Love among Couples Diagnosed with Schizophrenia
Brenda Geiger, Ph.D.
Juan Bar-El, MD, Mazrah Institution for the Mentally Ill
Geiger, B., Friedman, G., Ordan, H., Lasry, A. & Ohn, T. (2005). Love among Couples Diagnosed with
Schizophrenia. International Journal of Psychosocial Rehabilitation. 10 (1), 105-122
University, Western Galilee Campus, PO Box 2125, Acre 24121, Israel E-Mail:
Awareness of One’s Own Needs and Those of One’s Partner
Being in a romantic relationship made the participants concerned about their own appearance, which they had previously often neglected. In their own words,
When I did not have Natalie I did not want to take a shower or comb my hair. I had mental depression; I was neglecting myself (Barry).
When you live with someone you want to be clean and orderly; you want to change clothes! (Ed).
Similarly, destructive behaviors were rejected as no longer needed. For instance, once in a relationship with Waffa, Vadim no longer needed to drink
I drink when I do not feel good. She makes me feel good! When she comes I dress nicely and put on perfume. When I was drinking I was neglected. I was not okay!
Awareness of the Partner’s Needs
To love was to be aware and to take care of one’s partner’s needs. Dany and Osnat would obtain a pass from to to go to the apartment that Dany shared with his mother. In his room, Dany helped Osnat relax while listening to music. In the words of Osnat,
He puts music, he helps me relax. We sleep together in the afternoon. He likes music, quiet music like me (Osnat).
Dany echoed Osnat’s sentiments,
If she wants me to make coffee, I make coffee. If she wants me to bring her a slice of bread with spread cheese, I bring it to her.
Sam and Mustafa perceived themselves as knights protecting their “ladies” from evil figures around them. In the words of Sam,
She needs someone to protect her from all these dogs! She is too easy! She runs very easily to men. Anyone throws a good word at her and he buys her. I just leave and they all jump on her.
Speaking about his girlfriend’s husband, Mustafa explained.
He does not help her, worry for her or take care of her. I do anything for her. Yesterday he came to visit her, but did not bring her anything. I want to help her. I want to do everything for her. Her husband does not give her a shekel [equivalent of 21 cents]. He takes all of her Biteuch Leumi [social security].
For Waffa, to take care of Vadim was to cook the food he liked: “I know that Russians love fish, and Kaviar, so I cook fish with potatoes, it tastes good. He likes it.”
Participation in Joint Activities
When in love, partners wanted to share their recreational activities. In the institution this meant sitting on the grass, talking, holding hands, eating together, and at times buying ice cream at the minimarket nearby. In the words of Mustafa,
We eat together. The kids bring food and things, and we eat together. Then I go to rest a little and then I go back to her. We also eat breakfast together. I do not work or anything. I can be with her all the time.
The one couple who lived in assisted living and came daily from to to the institution, was much more autonomous and could engage in a wider range of activities. Ed recounts,
We cook together, do the laundry, shop together. We do everything together! I prepare the food, she cooks it. I cut the potatoes; she fries them. We hang out together, we go out to restaurant, we take care of the dog together.
She does not keep things inside, she says it, she gets angry. I shut up and keep quiet. There are things I want to tell her, but I do not. I do not know if she can take it (Dany).
I keep everything inside. I do not tell anyone! She shares with me her feelings and thoughts. I listen to her and try to help her, and answer her, but what I feel, how I feel, she does not know! (Andre).
Barry, on the other hand, felt no need to share his problems with Natalie. The social worker would fulfill that purpose. With Natalie he spoke of love. In his own words,
I do not talk about my problems. I talk to her about love. I talk to her about what is good in my soul! About my problems, I talk to Olga, the social worker.
The capacity for empathy and sensitivity for the partner’s suffering were best captured by one of the research participants, Ed. Ed was stayin up all night to be there for his girlfriend Linda who worried about her sick father.
Ed: Yesterday she did not sleep all night! She is a little worried, her dad is sick!
Interviewer: How do you know that she is worried about her dad?
Ed: She calls him on the phone!
Interviewer: Does she tell you she is worried?
Ed: No, I hear her voice on the phone. So I know.
Interviewer: And when she does not sleep, do you sleep?
Ed: No, we both stay up and watch the TV show “Life of Love”.
Expressing Negative feelings
Love led partners to experience negative feelings such anger and jealousy. Sam and Andre were experiencing these feelings because of the rumors they heard circulating about their girlfriends’ unfaithfulness. In their own words,
Sam: They try to flirt with her. She had many boyfriends in the half-way house, not only one― four.
Interviewer: How do you feel when other men talk to her?
Sam: I am jealous. It makes me mad, because she is not guilty. He takes advantage of her.
As the interview progressed, Sam also revealed that he had hit his girlfriend, who was now fearing him.
I like to be with her, but I think she is a little scared of me. A couple days ago I hit her. She is okay. She always asks me if I want to be alone, if she disturbs me. I tell her “Enough! Do not feel that I do not want you or reject you!”
Maia, Andre’s girlfriend knew that he was angry because she had kissed someone else. She noted that “There is here another guy who is crazy about me. He all the time looks for me! I would not say that in front of Andre, because he is very jealous.“
Future Orientation, Love, and Personal Strengths
Each one of these romantic episodes, unique in its autobiographical details, progressed along a timeline. Some of the partners, at the beginning of their love relationship, were still unsure of their love and therefore, could not enjoy the psychological security that would have allowed them to escape loneliness. For instance, Andre, 22 years old, was still feeling depressed even though had a girlfriend, Maia 30 years old, whom he had met three months ago. In the words of Andre,
I am a little depressed. My life here is empty. I want to be home, to find a job and live my life.…Maybe we will live together. I am not sure.
Comparing past and present relationships, Andre did not feel for Maia the same love he had felt when he was 16 years old. He recounted,
I loved her so much. I was a little kid and until today I still love her! I do not yet feel those things for Maia. I do not know if it is serious, I have to live with her and see. I want to see how she is at home, her nerves, see everything, then decide maybe if she will fit me. If I love her, I will marry her.
In contrast, the partners who were deeply in love had acquired the strength and motivation to plan for the future. Barry’s future plans were very clear― He wanted e wantto spend his life with Natalie! “I want to marry Natalie, I am big already! Thirty-five years old! I want to live with her―that’s it.”
To achieve this goal, Barry had applied for subsidized assisted living and was on a three-month waiting list. Barry was also planning to have children: “I want a boy and a girl” (Barry).
Similarly, the love Waffa had for Vadim had given her the strength to think about finishing her bachelor’s degree. In her own words,
I love him. Without him I was desperate, now I have hope. I do not want to be in the hospital. It destroys your confidence. I want to work, to study, to have fun. I want to go back to school. Studying is important. It gives you confidence and dignity. I want him to be released from the hospital. I want him to work, that we have a life, a home, and money!
Despite some disassociative thinking, and inappropriate laughter Osnat also shared with us her plans for the future as she explained:
You cannot climb a ladder all at once, you will slip! [laughing] I like to joke!
[Three sentences later she explained]
Me and Dany love each other terribly. We have decided on a wedding date January 10th next year, and the place of the wedding. I want a wedding without a dress and without guests because they drive me crazy (Osnat).
In the case of
mixed couples, love also gave the partners the courage to fight a
battle against religion and tradition.
For instance, Vadim, a Russian
Jew, was ready to convert to Islam to marry Waffa.
In Vadim’s words, “On the paper it will be
written that I am an Arab. But in my heart, I will stay Jewish!” Waffa, Vadim’s girlfriend, was full of
apprehension. She feared that even a
conversion would not
suffice. Waffa knew she could have a civil wedding in
Mustafa and Yisha, both Muslims, and already married, were deeply in love and dreamt about an impossible future together. The fact that Mustafa was married did not represent a problem, since according to the Muslim religion men are allowed to have up to four wives. Mustafa reported that
However, a different destiny awaited Yisha outside the institution. Death and bloodshed were the price unfaithful Muslim women had to pay, as family members avenge the honor of their family through murder. One of the interviewers reminded Yisha of these facts while speaking in Arabic, since she did not understand Hebrew. Yisha’s face immediately became sad and stern. Mustafa switched from Hebrew to Arabic to clarify his intentions to Yisha. In case she does obtain a divorce, they would remain forever in the insitution. Mustafa explained that
I want to speak in Arabic so she understands where we are going. We shall talk to him [her husband] and ask him to divorce her. We shall get married, ‘in sha Allah’ (if God pleases). If her husband leaves her or divorces her, we shall get married. If he does not let her, we shall stay here. Here we are with one another. Maybe rather than killing her, God will take his soul instead!
Coping with Separation
At times, the future meant being temporarily separated from each other. Osnat and Dany had planned to get married, yet, Osnat was about to leave to a half-way house located 2 hours from the insititution where both partners presently resided. Dany’s script of the separation was unclear. He told us that he would travel by bus to go and visit Osnat and maintain phone contact with her. When addressing the eventuality of a permanent separation, Dany explained that he would be sad for one or two weeks, call ERAN (the emergency hot line), and forget about it!!
Similarly, Sam seemed quite detached when facing a hypothetical separation
When I leave a place, I detach myself from it. It is my defense mechanism! Without wanting to detach myself, I detach myself! I find something more interesting to do! I look forward, not backward. Sick people have to understand that here it is not their house! What is love? Far away from the eyes, away from your heart! What do you want me to feel? That day and night I think about her because I love her? I love many things! I also love cigarettes! If I do not have any I go crazy!
Separation had become a reality for one of the participants at the time of the interview. Heartbroken, Itzak (53 years of age) was longing for his beloved girlfriend, Lisa (38 years), who for the past three weeks had stopped coming to the half-way house in which he resisded. Lisa was upset with him because he had refused to give her 300 shekels [about 65 US dollars]. Repeatedly squeezing his neck as if he strangulating himself, Itzak explained that he had been warned that Lisa was only after his money but he disagreed:
Since the time she came and asked me for 300 shekels and I did not give it to her, she stopped coming. I simply did not have money in my pocket! I could not give it to her. Since then she did not come… I know her from a long time! I want her! I love her…. I know her, but I did not have money, so she got mad at me! She is a good girl, a good soul! She will come back!
Interviewer: Does she take advantage of you financially?
Itzak: She does not take advantage! For a girl you do everything! [Itzak knew she was seeing other men] This girl goes one time with this guy, another time with that one. [Yet, she showed concern for him] She also washed my laundry and put it in my room!
Longing for Lisa, whom he had known for so many years, Itzak continued,
I love her, so I give her! She will come back! We shall be friends! Every man wants a woman! She hugs me and kisses me. She makes me feel good! She makes me feel love!
Listening to this sad tale made the researchers wonder whether Itzak was really being taken advantage of, or simply exchanging money for kindness and an illusion of love many “healthy” people were also ready to pay for!
For one of the
women, the love relationsihp had
turned into a nightmare! Nava, a 36-year
old Muslim woman, had fallen in love with a Jewish man while in the
institution. Once released, the couple
had eloped to
He played it cool in the institution! In love! When we went out he stopped taking medicine. He also cheated the doctors. He told them “I take the medicine! I feel good, I love my wife!” He told me:” The doctor did not give medicine.” But, I knew that he was lying.”. Before the wedding, everything was okay! He used to sleep with me, but after he cheated on me. I saw him kiss a woman on the lips! I told him: “What is this?” He said: “She kissed me!” In 1997 we got married…the social worker arranged that I work as a cleaning woman. I gave him all my money and did not buy anything for myself. He spent all the money on his friends, to buy cigarettes and beer for them. When I told him ”It cannot continue like that!” arguments started! the problems started!”
Nava had lost all illusions about love! She reported that,
He told me “I will protect you! I love you! Nonsense! I do not believe in love! I do not want to fall in love! Love is blind! It disappoints you!
Falling out of love all that Nava now wanted was to be independent. She told us:
I do not want men who tell me what to do, who decide for me what to do! I want to be divorced, free with myself! I want my own home. I only look for a guy to speak with, to spent time with! They make me feel good. I do not care what other people say!
Sex and Lack of Privacy
Love relationships were not always consummated in sexual intercourse. The level of sexual intimacy of the participants had reached was usually determined by the level of religiosity and sexual freedom of the female partner. Five of the ten couples did not have sex based on cultural and religious grounds. The female partner was the one who set the limits concerning how far she was willing to go by either wearing traditional clothes or indicating outright to her partner that sex was not the right thing to do outside of marriage. Osnat, who was 28-years old, stated “We love each other, but with limits! What I like about myself is that I watch myself.”
For Mustafa and Yisha, the Muslim couple, sex was out of question. Yisha was religious. She was wearing a white scarf on her head. When asked about sex, Mustafa exclaimed:
No! It is forbidden! She is religious!… She prays! It is forbidden! It is a sin . But God will help us.
The male partners complied with their girlfriend’s request. For instance, Osnat went to Dany’s apartment in the afternoon and layed next to him in bed while listening to music. Yet Dany never took advantage of the situation to force sexual intercourse on her. Vadim, a Russian immigrant, also respected his girlfriend’s wishes, when he explained:
Vadim: Only kisses, no sex, until after marriage
Interviewer: This is what she wants?
Nevertheless, the limits set by the female partners did not prevent male partners’ from fantasizing about better days! When asked: “Why is it good to be together?” Vadim replied: “Because of sex!” Similarly, Dany who never had a girlfriend before expressed the same longing for sex:
Dany: To love! To get married! To have sex! To tell you the
truth, after many years you can have a lot of sex!
Interviewer: Do you like sex?
Dany: Of course, every man likes sex.
Interviewer: Does she give you sex?
Dany: Yes! In the future! [Italics added for emphasis]
For those female partners who were sexually liberated, sex was a natural thing when you are in love. In the words of Rita,
A boyfriend is something natural! If a woman does not have sex with a man it is not worth it!! I did not have sex for 15 years….. A woman who has a boyfriend and has sex loses weight. A boyfriend is good for your soul, except those who hit….the truth is that we did not have sex…but here and there!
For Maia, to have sex was a way to achieve serenity:
Without sex there is no bond, no communication, no hugging and kissing… and they are the moments when your partner is calm and you are calm and you enjoy doing things together. You go on the grass and drink coffee together, we sit in canteen or we look for something to do together.
Making love was not easily accomplished within the narrow confines of the institutional framework. Whether in the half-way house or in the closed institution, there was no physical space allocated for couples to be intimate with each other. The staff seemed to close their eyes and ignore the issue, while fully being aware of the existence of those relationships. Maia recalls that
The female doctor said: “How was it! Or watch yourself! People have a big mouth! But they do not make problems! It’s like there is no law that says not to have sex in the hospital”
Andre explains that everyone finds a corner of his own to have sex. Mattresses have been placed in all kind of “secret places” for that purpose!
It is allowed, but not in….In the institution, I do not know! In the rooms it is forbidden. You have sex where you find a place. There are places where there are mattresses, you can go there.
Nava told us about a greenhouse in the mental institution called “the agriculture,” which was the most popular place to have sex. She explained:
I go with them to the agriculture [a greenhouse]! There is there a “suite” between the trees! There is a mattress and a bed that the guys have fixed!…But there is another place and no one knows about it!
The lack of privacy, whether in the institution or half-way house, was a major problem encountered by those couples who wanted to be intimate with each other. Maia explained how difficult it was to find privacy “We have to look all the time for a place.” When asked about the greenhouse, she exclaimed:
Maia: No! Out of the question! Imagine that everyone would come to the agriculture. It would end being a very cheap place. To be discreet is the nice part about it.
Interviewer: What would that be like?
Maia: I would have liked that they give us a private place to sleep together. Its like a prison here!
Barry, who lived in a half-way house, also had to confront institutional rules that prevented him from being intimate with Natalie. Even though Natalie had her own room, it was against the regulations to spend the night together. In Barry’s words,
There is an hour where everyone has to go to sleep. At we have to go to our room. If I stay they make me go up. The night guard yells and tells me go to sleep!
Barry expresses his feelings concerning the lack of privacy,
Interviewer: Are you lacking anything here?
Barry: I lack being alone, that they do not watch us all the time.
Interviewer: You mean privacy?
Barry: Yes! There is no privacy here! If I had a home we would feel closer. Here you cannot do anything, sleep together, kiss or pet. They see everything.
Female partners revealed problems related to sexual intercourse such as vaginal infection, pregnancies, and abortions. In their own words,
I have a sexual problem….I am ashamed to tell you! It is always itching down there (Osnat).
It is forbidden to have sex. I am itchy. I have to go to the doctor to be checked! (Rita).
This qualitative study aimed at examing what the experrience of love and being loved meant to heterosexual couples both diagnozed with schizophrenia who resided in the mental health institution or in the community mental health setting. Content analysis of in-depth semi-structured focused interview were conducted with each member of 10 heterosexual couples treated with “atypical” antipsychotic drugs. Despite some looseness of association, and eccentric affective responses, research participants told us clearly what the experience of being in love meant to them.
Aside from capturing the subjective experience of the respondents, this study identified concrete problems arising in the institutional framework that must be addressed to accommodate for the emerging needs of schizophrenic couples. Research participants’ most pressing needs for privacy and intimacy conflicted with the very norms of the asylums and those of the institutional framework (Goffman, 1964). Yet, residents need priviacy, love, and to make love with dignity. Leaving old mattresses throughout the institution in clandestine places, allowing the residents to find “secret places” to make love, and pretending that staff is unaware of this practice, is far from effective hospital administration. Therefore, a separate unit for couples and other institutional arrangements could be established.
This study clearly shows the beneficial impact of loving and being loved on the motivational, and socioemotional functional of persons diagniozed with chronic schizophrenia. Mental health professional must, therefore, recognize and reinforce love relationships as one of the best indicators of recovery.
R., Carlso, G., &
Guthrie, D. ( 1991).
Span of apprehension in Schizophrenia. In
J. Zubin, S., Steinhauer, & J. Gruzelier
(Eds). Handbook of schizophrenia:
psychophysiology and information processing. Vol. 5, pps. 353-370.
Bengtsson-Tops, A., & Hansson, L. (1999). Clinical and social needs of schizophrenic outpatients living in the community: The relationship between needs and subjective quality of life. Social Psychiatry and Psychiatric Epidemiology, 34, 513-519.
Berg, J. & Mcquinn, R. (1986). Attraction and exchange in continuing and noncontinuing dating realtionsihps. Journal of personality and social psychology, 50, 942-952.
E. (1983). Emotion. In H. H. Kelly, E.
Berscheid, A. Christensen, J. H. Harvey, T. L. Huston, G. Levinger, E.
McClintock, L. A. Peplau, and D. R. Peterson, eds., Close
E., & walster, E. (1978). Interpersonal
J. (1990). Acts of Meaning.
J. (1969-1980). Attachment and loss. ( Vols. 1-3).
Buber, Martin. (1958).I and Thou.
Translated by Ronald Gregor Smith.
K., Parry-Jones, W., Livingstone, M., Bogan, A., & Wood,
S., (1998). Qualitative research. British Journal of Psychiatry, 172,
Carini, M. & Nevid J. (1992). Social appropriateness and imparied perspective in schizophrenia. Journal of clinical psychology, 48, 170-177.
Charmaz, K., (1991). Translating graduate qualitative methods into undergraduate teaching: Intensive interviewing as a case example. Teaching Sociology, 19, 384-395.
R. (1989). The call of stories:
Teaching and the
L., & Strauss, J. S., (1995). Beyond the biopsychosodal model:
health and recovery. Psychiatry, 58, 44-55.
N. K.( 1989). Interpretive
Elkins, I. ( 1992). Span of apprehension in persons diagnozed with schizophreniapatients as a function of distractor making and laterality. Journal of abnormal psychology, 101, 53-60.
Identity and the life cycle.
Erickson, M., Egeland, B., & Sroufe,L. ( 1985). The relationship between quality of attachment and behavior problem in a high- risk sample. In Bretherton & E. Waters ( Eds.) Growing points of attachment theory and research. Monograph of the Society for Research in Child Development.
Erickson, Beiser, William, G.I. Jonathan, A., Fleming, M. Tsung-yi L. (1989). The role of social relationships in the course of first episode schizophrenia and affective psychosis. American Journal of Psychiatry, 146(11), 1456-1461.
Erickson, D., Beiser, M., & Iacono, G. (1998) Social support predicts 5-year outcome in first-episode schizophrenia. Journal of Abnormal Psychology 107: 681-685.
Fromm, E. (1957) The Art of Loving.
Gergen, K. (1980). Toward intellectual audacity in the social sciences. In R. Gilmour & S. W. Duck (Eds.) The development of social psychology.
B. G. & Strauss, A.
L. (1967). The discovery of grounded
theory: Strategies for qualitative research.
Grillon, C. ( 1990). Increased distractibility in persons diagnozed with schizophreniapatients. Archives of General Psychiatry, 47, 171-179.
E. & Traupmann, J. (1980). Intimate relationships: A
perspective of equity theory. In S. Duck
& R. Gilmour eds.
Studying personal relationships.
Heinssen, R. & Cuthbert, B. (2001). Barriers to relationship formation in schizophrenia: Implications for treatment, social recovery, and translational research Psychiatry vol 64(2) pps 126-131.
R. K. (1994).
Expressed emotion among psychiatric treatment personnel.
for staff training programs. Paper presented at the 28th Annual
the Advancement of Behavior Therapy Convention,
Hogarty, Schroeder, Ulrich,R.Mussare,N. Pergino, F., &Herron, E. (1986). Family psychoeducation, social skills training and maintenance chemotherapy in the after care of schizophrenia. Archives of General Psychiatry, 43, 633-642.
Holsti, O. (1969). Content
analysis for social science and humanistics.
sequence: the cognitive-developmental approach to socialization. In D. Golsin (Ed.), Handbook of
scoialization theory and research.
Leff, J. & Vaugh, C. (1991) The role of maintenance therapy and relatives expressed emotions in relapse of schizophrenia: A two- year follow-up. British Journal of psychiatry, 139, pp 102-104.
McGlashan, T. H. (1986). Schizophrenia: Psychosocial treatments and the role of psychosocial factors in its etiology and pathogenesis. In A. J. Frances and R. E. Hales (Eds.), American Psychiatric Association Annual Review (Vol. 5, pp. 96-111).
McGlashan, T. Fenton (1992). Positive-negative distinction in schizophrenia: Review of natural history validators. Archives of General Psychiatry, 49, 63-72.
Messand, P. & Berry, S. (2000). Switching antipsychotic therapies. Annual of Pharmacotherapy 34 pps. 200-207.
Nisenson, L. G., And Berenbaum, H. (1998). Interpersonal interactions in individuals with schizophrenia: Individual differences among patients and their partners. Psychiatry 61:2-11.
Nisenson, L. G., Berenbaum, H., And Good, T. L. (2001). The development of interpersonal relationships in individuals with schizophrenia.Psychiatry,64, 111-125.
Patton, M. Q. (1990). Qualitative evaluations and research methods (2nd ed.).
Plato's Symposium : A Translation
by Seth Benardete with Commentaries by Allan Bloom and Seth Benardete. Penguin classics paperback edition.
Richardson, L. (1990). Narrative and sociology. Journal of Contemporary Ethnography, 19, pp. 116-135.
Rubin,Z. (1973). Liking
B. (1929) Marriage and Morals.
Samem, J. E., Kring, A. M., And Kerr, S. L. More evidence for generalized poor performance in facial emotion perception in schizophrenia. Journal of Abnormal Psychology (1996) 105:249-257.
Sandelowski, M., (2000). Whatever happened to qualitative description? Research in Nursing and Health, 23, 334-340.
R. (1980). The growth of interpersonal understanding:
Developmental and clinincal analyses.
L. E. Waters, E. & Matas, L. ( 1974).
Contextual determinants of infant affective response. In M. Lewis & L. Rosenblum ( eds.), The origins of behavior.
Sternberg, R. J. & Grajek, S. (1984). The nature of Love. Journal of Personality and social Psychology, 47, 312-329.
A. (1987). Qualitative analysis for
H. (1962). Schizophrenia as a human process.
E. & Walster, G. (1978). Love.
E. Berschied, E., & Walster, G.(1978). New directions in
equity research. IN L. Berkowitz(ed.) Advances in experimental
end of the second interview, the researchers saw Natalie coming down
with wet hair, and another dress. Barry
was smiling―she had taken a shower!