while some of us have symptoms that persist our entire lives? Why is suicide the leading cause of premature death in people with schizophrenia? Many say that the answer lies in psychological resilience. So, does that mean that some people are more psychologically resilient than others? If you have a mental disorder, does that mean that your brain is even less resilient than the norm to start with? Joining us today is Dr. Nicole Washington, who is a psychiatrist and also a good friend of Gabe’s and the co-host of Healthline’s Inside Bipolar. She spent most of her career caring about and advocating for people who aren’t typical consumers of the mental health services, namely underserved communities.

Gabe Howard: Rachel, I’m a big believer in defining our terms, and I have never heard of psychological resilience before. I’ve heard of resiliency, of course, but never with the word psychological tacked on in the front. What exactly is psychological resilience and how is it different from just being resilient?

Rachel Star Withers: I think it’s the exact same thing, honestly. I feel like the psychological resilience, the term just makes it sound fancier, but it’s exactly what you would call resilience, and it’s the ability to cope mentally or emotionally with a crisis. And you might even say it’s just, okay, remaining calm under pressure. Being able if something bad happens to you, how are you able to bounce back from that situation?

Gabe Howard: Rachel, I want to disclose that I’ve always thought that resiliency was just the latest buzzword. And it makes me wonder on a show like ours where science and research really matters, is this measurable? Is this research-able? Is this something that’s more than just, you know, the fluff that we’re reading on social media these days?

Rachel Star Withers: There’s a lot of criticism around this exact topic because, yeah, how in the world do you measure resilience? How do you test it? Because everybody is going to react to situations differently. And what your definition of being resilient is, is probably completely different than my definition. And that’s what scientists have learned, is that across these different types of studies is that everybody has a different interpretation. However, the two main concepts that you would define resilience would be adversity and a positive adaptation. There has to be some type of issue, stress, crisis, to cause there to be resilience and then you adapting to whatever that, let’s go with negative, thing is. That’s the core of psychological resilience. A problem, and then how do you deal with it. Now as far, you know, is this all just kind of fluff and buzzwords? Not exactly, because there is something called neuroplasticity, and that is the brain’s plasticity. The ability of the little neural networks in your brain to change and grow through reorganization. I know now that just got, like, really complicated, but it happens all the time when you learn a new ability, when you learn an instrument, when you learn to speak a new language, your brain is able to like, change how it works naturally. So yes, there is an actual physical component to all this. It isn’t just believing in yourself and having a positive attitude. The brain does adjust to things that happen around it.

Gabe Howard: Rachel, that is all incredibly fascinating. I do think it’s fair to tell our listeners that research into the brain is always ongoing and we’re constantly learning new things. So that is that is the current school of thought by a lot of researchers. But I really think that the big takeaway is this is how habits are formed, right? The thing that we do over and over and over again changes the way that we see things, think about things, behave, react and respond.

Rachel Star Withers: Unfortunately, schizophrenia and other serious mental disorders like bipolar disorder are associated with impairments in both resilience and cognitive function. However, the impairment of resilience is completely independent to any deficits in cognitive functioning. A lot of times with schizophrenia, people think, okay, there’s like cognitive problems going on and these people aren’t as mentally strong as others. But the problem is that those two things are not connected. And I think that that right there is that’s a huge piece of stigma, this automatic assumption that, okay, if you have a serious mental disorder, obviously these people, they’re not as resilient. If your brain is working normally, your brain must be stronger. And so, it’s weird because here’s like a scientific thing, and yet there’s stigma in this scientific fact. And then on top of that, it disproves itself because they’ve learned that the cognitive deficits have nothing to do with an individual’s resilience.

Gabe Howard: People living with schizophrenia have deficits. There’s a disability involved, there’s a concern involved. There’s a medical condition involved. But at the exact same time, they’re just as resilient as everybody else. And that’s where it gets confusing. I imagine, Rachel, it’s got to be difficult for you as someone who lives with schizophrenia because you want to be treated with kindness and respect and just like everybody else. But you also acknowledge that there are some deficits, there are some differences. You do need some supports that maybe other people don’t need. And it’s I guess my question for you and I just want you to just grab the bull by the horns. Does this kind of make you mad where they’re just kind of saying, hey, yeah, you live with schizophrenia, but you need to be resilient and just tough it out because sometimes that’s what it sounds like to me.

Rachel Star Withers: It is very frustrating to me. For one, if you have a physical disability or a physical sickness, no one sees someone going through cancer and thinks, Oh my gosh, they’re just not as resilient. You don’t think that. If anything, you think the opposite. You’re like, oh my gosh, wow, that person has gone through so much. And look, they’re still going, you know, someone who’s been born with the physical disability, you never think, Oh, wow, That’s just they’re just such less of a human. They just have it. You know, You’re like, Wow, that’s incredible. Here you are living your life and you’ve had to deal with this thing, this other issue. It’s very much a double standard for serious mental disorders.

Gabe Howard: But at the same time, Rachel, there is some control that you have. There is some resiliency that you can apply to your life to have better outcomes. How do you manage those two things?

Rachel Star Withers: That’s a hard question because it’s going to be different for everybody. And it’s something that unfortunately has come up repeatedly when people message me. And I always feel bad because they’ll want to be like, well, how come my loved one isn’t like you? Well, how come you’re able to do this and my loved one can’t? How come you’re able to host a podcast and my loved one can’t, you know, etc., etc? And there really is no exact answer. It’s not as simple as well, I take my pills every day. Like it really is not the answer. You know, it’s good to take your medication, but it’s not that simple. It’s not as simple as, hey, make sure you go to all of your counseling appointments. Make sure you see your doctor regularly. Because I can tell you I was doing the medication and the counseling and seeing all of my doctors, and there was a long time where I was much worse off than I am now. And I was doing even then all of the right things. It’s just going to be like throughout your lifetime, things change. Sometimes what works at one point won’t work at other points, and no one’s going to like this answer. But I do believe that a lot of it is luck, just where you’re at. What are your support systems? So much of that is going to be how you are able to handle what’s in front of you.

Gabe Howard: I appreciate your candor. And it’s not a one size fits all approach. But the more that we understand about resiliency, the better odds that we have to be resilient.

Rachel Star Withers: One of the best ways to look at the concept of resilience is through suicide. And suicide, as many people know, is the leading cause of premature death in people with schizophrenia. It’s something that as far as suicidal ideations, I’ve dealt with, I’d say as long as I can remember, I just always had like self-destructive, but like a self-harm thing inside of my brain. I think everybody has like this big red button in their brain that says like, do not touch, it’s like a self-destruct button. Like, why would you ever even build this button? But some of us, it got hit and I feel like that’s how it’s always been for me is that I’ve had these suicidal ideations just constant. And for so many people with schizophrenia, this is just this is part of it, is dealing with that self-harm, suicide, self-destruction, that pool. It’s always there. Not like I’m about to, like, run out and do something, but just, it’s always there in the back of my mind.

Rachel Star Withers: When you put suicide and schizophrenia together, as you look at psychological resilience, some very interesting things come to light. One thing we’ve learned is that the ability to cope with psychotic symptoms is connected to the severity of suicidal experiences, and that means kind of a lump term, suicidal experiences, self-harm, thoughts of suicide to actual attempts are all under that. Many times, with people with schizophrenia. The suicidal ideations and whatnot are connected with command hallucinations and delusions. So, if you’re able to understand where, understand where the suicidal pull is coming from, you’re able to deal with it better. But they have found that out with schizophrenia, that, yes, that psychotic symptoms and suicide are connected.

Gabe Howard: Rachel, I’m curious if you’re suffering from psychosis, if you’re hallucinating, if you’re doing any of the things that well are common symptoms of schizophrenia. Doesn’t this just throw resiliency right out the door? You’re not in your right mind.

Rachel Star Withers: Correct. What we’ve learned is that having an understanding of psychotic experiences like understanding what’s happening to you whenever you start to have these hallucinations, delusions, etc., that helps. Because you’re able to kind of rationalize. Now, I know what you’re thinking. Rachel, if you’re psychotic, how are you rationalizing? Well, it can come and go. So even if my entire episode, I’m not fully grasping reality usually, especially with me, there are like little spurts where I do. I always kind of tell my parents I’m getting confused. And that’s where, like, I’m in between and I might go fully psychotic and I might come back, but I’m starting to like kind of lose grip. Those are those times where you’re starting to lose grip that you want to be like, okay, I’m having a psychotic episode. The voices, I’m having a hallucination. What that does is it helps you kind of ground yourself. And people with schizophrenia have found that it becomes significantly easier to deal with the suicidal ideations. If they’re able to just even in little spurts, acknowledge I’m having a hallucination. One thing I want to stress is that psychological resilience or resilience in general has nothing to do with you having suicidal thoughts. If you have a self-harm suicide ideation, that does not mean you are weaker than other people. That desire to hurt yourself does not make you weaker. Resilience is not acting on them. Resilience is accepting, hey, they’re here. All right. What am I going to do to keep going? That’s what resilience is. And I think that’s very important because so many of us with schizophrenia, we already have kind of self-esteem issues. Understand that you just have to keep going and finding ways to keep going. That is the resilience. That’s what building psychological resilience is about.

Gabe Howard: I think that’s the million-dollar quote of the episode, Rachel. So many people believe that if they think that they have already failed and it’s quite the opposite, right? Thinking it, being curious about it, that’s normal. That’s typical. Let’s use a diet example, right? Wanting the cake is not the failure. If you are trying to lose weight or eat healthier or stay away from sugars. Right. It’s perfectly natural to want the cake. Cake is delicious. Right? It’s being resilient enough to say, you know what, I’m going to make a better choice. And I think we do need to apply that over with mental illness and with schizophrenia because we can’t control what pops into our head. Right? I can’t say it any more bluntly than that. Preventing thoughts from entering our head is a fool’s errand. And it’s an unreasonable standard that will make us fail. We just can’t control the thoughts that enter our head. But if we focus our attentions on controlling our actions, we will have significantly more success. And I think that is what we want to focus on. Now, Rachel, I want to ask you, if there is a mistake, if there is a setback, if you’re we’re going to use my analogy. If you eat the cake, can resiliency come out of that moment as well, or is that just immediate failure? You’re not resilient. It’s done.

Rachel Star Withers: Absolutely resilience comes from that because you’ve learned, okay, what can I do different now? You know, you now have an opportunity to say what needs to change. Maybe I had a psychotic episode and that kind of wore me down and yeah, I self-harmed. So, looking back, what needs to change so that doesn’t happen again? Okay, when I have my psychotic episodes, for one, I need to be around people that I trust and that that usually takes out the self-harm. Because if I look back across my life, I’ve only self-harmed whenever I was alone. So, when you look back at times where you didn’t do the correct thing, you can use each of those times to prepare for the future.

Gabe Howard: And I think it’s a really important message for our family, our friends, our caregivers, the people in our lives to understand that, you need to help us understand that, because in the moment we’re very stuck in this. I just ate the cake. I just ate the cake. And having the people around us say, you know, that’s not how I see it. I see that you collected data. I see that you had a momentary setback. I see that you’re going to get right back on the horse. That’s super, super helpful. And if I can switch gears ever so slightly, often when the people in our lives see a mistake, when we see Rachel do something that we tend to have this negative attitude, like, oh, there she goes again. And that’s going to reverberate into Rachel. If you do make a mistake, if you eat the cake and all the people around you are like, yep, Rachel failed versus if you eat the cake and everybody’s like, Look, that’s okay. What have you learned? How can we help you? How can we get you through it? Which friends, family support system and caregiver do you want on your side?

Rachel Star Withers: The second one. It also makes me feel more comfortable to share with them when I start to go downhill. If I’m worried about the minute I admit something, everybody’s going to just kind of judge me and be disappointed in me and just think that I’m failing. I don’t want to tell anybody that I’m starting to downward spiral. It makes me want to just like, keep it to myself and power through alone, which never works out. It never works out, at least for me.

Gabe Howard: So, resiliency is a group activity. That really is sort of one of the things that I’m learning, that we all have to be resilient together and we can support each other, which builds, which builds resiliency.

Rachel Star Withers: Absolutely.

Gabe Howard: I’m starting to think maybe the memes are a little bit correct on this one. It’s still annoying. I’m not saying that social media has cured all of our ails, but some of this is starting to make a little bit of sense.

Rachel Star Withers: Well, let’s pause for a second and go back to the beginning of the episode where I was telling you what the two components of psychological resilience usually are. First one was something bad has to happen, a crisis, and then pretty much the response to that crisis. What needs to change is when you’re looking at serious mental disorders like schizophrenia and you’re saying, well, Rachel, what’s the crisis? I mean, schizophrenia would be the crisis. But that isn’t just this thing that pops up and okay, well, I dealt with that for a week. Now I’m good. It’s a constant thing. And people with schizophrenia have to have this psychological resilience that basically never gets to turn off. And I think to me, that’s one of the most impressive things about people living with serious mental disorders is that this is a day-to-day, hour-by-hour situation. You are having to constantly monitor your thoughts, having to pay attention to when they start to veer from reality. Resilience is exhausting for people with serious mental disorders. When we talk about suicide, it’s always a very hard topic

Rachel Star Withers: I think for a lot of people it’s just that constant resilience does have to give at some point. If you’re dealing with the suicide, all I can ever say is keep going. And dealing with something constantly, what we’ve learned is that acceptance that you’re going to have psychosis and acceptance that you’re probably going to have suicidal ideations, thoughts, self-harm, etc., is interwoven into resilience. It’s just going ahead and accepting, hey, this is my reality. How do I deal with it? Because this is something I’ve just been dealing with my entire life that, yeah, it’s gotten easier to not self-harm. I still do sometimes, unfortunately. But it really has just been an over time situation and I think a lot of like if something happens in my life with certain psychosis, maybe if it had happened 15 years ago, it would have been a lot worse. But it doesn’t bother me as much now. And it really is just that every day. Taking it day by day to even hour by hour to even minute by minute, and that that’s how you build up that resilience.

Gabe Howard: And it’s important to understand that, like anything, it takes practice. Resilience is like any endeavor in human life. Could you imagine if you showed up for a piano lesson on the first day and if you weren’t excellent at it? They’re just like, don’t come back. I do think that sometimes people believe that resiliency is this innate thing that you are just supposed to have. And if you don’t have it, you cannot get it. And nothing could be further from the truth.

Rachel Star Withers: I think a lot of people think it’s like a switch, like, okay, now the bad thing has happened. I just need to sit down and I just gotta push on through. Like it’s just something you can turn on and off.

Gabe Howard: Wouldn’t it be great if you could, though? I mean, be honest. Like, wouldn’t that be awesome?

Rachel Star Withers: Yes, because being resilient is exhausting. You know, it’s like, oh, it sounds good, you know? Oh, I’m resilient. But resilient means you’re going through something. It’s like I would rather not be resilient and just be able to relax and chill. But it’s the opposite. I have to, like, stay on my guard all the time.

Gabe Howard: I think we’ve done a really good job of explaining that resiliency can be learned and that it’s not innate. But what we’ve sort of not covered is how do you learn this? Remember, go back to my piano lesson analogy, right? You’re not expected to be great on the first day of piano lessons, but everybody understands that you can sign up for piano lessons. You would have to practice and you’d need to buy a piano. And we sort of know the steps. How do you learn resiliency? What are some hints and tips to grow this? Are there resiliency lessons like do you go to some like old woman’s house and sit on the bench and she has the shawl and she smacks your knuckles? I’m assuming that’s how piano lessons work.

Rachel Star Withers: I took them for seven years. I still can’t play the piano. So maybe if I had an instructor who’d, like, smacked my knuckles, I would be able to play beautifully right now. So no, my lessons were nothing like that. But I also can’t play the piano. So?

Gabe Howard: [Laughter] Very, very fair. But. But how do you learn resiliency?

Rachel Star Withers: Well, if you go back to the crisis approach, that’s pretty hard because it’s like, well, is there is there a way to sign up for crises? And I can just like try the different crises and see how I come out? No, that doesn’t exactly work that way. However, you can mentally prep yourself for when crises come. As we’ve talked about on the show many times, cognitive behavioral therapy. One technique is to mindfully manage the nature of your self-talk. So self-talk meaning you know, your thoughts like, oh, I can’t do this to I can do this or I can’t handle all this stuff going on to I can handle it. Basically, having a good attitude no matter what. And even if you’re like, Rachel, that’s dumb because certain things are just plain bad. There’s no way of seeing them good. No, but having that mentality of, okay, I have this really bad situation going on. How do I make it through? I don’t mean make it through unscathed. Just make it through. Period. Like, how do I just or mostly through. How do I get most of me through it?

Gabe Howard: I want to ask you a follow up question, Rachel, because you said get through it. But you mentioned that you will probably not be unscathed. I think many people, myself included, believe that resiliency is, hey, that didn’t bother me. That took nothing away from me. I’m just as good coming out as I am going in. It seems like you’re saying that resiliency isn’t about being perfect on the other side. It’s just about getting to the other side.

Rachel Star Withers: Yes. And, if you’re listening to this podcast right now, you’ve gotten to the other side many, many times. And that’s what it’s about, is just getting as much as you can through to the other side. And as you do that, you’re going to get stronger and stronger. Gabe, this is stayed with me for a long time. When I was 17 years old. I had I was having some problems and I had this girl, my quote-unquote mentor at the school I was at. And I was having a hard time. And she sat me down and she told me this story. She goes, Rachel, right now you’re running a race and everybody’s passing you. You’re falling and you’re doing terrible. You’re struggling because you’re running against the wind and no one else is. One day that wind’s going to stop. And when it does, you’re going to shoot forward and be so much faster than everybody else because you were trained in the wind. Now that has a nice thing. Here’s the deal, though, because she was wrong about one thing.

Rachel Star Withers: The wind has never stopped. It has never stopped once. However, yes, I have learned how to run in the wind. And that’s something I think about a lot. I compare myself to the kinds of problems I was having when I was 17, when I was 21, when I was 25. Hell, last year, you know, And I think, oh, that’s nothing. I can handle that now. That’s easy. You know, even though at the time it was like life or death. When I had electroconvulsive therapy and then I was in college at the same time and I had to relearn how to read, you know, that was like a huge deal. Whereas now I’m like, okay, if it happens again, it is what it is. I did it once. I can do it again. That’s what resilience is, I think is just being able to make as much as you can of yourself through the problem. And then you know, hey, once you’ve made it through that problem, you know you can do it again and again and again.

Sponsor Break

Gabe Howard: And we’re back discussing resiliency with schizophrenia.We have a tradition on the show of having a medical expert or somebody. Well, just other than us. Come on and talk about it. And I am super, super excited that you invited Dr. Nicole Washington. I host another podcast called Inside Bipolar. It’s kind of like inside schizophrenia, except I’m the Rachel over there, and I guess that would make Dr. Nicole the Gabe. And she agreed to come on and spend some time with Rachel. So, let’s go ahead and roll that.

Rachel Star Withers: So excited today to be talking with Dr. Nicole Washington, who is a board-certified psychiatrist. Thank you so much for joining me today.

Dr. Nicole Washington: Thank you for having me.

Rachel Star Withers: Now, tell us a little bit about your background. Tell us who you are and what attracted you to working in mental health care.

Dr. Nicole Washington: That is such a fun question because I don’t know if your listeners are aware, but the first two years of medical school are all coursework, classroom. The second two years are all clinical experiences. While I entered those clinical experience years knowing for certain that I did not want to be a surgeon and that I did not want to be a psychiatrist. And here I am. Here I am. 20 some years later, I am a psychiatrist. It was a pretty enlightening process. I mean, the ability to work with people at some of their lowest moments and help them get to a place that they either never thought they would get back to or to get comfortable in a new space, the new normal. That just felt really, really good to me and in the brain is still, I think, that last area of medicine that we just aren’t quite sure about.

Rachel Star Withers: Can I ask why? Why? Why were you at first like, no way on psychiatry? Was there a reason that you were just like, no?

Dr. Nicole Washington: I don’t think that, I don’t think that psychiatry does a great job or at that point did a great job of kind of marketing itself to students. I think a lot of medical students felt like it was a waste to go through all that medicine and learn all that stuff. Kind of I’m quoting here just to become a psychiatrist. Plus, growing up, in the Deep South. I grew up in a black neighborhood. And, you know, that’s just not something that we did was go tell what. By and large, with some strange white person, all your problems, because that’s what we kind of thought of psychiatrists as. So, I think for me as a as a black woman, I was like, well, why would I why would I do that? I mean, 2 to 4% of psychiatrists are black, so there’s not that many of us to see. So, it just it just wasn’t on my radar.

Rachel Star Withers: What changed?

Dr. Nicole Washington: Being in an inpatient unit. My rotation or my clinical experience was in an inpatient setting. So, a lot of acutely ill people with severe illness and seeing so many people who were happy to see me because they had never seen a black psychiatrist before or someone who could relate to them in a different kind of way. I enjoy working with people who are acutely ill, probably because nobody else does. Right. Those are the people that people don’t want to deal with and the ERs and the primary care clinics. But, someone who’s acutely psychotic and not able to make great decisions, like they need someone who wants to work with them, not somebody who doesn’t want to be bothered with them. I love working with that population because there’s a lot of value there. There’s a lot of ability to really, really, really make a change in somebody’s life, I think far more than you can in other areas. And it just it, it was it was my jam, let’s just put it that way.

Rachel Star Withers: Thank you so much for working with this population. Especially when you’re talking about like race and different communities, how that makes a huge difference about being able to actually feel like you can open up and talk to the person who’s supposed to help you.

Dr. Nicole Washington: Yeah, absolutely.

Rachel Star Withers: So, on that topic of opening up, what exactly is psychological resilience?

Dr. Nicole Washington: You know, it’s your bounce back. It’s your it’s your comeback, your bounce back. Something happens to all of us at some point where we don’t quite fire on all the cylinders we typically fire on. Is that depression? Is that just a life stressor? Is it schizophrenia episode? Is it an acute episode? Have you been stable for a while and all of a sudden something happens. You get a physical illness and there’s a stress on your body and all of a sudden, you’re having symptoms again and you hadn’t had symptoms in five years? Is it something big happened? You had a death in your family, you had a loss, you something happened big and it kind of knocked you down a little bit. It’s your it’s your ability to bounce back. And to try to get back to where you were before the fall.

Rachel Star Withers: Is this something that you’re born with? Can I. Is there a workshop that I can take to boost it?

Dr. Nicole Washington: [Laughter].

Rachel Star Withers: You know, is it just like life just kind of keeps hitting you and it’s a choice? How do I get psychological resilience?

Dr. Nicole Washington: Yes, I do think that some people are just innately more resilient by nature. You have two people who can have the exact same experience and get knocked down in the same way, and you’ll see one of them just kind of on their own bounce back and thrive. And then you’ll see the other one, same circumstances, really, really struggle. I think that’s one of the things we don’t really know is why does that person have the ability to bounce back so quickly? And this other person, it just takes them down longer. Is that environment, is that just who you are temperament wise? But there are things that you can do and put in place when you’re well to try to minimize the stress of trying to bounce back once you get knocked down.

Rachel Star Withers: How does this play into schizophrenia? How does psychological resilience affect schizophrenia?

Dr. Nicole Washington: Yeah. For people who have schizophrenia, I think it’s even more important to have a plan because the falls can be so hard and they can they can just keep you down for longer than you expect. And I’m not minimizing any of the other illnesses. But the thing I know about, you know, my patients that I’ve taken care of who have schizophrenia, the falls are huge. I mean, they come with very, very serious symptoms. They come with just a lack of functioning at times. And those are things that just societally it’s hard to recover from if financially you’re all of a sudden homeless or you know, you don’t have benefits and you don’t have insurance and there’s just a snowball effect and it can just be such a hard hit. So, one of the things I really encourage my patients with schizophrenia to do is to really develop that plan when you’re well. So, let’s talk about what the what the plan looks like. We’ve got to take care of your body, right? We have to have to have to take care of your body and have good habits in taking care of your body that include taking care of your diet, taking care of your sleep, making sure those things are well and that you have a plan.

Dr. Nicole Washington: As far as those things go. Are there things that minimize stress for you? Have you ever tried stretching or yoga or meditation, or are there any things like that for you that help bring you back to kind of center? You kind of can help minimize the voices, kind of decrease the focus on those If there are things like that that, you know, you can do get really good at those things when you’re well, because you will need all of those tools when you don’t feel as well. And you need people to help kind of hold you accountable during that time. So, your support team is going to be the more probably one of the biggest things in helping you kind of bounce back a little bit quicker. The people that know you and love you and understand your illness and are non-judgmental when you do things are the people that you’re going to find support in when you’re that when you’re down. Those are the people that are going to kind of help lift you up and help make sure that some of those other things are in place. So, it’s important to have those things in place.

Rachel Star Withers: Many times, with schizophrenia and even just in life, we might suffer some sort of fall, something like will happen and we just feel lost. What is your advice when these things happen to us?

Dr. Nicole Washington: I really like to focus in on the fact that even though you feel like you have no control over anything, that you do still have some control and some say and I know that’s hard for a lot of people with schizophrenia to imagine because they feel like when I fall, you know, if I end up in the hospital, they’re telling me where I have to go. They’re telling me I can’t leave. They’re telling me when I get to go to bed, when I get to eat, they’re telling me what meds to take, even if I don’t want them. And it really does feel like there’s very little control. And I fully understand that. And I don’t want anyone listening to think that I am saying that you have full control if you end up in a hospital, because I completely understand that you have minimal control over most things once you get to that point. However, if we’re not in that setting and we’re just talking about control in general, you have more power over what happens to you than you think. You can make the decision to do the things that we talked about that are in your resilience plan, the meditation, that you had the power to learn those skills and you have the power to try to use them. I think it’s important for people to remember that they’re in control of this thing.

Dr. Nicole Washington: You’re in control of how this goes. You have a lot of power, aside from you being so severe that you do end up in a hospital. If you’re out in the world and you’re still trying to bounce back and pull yourself out of this hole, you do you get to choose who gets to be a part of your system. You get to choose how you want to address certain things. Yes, I know it feels like the world is pushing in on you and controlling you and you have no say. But I think it goes back to what we talked about earlier. If you can build that support system and everybody kind of understands what you need from them when you’re not in the greatest space. So, when you fall, if they all know what their roles are and what they’re supposed to do, that was all you. That was you having the power to make that happen, to set that plan in motion before. That was all you. So, reminding yourself that I did this, I created this support team. I’m the one that learned meditation or I’m the one that started yoga classes, or I’m the one that has a psychiatrist that I see regularly for meds, or I’m the one that did all these things. You did all those things. So, you have a lot more power than you think you do.

Rachel Star Withers: That’s awesome. And it is so important to remember because with schizophrenia so much of our power, I feel like we don’t have. We feel like we’re just hopeless and we have no control over our own bodies in a way. And yeah, just finding that what do I still control is, can be very empowering.

Dr. Nicole Washington: Yes, because it can be exhausting to put so much effort into the things you can’t.

Rachel Star Withers: It’s a question I always get a lot is many times people’s loved ones who have, let’s say, lost someone who had schizophrenia. A lot of times they’ll ask me, Rachel, what was the difference between you and then my person? How come you’re still alive and they’re not? And I never really know what to say because unfortunately, I usually have to be like, It’s luck a lot of times. There’s just so many factors that go into coming back from a psychotic episode.

Dr. Nicole Washington: Yeah.

Rachel Star Withers: Where does psychological resilience fit into all of that?

Dr. Nicole Washington: It’s like I was saying earlier, we don’t know why one person is more resilient than another. We don’t know why Rachel is hosting a podcast and is able to have success in this area when there is someone else who is homeless and can’t hold a job and can’t stay out of the hospital. We don’t know why that is, but we, we do ask the same questions when someone has cancer and says, well, my so-and-so had this kind of cancer and they died, and here you’ve lived, you know, you’ve lived 40 years. I think it’s human nature to ask why? Why me and why not that, you know, why me? Why did this happen to me? Why did I have to lose somebody? Why did my loved one not have this ability? And with mental illnesses, I think it’s even more because I think a lot of parents and a lot of families blame themselves. They just want to know why. Because a lot of times the parents of families of those who aren’t doing as well, there is a lot of guilt involved in that. And there’s a lot of feeling like I did something wrong as a parent because my kid has this and they’re not doing well.

Rachel Star Withers: Where does psychological resilience fit in than with caretakers and loved ones and those type of relationships?

Dr. Nicole Washington: Family members, support systems, they play a huge role in resilience because they are the people that can really build you up when you’re well. To be able to feel like you can handle these things. They can support you. They can. They can give you the space to grow a little bit and to learn a little bit. They can give you the space to learn about your illness. They can hopefully support you. And in seeing a therapist, maybe to help you understand this thing. Not for long term, but just for education, maybe some NAMI education groups. It’s very difficult to wrap your hands around schizophrenia when you get a diagnosis like that. You don’t you don’t really know what to expect. There’s a lot of, well, this is in my brain? What schizophrenia looks like. But I don’t see my kid that way or I don’t see myself that way if you’re the one with the disorder. So, I think education on all parts of the family support system being educated, the person being educated, just huge. If a family member, a loved one, is educated in the illness, they are so much more well equipped to help that person with resilience because they can help set realistic goals for them. They can help them actually plan for things. Some of the things I see families push their loved ones to do are so unrealistic. Because you’re like, there’s, there’s no way this is going to happen, but it really just comes from a space of.

Dr. Nicole Washington: The family just not having a lot of knowledge about the illness and what it can do. And so, there’s the balance between I know what the illness can typically do, but I don’t want to hinder my loved one. I think that if a family member is well educated, they can really support a person in the bounce back because the bounce back goal has to be realistic. And I think family plays a huge part in that. I see parents trying to push their kids to enroll in classes and go to college and take full loads and do all these things that they desired for them, probably when they were little. But maybe that needs to be backed off a little bit. Not saying they can’t go to college, but maybe we should start with one or two classes. Maybe we should. Maybe we should get an associate’s degree instead of going for the bachelor’s master’s PhD route. Maybe we should take our time and make sure that the goals are realistic. So, I think families really, really have the ability to kind of help that person set realistic goals. And that’s not always something I see. So, I think if families can get educated, support their loved one in the right way, I think that makes a huge difference.

Rachel Star Withers: Absolutely. And if our listeners have been pulled in to your wonderful advice, as I have, how could they hear more of this great advice coming from you, Dr. Nicole?

Dr. Nicole Washington: I am on all social media platforms @DrNicolePsych. You can also go to my website, DrNicolePsych.com.

Gabe Howard: Now, I’m not going to lie. It is super cool to see two people that I know in different areas come together. That was awesome for me. Rachel, what was your biggest takeaway in the time that you spent with Dr. Nicole?

Rachel Star Withers: It definitely stood out to me how important family is in building psychological resilience. I think even just the term psychological resilience, it makes you feel like this is just something you have to do on your own. It’s just like you against the world when it’s not. You know, your family, your loved ones, your friends, you know, everybody that’s in that support circle that you have is important. They help you build psychological resilience as you help them build their own. It’s not just take, take, take, you’re part of their support group also. And you’re helping them grow. Especially with my own life. My parents are, they’re the cornerstones to any resilience that I have because I know I can constantly go to them for help. And I do hope that they think of me the same way. I’m part of their support system also.

Gabe Howard: And Rachel, as you recall, when we interviewed your mom on this show, she very much feels that way. It’s a partnership between you and your support system. And I think that really is one of the keys to overall resiliency is that everybody is working together for a common goal. Everybody is being resilient together because you can’t give somebody resiliency, right? No matter how hard I try, I can’t force you to be resilient. I can only help you build resiliency.

Rachel Star Withers: One study asked 14 people with schizophrenia who were currently doing well what resilience meant to them. And they found a bunch of different factors, but they kind of labeled them into three groups. One were positive, supportive. So, for instance, growing, kind of learning from your mistakes, that kind of thing. Some of them were negative, like a feeling of being lost, being under pressure or you’re a victim. And the third one were things that could be considered both positive and negative at the same time. And what I mean is like taking a new medication. I t could be positive that it could help you deal with your symptoms, but negative, because now you also have to deal with these side effects. And what the study concluded was that taking a risk is very important to building resilience, that to actively face a situation head-on, like the decision to try a new medication, like the decision to go to a new doctor, a decision to change your living situation. Yes, it could get better or it could get worse. But you having an active part helps build resilience. With schizophrenia so often we feel we have no control and we’re just like being trapped and we’re being hit with all these crises, these situations that we just have to try and just make it through. Learn to figure out what do you have control over? And that’s how you build resilience. How do I take this situation, this issue, this symptom of my schizophrenia? And how do I make it through? And being an active participant in the crisis? Thank you so much for listening to this episode of Inside Schizophrenia. Please like share, subscribe and rate our podcasts and we’ll see you next time here on Inside Schizophrenia.

Announcer: You’ve been listening to Inside Schizophrenia, a podcast from Psych Central and Healthline Media. Previous episodes can be found at psychcentral.com/is or on your favorite podcast player. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. Thank you and we’ll see you next time.