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Maintaining Social Connections with a Psychotic Disorder

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When people carry a more severe diagnosis or disorder, such as psychotic disorders and symptoms of psychosis, socialisation is even more important. Why? On the mere level of orientation and perception, when people maintain their connections with other people, it also means, with some exceptions, that he or she is ‘tuned in’ to the world around them given that their social world demands their attention, focus, and enough concentration to operate without incident on a socialised landscape. There is no question that folks suffering from psychosis and experiencing symptoms of psychosis pass through altered realities, otherworldly states, and extreme changes in perception. However, when other people are included in our worldview, so too is their orientation, which is hopefully healthy in nature, as this both passively and actively contributes to the way we come to understand our world.

When my perception shifted, I was isolated, ostracised, and abandoned by friends. This is the outcome for so many with active psychosis symptoms because (let’s face it) our friends are exposed to a radically different shade of our self. We can seem strange, bizarre in behaviour, and our speech can be altered irreconcilably. Such poor timing for changes in our disposition when we are in a space that desperately demands stabilisation, peer connection, and other organic supports best cultivated by good health. This is why these conditions are so serious, difficult to rally back from, and can position the person carrying the diagnosis in potentially dangerous situations. All the while, we feel increasingly isolated and misunderstood.

For affective or mood disorders, socialisation can be a tricky endeavour too. Have you ever tried to socialise while in a manic state? I mean, totally elated, grandiose, and speaking at a rate that your mouth can’t keep up with your thoughts, all of which seem more brilliant than the next. Given I have experienced this first-hand and also observed it with friends battling mood disorders, I know very well how difficult it is to maintain healthy connections with friends when they are fearful and so concerned about your welfare that they spend more time watching over you than connecting with you in a meaningful way. This is the most gut-wrenching aspect of having a mental health condition – needing support, and simultaneously pushing away our support because of a disordered mental status.

While the specific benefits of socialisation to disorder type are unclear, the importance of maintaining social connections is not. The unwavering need for people with and without a mental health condition to develop and cultivate meaningful, supportive, and organic connections is also as clear as day. More research needs to be conducted to determine how specific mental health symptoms can be targeted by different social interactions, kinship networks, family support, and other socialised mediums which enrich our lives and offer conditions supporting a healthy lifestyle.

I am suggesting the socialised landscape can be mapped out, charted, and better understood by researchers evaluating support and the prognosis of people with serious mental health conditions. In doing so, research can offer clinicians working with people with serious mental health disorders recommendations and other suggestions in how to re-work and re-pattern their social world to best promote a healthy space for their recovery to blossom. With this said, clinicians can identify and mark protective factors more easily, and leave their patients or peers in a better position when they are left to their own devices. Alas, the mental health system speaks so fondly of socialisation but does little to support those engaged in the process.

This is a problem for everyone involved in the recovery process. Clinicians need to be providing psychoeducation to the friends and relatives of those with a diagnosis, not just the patient, to truly expect real natural support cultivated that will have a lasting impact on the life of those in recovery. Friends, relatives, and other collaterals without psychoeducation are not only ineffective players in the recovery process but can put the diagnosed person at risk of relapse or worsening symptoms without training to respond to the diagnosed person’s particular set of needs for maintaining and accessing social support and resources.

Even more important is providing recovery-focused attitudes about what to expect from someone with a specific diagnosis in terms of their capacity to socialise and access social support appropriately given where they are in the recovery process. This is a skill set that’s multidimensional and not quite as simple as telling someone to make a friend, so they have someone else besides a therapist or case manager in their lives.

Without teaching realistic expectations and a skill set targeting specific disorders and course of treatment, expect little in return for the person diagnosed or, better yet, prepare to listen to that patient explain their heartache because their friends were unprepared when that person acted out and misbehaved. There is no question that preparing all system supports with a realistic clinical picture might just preserve the feelings of those with a diagnosis trying to move forward in their recovery.

Max E. Guttman, LCSW  is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.


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