Schizophrenia affects more than 3 million adults in the United States, yet many people don’t know what schizophrenia or psychosis looks like — or what to do when they notice changes in someone they care about. Knowing what to look for and how to respond can make it easier for someone to get support earlier.
Krissa Rouse, MA, LCPC, is a licensed clinical professional counselor in Maryland and has worked exclusively with individuals and families following a first episode of psychosis for more than a decade. As Schizophrenia & Psychosis Action Alliance (S&PAA)’s director of programs & community engagement, she develops and delivers programs that increase understanding, reduce stigma and connect people and families with support throughout recovery.
In this Q&A, Rouse explains what schizophrenia and psychosis are, what changes someone may notice in a loved one, friend, or coworker, and how to respond when someone may need support.
RUGGED: Schizophrenia vs. psychosis — what’s the difference?
Rouse: Schizophrenia and psychosis are sometimes used interchangeably, but they are not the same.
Schizophrenia is a mental health condition that can affect how a person thinks, experiences the world, manages emotions and relates to others.
Psychosis is a set of symptoms that can occur with schizophrenia and other conditions. It may include experiences such as:
Hallucinations: Hearing, seeing, smelling, tasting or feeling things that others do not. Hearing voices is the most commonly recognized example.
Delusions: Strong beliefs that others may not understand or share.
Disorganized thinking or speech: Thoughts may feel jumbled, or speech may become difficult for others to follow.
The simplest way to understand the difference is that psychosis is a spectrum of symptoms a person experiences, while schizophrenia is a broader condition that can include psychosis.
What changes might you notice in a coworker, friend or loved one?
Changes can be gradual or sudden, and they don’t always look the same from person to person. Someone might notice:
Pulling away from coworkers, friends or family
Having more difficulty concentrating or getting work done
Noticeable changes in mood or energy
Changes in sleep
Expressing unusual or concerning beliefs
Hearing or seeing things that others do not
Speech becoming harder to follow
Becoming unusually suspicious or fearful
Having difficulty with everyday routines, such as getting ready for work in the morning or bathing.
One of these changes by itself does not mean that someone is experiencing psychosis or schizophrenia. But when several changes occur together, especially when the person seems distressed or is having trouble functioning at work or in their daily life, it may be time to check in and encourage support. Early support and treatment, following a first episode of psychosis, can play an important role in recovery.
What’s the best way to check in on someone you care about?
Approach the person with calm, curiosity and respect. Try not to argue about the other person’s experiences or immediately label them.
Start with what you have observed. You might say, “I’ve noticed you’ve seemed more withdrawn lately. Are you feeling OK?”
Acknowledge the person’s distress, even when you do not share their interpretation of what is happening. You might say, “That sounds frightening,” or, “I can see this is causing you a lot of distress.”
Offer support instead of trying to prove or disprove the experience: “I’m here with you. Would you be open to talking with someone who may be able to help?”
Avoid dismissing or mocking the person’s experience. Do not escalate the conversation by arguing about what is or is not true, and do not pressure or corner someone, especially if they are frightened or agitated.
If the person is in crisis, always prioritize safety over conversation.
When should someone seek professional or emergency help?
Seek professional help promptly if symptoms are new, worsening or negatively impacting daily functioning, especially if there are signs of psychosis or a major decline in sleep, work or relationships.
Some situations require immediate help. Seek emergency help if someone is at immediate risk of harming themselves or others, is unable to care for themselves or is experiencing rapidly worsening symptoms:
Immediate danger of harm to themselves or others
Suicidal thoughts or self-harm
Severe agitation, or inability to care for themselves
Not eating, drinking or sleeping at all
If someone is unsafe right now, contact 988, local emergency number or crisis services.
What would you want family, friends or a coworker to know?
Supporting someone experiencing schizophrenia or psychosis can be exhausting in ways that are hard to explain to people who haven’t lived it.
It’s normal to feel scared, isolated or even frustrated sometimes. That doesn’t mean you’re doing something wrong. If you’re supporting someone else, your own support matters, too. Connecting with people who understand what you’re going through can make a real difference.
What do you wish more people understood about schizophrenia or psychosis?
I wish more people could see the extraordinarily intelligent, creative, compassionate and funny individuals who are living with schizophrenia or psychosis-spectrum disorders.
These conditions are treatable and recovery is possible. Many people live full and satisfying lives with the right support, which may include medication when appropriate, therapy, practical assistance and understanding from others.
One myth I hear often is that people with schizophrenia are violent. In reality, most are not, and risk isn’t directly tied to the diagnosis alone.
Most of all, I want people living with schizophrenia or experiencing psychosis to know that they are more than a diagnosis. Their experiences and distress are real, and they deserve to be heard, supported and treated with respect. Reaching out for help can be an important step in recovery.
