Supporting Someone Through Psychosis: Navigating Challenging Emotions

What should you consider when returning to work after parental leave? It involves more than just logistics and can bring unexpected emotions and adjustments for the whole family

When parents return to work following full-time child-care, mixed emotions can often be anticipated. Some of us may feel a deep sadness, guilt, or confusion, while others may feel grateful or simply relieved to get back to work. Even trickier, is the realization that we may be experiencing some combination of all of these emotions. No matter how you are processing the transition, the change can be a sensitive period for the family, and we (the parent) may need just a little more support, too. Where we live (e.g., USA or Canada) can dictate parts of the transition, but that doesn’t mean that we don’t have personal agency and that we can’t make choices that work for each of us (and our families) to be more intentional as we enter this new phase of life.

Confusion: The prevailing emotion for many people, especially in the beginning, is confusion. Psychosis can arrive suddenly, or it can creep in so gradually that you find yourself wondering how long it has been there, and how you didn’t see it sooner. There are few things that are more alarming than when our perception of reality diverges from someone close to us. When someone you love begins experiencing hallucinations, delusions or behaving in uncharacteristic and unpredictable ways, your mind scrambles to make sense of it. What part of it is real? What does this mean? What can I trust?

What helps? Get connected. Reach out to mental health professionals, organizations, and support groups. Ask questions and seek out others who have walked this road; there is a community for what you are going through, and you don’t have to navigate this alone. The more knowledge and resources that you have, the less overwhelming the experience will be. You don’t need to become an expert overnight, but even a basic understanding of what psychosis is – a disruption in a person’s ability to distinguish what is real from what isn’t, often tied to conditions like schizophrenia, bipolar disorder, severe depression, substance use, dementia or extreme stress – can give you a foothold to steady yourself.

Fear: Fear may show up often and in many forms. There is commonly fear regarding safety – your loved one may be behaving in frightening ways, making threats against themself, against others, or against you. They may be using substances or engaging in self-harm. There is fear of saying or doing the wrong thing, of making things worse, or of pushing your loved one away. You may worry about your own mental health, whether you’ll be able to cope or whether you are at risk of burning out. Navigating a foreign and complex psychiatric system also comes with its own share of anxieties. Running through it all is fear for the future and fear of the unknown. What will happen next? Will they recover, how much, and when? What will our relationship look like from here?

What helps? Build your village. More than ever, you need to find, build, and lean on a support network of your own. This looks different for everyone and may shift over time. It typically includes a therapist with expertise in psychosis, a support group designed for caregivers, and family members who can step in when you need to step back. Create a crisis plan with your loved one and their care team. Knowing what to do in a crisis before a crisis happens – who to call, what to say, where to go – reduces the fear of the unknown and increases your sense of agency. Psychosis can be brief or it can be more chronic, it can be a single episode, or it can be recurring. Know that this is not a sprint, but a marathon of unknown distance. You need people in your corner, people who can support you so that you can continue to show up for those you care about, without losing yourself.

Anger: This one can often be harder to admit. It may feel wrong to be angry at someone who is suffering and not in control of their symptoms. But anger is a frequent and valid emotion among those supporting someone through mental health challenges; denying or repressing it doesn’t make it go away, it just makes it harder to deal with. It’s natural to feel anger in situations where there is an injustice, and there is no question that psychosis feels unjust and unfair – both for your loved one and for yourself. There is frustration with watching someone you love make choices that hurt their recovery, such as missing medical appointments or not adhering to recommended treatment. Not to mention anger born from the sheer exhaustion of sustained vigilance and caregiving.

None of this makes you a bad person. It makes you human.

What helps? Practice radical acceptance. Radical acceptance is acknowledging reality exactly as it is – without fighting it, judging it, or wishing it were different. What makes it “radical” is the complete and total acceptance, even when it feels unbearable or wrong. It does not mean agreement or approval of what is happening, nor is it complacency or resignation. It is simply releasing the futile battle against what cannot be immediately changed, and letting go of what is not in your control. Psychosis may reduce an individual’s ability to recognize what is happening to them – which is why your loved one may refuse help or seem unbothered by what is clearly a crisis to everyone around them. This is a symptom, not stubbornness or denial. Radical acceptance can look like accepting your loved one’s limited insight, meeting them where they are at, while supporting them in taking steps towards wellness and recovery. Radical acceptance also looks like making room for whatever emotions may emerge for you in the process, however unsavory. Anger, like all of our emotions, gives us important information about what we need.

Guilt: For many caregivers, guilt feels like a constant companion. You might feel guilty about things that you believe you should have noticed sooner. You might ruminate over whether you’ve done enough, or whether you are perhaps doing too much. You may grapple with boundaries that you’ve had to set to protect your own well-being. If you are caring for others at the same time – a partner, children, aging parents – you may find yourself in a constant negotiation over where to direct your energy, and feel like you are letting everyone down.

What helps? Lean into compassion. Compassion for your loved one, yes – but also critically, for yourself. Self-compassion – simply put, compassion directed inward – has been shown to protect caregivers from burnout, compassion fatigue, depression, and anxiety. It will not only help you to get through the hardest moments, it can also cultivate equanimity: the ability to feel the full weight of your loved one’s suffering, and your own, without being crushed by it. You are navigating a terrain that no one is prepared for, without a map and carrying enormous weight. The guilt that follows you is not evidence of the ways you have failed, it is a reflection of how deeply you care.

Grief: We tend to think of grief as something that follows death or some tangible loss. But there is a particular kind of grief that accompanies watching someone lose essential parts of themselves – and it is just as real, just as heavy, and just as deserving of acknowledgement. Psychologist Dr. Pauline Boss coined the term ambiguous loss to describe exactly this phenomenon: a type of grief that lacks clarity or resolution. With psychosis, the person’s physical self is unchanged, however important areas of functioning and familiar aspects of their personality can quietly vanish. What makes it even harder is the uncertainty of not knowing whether what has been lost is permanent, or how much can be regained.

You may grieve the person that you knew before psychosis entered your lives, their particular way of being in the world, or the ease of the relationship that is no longer there. You may grieve who they were becoming, the role they played in your life, the future you both imagined. Loving someone who is present and absent all at once is its own particular kind of ache.

What helps? Allow yourself to feel. Ambiguous loss asks you to do things that seem counterintuitive – to grieve without an ending, to hope without a guarantee, and to love someone across a distance that you didn’t choose and can’t always close. The goal is not resolution. It is the ability to hold all of it at once, and to keep going. You may experience many mixed emotions as you mourn the person that you knew while holding on to who they are now and sometimes the simultaneous need to redefine your relationship. Your loved one’s fundamental self – their values, humor, capacity for connection – often endure, even when it feels hard to reach. Many people recover significantly from psychosis with early and consistent treatment. It is the combination of optimism and realistic thinking that allows people to move ahead in this uncertain loss.

Supporting someone through psychosis is not a straight line, and it is not a journey that anyone should take alone. If you find that you are navigating this experience, please reach out to a trained mental health professional, a trusted support group, and communities who can embrace you as you care for your loved one. You are here, still trying, and showing up, and you deserve support and care too.

Dr. Wendy Zhao is a Clinical Psychologist who provides individual and couples therapy at Laksman Doell Psychology. She loves to help people develop a greater understanding of themselves to create systemic and sustained changes and progress towards meaningful life goals.