How Does Schizophrenia Impact Relationships?
The National Institute of Mental Health estimated in 2015 that roughly 2 million Americans live with schizophrenia. Maybe someone in your life has it. Maybe that person is in a romantic partnership, and you've watched the illness strain their ability to hold a relationship together over the long haul. If that's familiar, the sections below are meant to clarify how the condition and romantic life intersect. Before any of that makes sense, though, it helps to understand what schizophrenia actually is.
The NIMH describes schizophrenia as a serious, disabling, long-term brain disorder that produces a broad set of symptoms capable of reshaping a person's life. Nearly all of those symptoms show up in how someone thinks and how they behave, and the intensity varies a great deal: some people have mild or moderate experiences, others have severe ones. Delusions and hallucinations are common, often colored by jealousy, paranoia, love, hatred, or anger. A person may also lose the ability to speak in a clear, connected way, or struggle to keep up with basic hygiene like bathing, dressing, and brushing their teeth and hair. Ordinary daily chores can become hard too: paying bills, cooking, looking after children, driving, running errands.
Nobody has pinned down a single cause. Many scientists, psychologists, psychiatrists, and researchers point instead to a mix of biological conditions (viral infections during pregnancy, low oxygen levels before birth, imbalances in brain chemistry, structural abnormalities in the brain), inherited genetics, and environmental pressures that together shape how the illness develops and advances.
Clinicians have traditionally recognized three forms of the disorder. Disorganized schizophrenia shows up as scrambled speech, thinking, behavior, and reactions. The paranoid form centers on a persistent sense of being persecuted by other people. Catatonic schizophrenia involves greatly reduced or absent physical movement.
Loving someone with schizophrenia is not simple, and pretending otherwise does nobody any favors. It asks for real understanding, empathy, tolerance, patience, and affection, because whatever ordinary friction a couple runs into gets amplified when one or both partners are dealing with mental illness. A steady, genuinely happy relationship is still possible. The key pieces are keeping the condition monitored consistently and making sure the partner who is ill stays on the treatment their doctor prescribed. Where it's an option, the partner who isn't ill benefits from finding a support group built for people who live with schizophrenia and those who love them. What follows are the specific ways the illness tends to touch a romantic relationship.
Unpredictable behavior and depression. A partner with schizophrenia may act in wild, erratic ways that are hard to anticipate. Often these episodes surface abruptly, with no warning, though for some people the decline comes on slowly instead. The emotional peaks and valleys that every couple hits at some point tend to feel sharper and more extreme here. A partner might also lash out or hurl accusations with no visible trigger, which happens most when the condition isn't being watched closely or the person has stopped taking their medication and following their treatment.
Intimacy. Sex is one of the areas most likely to shift. The drugs used to treat schizophrenia can interfere with fertility, with libido, and with sexual function, and some people lose interest in sex entirely. If you or someone you care about is partnered with a person who has schizophrenia and notices a drop in desire or an inability to perform, that's a reason to talk to a physician or psychiatrist. Even when the medication or the illness does affect sexual performance, most couples can still share physical closeness in other forms: cuddling, spooning, foreplay, and the like.
Responsibilities. Few people are comfortable calling a partner a burden, yet being in this kind of relationship can carry that feeling, and the healthy partner shouldn't punish themselves for it. Frustration, irritation, sadness, anxiety: all of that is a normal response to caring for and loving someone, especially when you're the one helping them bathe, cook, handle the housework, look after the kids, or get dressed. If the ill partner can't hold a job or put money aside, financial pressure gets added to the pile, which can mean the healthy partner carries steady employment and the bills alone. Difficulty reading social cues can leave the partner seeming socially awkward, and that wears on the other person over time, sometimes breeding misunderstandings and arguments. The encouraging part is that help exists. A psychologist can teach a couple stronger problem-solving and communication skills that keep the relationship on solid ground.
Support. A stable, happy partnership with someone who has schizophrenia depends on the healthy partner staying supportive while the ill partner commits to treatment, and it depends just as much on that ill partner sticking to the plan their doctor laid out. The healthy partner's job, really, is to be loving and present, and to make sure their partner keeps taking medication, keeps going to appointments, and keeps up with care. Pulling close friends and family into the support network, wherever that's possible, helps too.
- Dr. R. Y. Langham
References: Brichford, C. (2015). Schizophrenia and relationships. Everyday Health. National Institute of Mental Health. (2015). What is schizophrenia? Smith, M., & Segal, J. (2015). Understanding schizophrenia. Help Guide.