Small Talk 1: Getting started and knowing what to talk about

group of friends in an apartment talking

Sometimes people with schizophrenia tell me that they have a hard time with small talk. However, people can get better at small talk through learning more about it and practicing it.

Starting a conversation-Icebreakers

“Icebreakers” are questions (or comments) that get a conversation started. They can be very specific if you know the person, like “How’s the new apartment?” or “Did you have fun at Jon’s bar-b-que?” You can ask any question about the person or their lives, or a general question, as long as it’s appropriate (see below).

If you don’t know the person, you may want to ask a more general question. Here are some examples:

  • How are you doing?
  • What do you do?/Where do you work?
  • (If in school) What classes are you taking? How do you like them?
  • What do you think of the weather these days?
  • How was traffic for you today?
  • Did you do anything fun over the weekend? What was it?
  • What brings you here today?
  • What do you do in your free time?
  • What kind of TV or movies do you like?
  • What’s your favorite sport?
  • Did you see the game on Sunday?

Use follow-up comments/questions to keep the conversation going–make a statement about the topic or ask questions about the topic. An example would be:

Natalie: “Hi, nice to meet you. I’m Natalie. So, what do you think of the weather these days?”

Isaac: “I’m so sick of winter!”

Natalie: “What’s the worst part of winter for you?”

Isaac: “Feeling stuck inside. I like to get out and go for walks and play Frisbee, but it’s impossible when it’s so cold.”

Natalie: “I agree. I walk my dog every morning, and sometimes it’s really hard to motivate myself to go.”

Isaac: “What kind of dog do you have?”

Natalie: “She’s a lab mix. Her name is Molly. She’s super sweet, but she gets hyper if she doesn’t get walked every day.”

Isaac: “I love dogs. When I was a kid I had a Basset Hound named Harvey. He was never hyper, haha. It was hard to even get him to go for a walk. But he was still so awesome, he was super mellow. I wish I could get another dog.”

Natalie: “Why can’t you get one?”

Isaac: “I can’t really afford one right now. Plus my roommate is allergic to dogs.”

Natalie: “Oh, dang, that sucks. But you’re right, dogs are expensive. Molly got an ear infection once and seeing the vet plus medications was like $200, it was so expensive.”

Isaac: “Wow. Well, I gotta head out. It was nice talking to you, maybe I’ll see you again soon. Take care.”

Natalie: “Good talking to you too. Bye.”

As you read the conversation, notice how Natalie starts the conversation with an introduction and a general question about the weather. Then when Natalie says something about walking her dog in the cold weather, Isaac changes the subject to dogs. Since Natalie had just mentioned her dog, this is a good way to change the subject.

Starting a conversation-appropriate topics

Appropriate Topics for anyone

It’s important in small talk conversations to talk about topics that everyone is comfortable with. Below is a list of general topics that most people will be comfortable talking about, no matter how well you know each other.

  • weather
  • sports
  • your job
  • school
  • news headlines
  • hobbies
  • TV shows
  • interesting things you saw on the internet
  • movies
  • books
  • food
  • travel
  • celebrity gossip
  • upcoming events or holidays
  • pets
  • new babies/kids
  • traffic

In the conversation between Natalie and Isaac above, they talked about two of these topics, weather and pets.

Topics to Avoid

Some topics aren’t appropriate for small talk, or will make people uncomfortable or upset. Try to avoid talking about these things during small talk conversations. Some of these topics are:

  • religion
  • politics
  • schizophrenia (unless they know you have it and accept you)
  • dating
  • things of a sexual nature
  • personal medical issues
  • personal or psychological issues
  • family problems
  • relationship problems
  • money
  • bad news
  • gossip
  • details-most people aren’t interested in the small details of things, just the general
  • anything that makes the person seem uncomfortable

Good friends and family members

The better you know someone, the more subjects that are appropriate during small talk. The list above is good for anyone, someone you don’t know or someone you do know. But if you do know someone, there are a few more topics you can talk about. Some of these are:

  • religion (but be careful, avoid this topic if people get upset)
  • politics (but be careful, avoid this topic if people get upset)
  • schizophrenia and other symptoms
  • dating
  • personal medical issues
  • personal or psychological issues (though people don’t want to talk about these things very often)
  • family problems
  • relationship problems
  • money
  • bad news

Partners, very best friends, very close family members, and your mental health providers

For the people you are closest to, there are a few more topics you can talk about:

  • deep personal issues
  • things of a sexual nature (be careful and appropriate)
  • fears
  • worries

Remember, small talk is a skill that can be learned. Practice. Ask someone you trust if they are willing to chat with you, and then ask afterward if they have any advice or ideas for how you could do better. A lot of people feel awkward during small talk, not just people with schizophrenia disorders.

Check the blog out for Small Talk Part 2: Keeping the conversation going, on how to show you’re interested in a conversation, and for tips on concluding one, Small Talk Part 3: Ending a conversation.

Meeting New People, Part 2

Friends camping on a beach

When clients tell me they’d like to have more friends, I ask them first if they have an idea of where they are planning to go to meet new people. If you’re not sure about where to meet new people, see part 1 (the previous blog). Once you’ve figured out where you’re going to meet new people, the next step is how you talk with them to get to know them and possibly become friends.

When you first go to a social event, try to talk to at least a few people. Start a conversation with a general topic that you think you’d have something to say about, like:

  • How are you enjoying the weather lately?
  • Did you catch the latest Vikings game?
  • I’m new to this group/event. Have you been here before? What’s it like?

You can also start a conversation specifically about the group or event you are at. If you’re in a hiking group, you could ask, “Where is your favorite place that you’ve hiked in the past? Why?” If you take a cooking class, you could say, “I’m not that familiar with this kind of food, do you like it? Why?” (More details on these conversations in Meeting New People, Part 3—Small Talk.)

Some people will talk with you for a while, others will talk for a few minutes and then excuse themselves to go talk with someone else or do something else. Don’t worry about the people that don’t end up talking very long with you. You are looking for people that you have a connection with, and some people are not a good match for your personality or have their own issues going on. Just move on to the next conversation when someone excuses themselves.

Also, remember that it may take more than just one conversation to get to know someone or be friends with them. Especially in Minnesota, people are slow to feel comfortable with each other.

You’ll probably end up having several of these “small talk” conversations before they may be ready to start doing social things outside the group together.

If you think you’ve made a connection with someone and would like to be friends with them, after having several conversations, ask if you can Facebook friend-request them or email them. Get their email/Facebook address and write it down. Then, a couple of days later, Facebook or email them and ask if they’d like to hang out sometime for coffee or something like that. If you think it might be confused with asking for a date, make sure that you state directly that you’re just looking for friendship, nothing more. (More on Dating Relationships in a future blog). When you first ask someone to do something social with you, invite them to do something that will take only a couple of hours or less and that is in a neutral place (don’t invite them to your place, for example). Good examples are going for coffee, going out to eat, going to a movie, going bowling, or going to a concert. Try to come up with some interesting things to talk about ahead of time, so you don’t have to think about them during the activity.

Be careful about telling someone you don’t know well about your illness–it usually works out better to have them get to know you first and then tell them.

Also, keep in mind your own safety when you don’t know someone well. Offer to meet them in a neutral place, tell a friend or family member where you’re going, don’t invite them over to your place or go to their place. Leave the situation if you feel creeped out or threatened.

One of the most common questions people ask when they’re getting to know new people is “Where do you work?” or “What do you do?” If you are a person who isn’t working right now, it can be helpful to think ahead of time how you’ll answer this question. Some replies to this question are:

  • “I’m looking for work.”
  • “I’m between jobs”
  • “I’m looking into going back to school.”
  • “I do volunteer work.”
  • “I’m retired.” (if over 55 or so)
  • “I’m self-employed” (if applicable)
  • “I’ve got some medical issues and I’m not working right now.”

Remember, you don’t have to give more detail than that, especially when you barely know the person.

When you’re done with the activity, if you had fun, tell them you enjoyed it and would like to do it again. If you didn’t really connect with the person, you need to decide whether you want to give it another chance, or if you’d rather just go your separate ways and meet other new people. Keep in mind that you may have to meet several new people before you find one that is a good personality match with yours. Meeting new people can be hard, but the short-term challenge of talking with new people is definitely worth the long-term benefit of making new friends.

Meeting New People, Part 1

Portrait of Seven People Having Fun in a Bar

Often clients tell me they’d like to make more friends, but don’t know how or where to meet new people. This is a skill you can work on, you can get better at it. Meeting new people isn’t always easy, and it can be nerve-wracking, but it’s worth it. Also, remember that many people feel nervous around meeting new people, not just people with a schizophrenia disorder.

Where to meet new people

The first step to meet new people is to go to places or join activities where you are likely to meet people that you have some things in common with. Some people meet new people at work or at a volunteer position, though you may have less time to talk about interests or to socialize at your work/volunteer job. If you aren’t working/volunteering or if you don’t have things in common with people there, here are some other ideas for places to meet others.

Often, if you have a certain interest or hobby (like old cars or reading or hiking), you can find a social group of people who have the same interest. This is helpful because you then have a built-in conversation topic, since you know the person is interested in the same activity as you are. If you have a computer with internet, you can look these up pretty easily. (If you don’t, go to your local library and use their computer for searching). For example, you could Google “classic car festival in Minneapolis” you’ll find several helpful links with websites that list dates and locations of these festivals. You can also join MeetUp, which is a free website that lists a huge number of social group by location and interest. MeetUp usually doesn’t have any fees or obligation to go if you join and then change your mind.

If you go to church, churches often have social or special-interest groups that meet regularly. There are also lots of volunteer opportunities at most churches, though some are social and others are not.

If you have some extra cash, you could take a class. One type of class would be a Community Education class (which is listed online by county) such as woodworking or learning new computer skills. Another type is a class held at a retail store, like a cooking class at a kitchen store or a craft class at a craft store like Michael’s or JoAnn Fabrics. There are also classes offered by drop-in centers and other programs (like Artability and SEED classes in St. Paul and Spectrum ArtWorks in Minneapolis).

Finally, sometimes people meet others that they get along with in support groups for people with mental illness, like those through NAMI, or though a local mental health clinic. The advantage of these groups is that the people in the group already understand what mental illness is. They may have had some similar experiences and will understand what you’re going through.

Once you’ve gone to an event to meet new people, the next challenge is how to get to know them and become friends if you get along. This will be addressed in Meeting New People, Part 2.

What Makes Schizophrenia Symptoms Worse?

What makes symptoms worse?

This is a question I get a lot. Some people with schizophrenia disorders feel like their symptoms are random and unpredictable. It’s true that we can’t pinpoint exactly which symptoms are going to be up or down on a specific day, there are things that will usually make them worse. For ways to manage symptoms, see previous blogs. However, if you want to know what NOT to do, keep reading….

Using Alcohol and/or drugs. Over 50% of people with a serious mental illness abuse alcohol or drugs at some point in their lives, and this can really mess with your symptoms. It makes the effectiveness of your meds lower, it makes your emotions fuzzy and numb, and it makes symptoms worse overall. Plus people who are under the influence tend to make poor decisions and be more vulnerable to people taking advantage of them. Alcohol and drugs can make you feel numbed out for a while, but that will be canceled out by the negatives of using.

Ignoring stress. People with schizophrenia disorders are often affected by stress more than people without those disorders. You need to learn about stress management, and use those skills whenever stress comes up. Try to avoid situations that you know will bring you unhealthy stress, such as usign drugs or spending time with unsafe people.

Tinkering with your meds without talking with your doctor. As you know, not every medication affects everyone in the same way. However, if yours aren’t working right, talk with your doctor to come up with a better plan. One of the most common reasons for mental health relapses in people with schizophrenia is stopping meds. Your doctor went to many years of school to learn how to figure out which meds might be a good fit, put your trust in him or her and make sure your doctor knows if you’ve changed your meds.

Not taking care of your physical health. Everyone’s mental health is better when they eat right, get regular exercise, get enough sleep, etc. Take care of your body so that your mind is in good shape.

Spending too much time alone in your home. When you’re by yourself too much, symptoms can start getting worse without you even realize it. Make sure you get out and about and see people 5-7 times a week. Also, friends can be really helpful for support and keeping symptoms away, even if you aren’t talking about your symptoms with them. Just spending time with a good friend helps keep symptoms lower.

Not having any hobbies or daily activities. If you don’t have enough to do, symptoms will creep up. With too much time on your hands, it’s easy to fall into the pattern of sitting there with symptoms going over and over in your head, getting worse and worse. Having daily activities can keep symptoms lower. Examples include hobbies, work, volunteering, going to a drop-in center, or visiting friends.

Never talking about your problems or stress. Everyone benefits from getting support from other people. Friends, family members, crisis lines, therapist, and social workers can all help you get through tough times, whether it’s stress or symptoms getting worse. If you don’t tell anyone, no one can help you get better. Talking about your problems with a trusted person is very important.

Rain on window

Depression can happen to people with schizophrenia, too

With all the talk of Robin Williams’ recent death, and the renewed focus on clinical depression and suicide, it seems really important to address depression in people with schizophrenia. Sometimes people forget, or never think of, how often people with schizophrenia have depression. Over three dozen research studies have examined this very thing, and though rates between different studies varied, most often in these studies, at least 25% of people with schizophrenia had depression at some point in their lives, and sometimes the numbers were much higher. There are several ideas of why this is (though that discussion is for another day), but the important thing is the “occurrence of depression in schizophrenia has often been associated with worse outcome (5), impaired functioning, personal suffering (6), higher rates of relapse or rehospitalization (7–10), and even suicide (8,11, 12).” (Am J Psychiatry 2000;157:1379-1389. doi:10.1176/appi.ajp.157.9.1379)

Yesterday I came across a NAMI blog addressing Mr. Williams’ death and the things we all can do to identify, treat, and support people struggling with this disorder (see link). As you read it, please keep in mind that you or your loved one can get depression on top of schizophrenia, but that it is treatable and people get better. Many people in my practice struggle with depression at times, and I and their psychiatrist help them through it. Signs of depression to look for (some of which occur in schizophrenia, too, so talk to a mental health professional to be sure) include having the following for two weeks or more:>

Ray of Light

  • sad, empty, or irritable mood for a lot of the day
  • having trouble enjoying things, everything seems “blah”
  • a big change in sleep patterns
  • a big change in appetite, or a major weight change without a change in eating
  • low energy or being really tired
  • problems with memory or concentration
  • lots of negative thinking, like “I’m no good, nothing will ever get better, and this is all my fault”
  • feeling sluggish or slow, or sometimes, feeling really jittery
  • thoughts about death or suicide, whether or not you’d actually do it

If these symptoms sound familiar, take action. Get help. Don’t listen to the lies depression tells you. Talk to someone—your therapist, psychiatrist, a family member, call a crisis/suicide prevention hotline, or call 911. Don’t let depression take another person from us.

The following is a list of resources for suicide prevention:

  • if you need immediate assistance call 911
  • go to a hospital emergency room.
  • National Hopeline Network 1-800-784-2433 (1-800-SUICIDE)
  • National Suicide Prevention Helpline 1-800-273-8255 (1-800-273-TALK)
  • Local Suicide Prevention Line: 612-347-2222
  • Crisis Connection: 612-379-6363 or 1-866-379-6363
  • Dakota County Crisis Line: 952-891-7171
  • Fairview University Crisis Line: 612-672-6600
  • Ramsey County Crisis Line: 651-523-7000
  • Hennepin County Crisis line: 612-873-2222


Early Treatment for
Schizophrenia Disorders

Many people feel at a loss when a loved one is diagnosed with schizophrenia or schizoaffective disorder. Should my loved one take antipsychotic medications when they’ve got so many potential side effects? Can therapy help treat a schizophrenia disorder? Are community and job support services worth it? The answer is yes. Research has been pointing towards the effectiveness of early treatment for those with a schizophrenia disorder. NAMI (National Alliance on Mental Illness), a nation-wide nonprofit which advocates for effective treatment and education of people with mental illnesses and their families, recently linked an article summarizing these findings.

Getting Early Treatment

Getting a person early treatment can be challenging, the health system is huge and confusing, and each different state has different laws and resources available for people needing help. I strongly urge you to find a good psychiatrist first, as people with schizophrenia disorders tend to do much better when on antipsychotic medications (and many primary care doctors don’t feel comfortable prescribing those meds). This can be difficult in and of itself, as there aren’t enough psychiatrists in many areas. You many have to wait before you can get an appointment, but this is better than not seeing one at all. Also, ask if there is a waiting list or cancellation list, sometimes you can get in sooner that way.

Finding a good therapist is also important, not only for helping your loved one deal with their schizophrenia symptoms, but also for working through the life changes, losses, and depression that often accompany the disorder. Look for a good fit between your loved one and the therapist, a trusting therapy relationship can be extremely beneficial over time.

Finally, look into the support services for you and your loved one in your area. This can include social workers, financial workers, guardians, representative payees, home health nurses, vocational trainers, and others. They can help you navigate the system and get your loved one the supports to assist them improve their symptoms and their quality of life. Contact your local NAMI chapter for help on locating these resources as they vary from state-to-state.

Finally, getting treatment for your loved one can be especially challenging if your loved one’s have caused them not to think anything is wrong. Sometimes focusing on their goals and how they can achieve them more easily with treatment is helpful. An excellent book about working with people who don’t believe anything is wrong (when others all agree they have a schizophrenia disorder) is I Am Not Sick, I Don’t Need Help! By Xavier Amador. Other strategies include having them see a therapist only briefly every few weeks to check in, letting them have some control over their life and treatment choices, and giving them time to adjust. If you’re unsure how to proceed with this, talk to your local NAMI chapter, there are education and support groups for relatives of people with mental illness, they can likely give you some tips on how to best manage the situation.

Symptom Management: Persistent Symptoms

Boot Camp

What are persistent symptoms?

For many people with schizophrenia disorders, medications don’t completely get rid of all symptoms (though for some they do). The medications do get rid of some symptoms, and make the others less severe, but it can still be helpful for you to learn to manage those that are still there. These symptoms, called “persistent symptoms,” are ones you experience even when you are taking your medication as prescribed. (They are different from “warning signs,” which will be addressed in a later blog.)

Persistent symptoms can be any type of symptom, including voices, visions, paranoia, other delusions, getting stuck on thoughts, trouble with concentration and memory, trouble getting things started, over-interpreting things, problems showing emotions, thinking everyone is focusing on you, and others. If it bothers you even when you’re stable, it’s probably a persistent symptom.

Ok, but how do I cope with these symptoms? Skills to cope with persistent symptoms are critical to quality of life—the better you can manage your persistent symptoms, the more you’ll enjoy everyday life. Everyone’s symptoms are somewhat different, so you may want to try different coping skills until you find the right ones for you.

Examples of persistent symptom coping skills:

  • Make sure you’re taking your meds every day exactly as prescribed. If you don’t think your meds are working right, see your doctor, even if it’s not a relapse or emergency.
  • Learn to recognize the symptoms as symptoms, not reality (do a reality check with someone you trust if you’re not sure), remind yourself it’s just a schizophrenia symptom, not reality.
  • Take PRN (as-needed) meds if you have them for the symptoms that are bothering you.
  • Get support from a trusted person. It can help to talk to someone who cares.
  • Try therapy. Therapy can be extremely helpful in managing symptoms and stress.
  • Focus on something productive, like tasks you have to do at home or work.
  • Do something fun that takes your mind off your symptoms, like TV, music, time with friends, going for a walk, working out, doing hobbies, journaling, or sports.
  • Make sure you take care of yourself physically (eat right, sleep, meds, avoid alcohol and drugs, etc.) and emotionally (get support, get therapy if needed, be kind to yourself, etc.) so that you’re in the best shape you can be to manage your symptoms.
  • Keep a list of people to call and coping skills to use when symptoms are bad. It’s sometimes hard to problem-solve when symptoms are bad, it’s helpful to have a plan ready for when this happens

This is a brief list, there are many other skills you can use to cope with persistent symptoms. Try out different ones to see what fits your style and works on your specific symptoms. And once again, make sure you keep in contact with your doctor, and let him or her know if you feel your meds aren’t working right.

Causes of Schizophrenia

Woman Sipping Coffee

When a person is diagnosed with schizophrenia, often they or their family wonder “How can this be happening? What did I do?” Over the centuries, the causes of schizophrenia have been debated, and many theories have emerged, most of them wrong.

It appears that there is a combination of things that contribute to schizophrenia, with none of them being the sole cause. For example, if schizophrenia were completely genetic, when a person who is an identical twin has schizophrenia, his or her twin also would, which is not always true. If it were completely environmental, it wouldn’t make sense that schizophrenia runs in some families, across generations and situations.

So what is it? Researchers have found evidence that some people have a genetic susceptibility to developing schizophrenia, but that other things are involved, including life stress, emotional intensity of families, and the mother having a certain virus while pregnant (which virus hasn’t been pinned down yet.)

One theory that has been clearly discredited, however, is the “schizophrenogenic mother,” in which a mother’s parenting style causes schizophrenia. There is nothing any one person can do to cause schizophrenia. Without the genetic and other neurological factors present, schizophrenia doesn’t emerge. So, if you or a loved one has schizophrenia, please don’t blame yourself.

We may not know yet exactly the constellation of causes that come together for schizophrenia, but we know it’s a lot more complicated than just one thing. More helpful is to focus on recovery, there are more answers to recovery than to causes.

Talking about your diagnosis
(and deciding if you should)

post 3

It would be ideal if everyone understood mental illness and had no prejudices against people with them, but this just isn’t the case.

Bias, stereotyping, and mistreatment still occur, and sometimes you might decide it’s best not to share your diagnosis with some people. But how to decide?

First off, you don’t have to. You have the right to keep your medical status private. In addition, federal law usually prevents employers from asking you if you have a history of mental illness when you apply for a job (there are exceptions for certain jobs, like law enforcement and armed services). Employers can ask you about drug/alcohol abuse, but not about legitimate use of prescription medications.

A job interview is not usually the best time to tell people. If you get the job, then you can get to know the people and the situation, then decide if it’s in your best interest to tell them.

Some questions that might help you make your decision are:

  • Is there a reason for them to know? If you need special accommodations, like a flexible schedule at work so you can see your therapist, etc., this could be a good reason to tell your employer. You cannot be fired for telling them of your illness, though employers have the right to ask for a letter from your doctor or other documentation. (The employer has to keep this information confidential, they aren’t allowed to tell your coworkers.)
  • Is the person likely to find out anyway?
  • How understanding do I think they would be?
  • Will it make things easier for me if they know?
  • Have I known them long enough to tell them this kind of personal information?
  • What are the risks of my telling the person? What could go wrong?
  • How well can I handle it if the person judges me as a result of telling them?
  • If I don’t want to tell them, do I think I can continue to maintain it as a secret, even if I have to lie?

You may want to ask someone you know and trust what their opinion is of whether they think you should talk about your illness.

When you approach the conversation about your illness, decide how specific you want to be:

  • very general: refer to a “medical condition” or “illness”
  • a little specific: refer to a “neurological problem,” a “brain disorder,” or “difficulty with stress”
  • more specific: mention “mental illness” or a “mental disorder”
  • most specific: give them your exact diagnosis

Pick a quiet time without a lot of distractions if possible. Tell them you want to talk briefly about something important. Think about what information will be helpful for them to know. Use that to help you decide what details you want to tell them.

You might want to make a comparison to diabetes–it can be well-treated with medications. Finally, remember to remind them of who you are as a person–this will help them remember that you are not your illness.

It’s not a bad idea to practice this, to do a role-play with a friend or family member who already knows about your illness so you can try it out.

Introduce the topic with something like, “I wanted to let you know about a challenge I have. I have a mental illness. It’s not like in the movies, I’m not a criminal or scary or anything. But sometimes the symptoms of my illness get more severe, and then (you might notice I’m very quiet/I might have to take some sick leave/I might have a harder time getting things done).”

Tell them as much as you’re comfortable with and as much as they need to know. Be ready to answer questions, and be ready to refuse to answer questions if they get too personal for you.