The word “schizophrenia” tends to conjure ideas of dramatic imagery: hallucinations, delusions, insane asylums in the general public’s mind. Most people don’t think of the boring parts that consume many with schizophrenia, like lacking the motivation to get out of bed, to make friends…
Host Rachel Star Withers, a diagnosed schizophrenic, and co-host Gabe Howard discuss avolition and ways to help motivate loved ones in this episode of Inside Schizophrenia. Family Counselor Ms. Breen joins to share ways to sort through dilemmas. And Rachel does an experiment on her own to address her lack of motivation in being social.
Highlights from “Motivation in Schizophrenia” Episode
[00:52] The Boring Parts of Schizophrenia
[04:00] Do People with Schizophrenia Want to Get Better?
[06:23] Avolition- lacking the ability to initiate
[09:40] Why is my Loved One Ignoring Me?
[14:00] Social Anxiety vs Avolition
[15:40] What is the Treatment?
[17:00] How Friends and Family can Help
[25:20] Rachel’s Pre-Planning
[28:20] Interview with Guest Family Therapist Ms. Debbie Breen
[37:17] Lacking the Choice
[38:00] Rachel’s Experiment
[43:10] Do Something
[45:45] Rachel’s Closing Remarks
About Our Guest
Ms. Breen is the principal therapist and owner of South Charlotte Family Counseling in Matthews, North Carolina.
At South Charlotte Family Counseling, we value truth, simplicity, and peace of mind, trusting these qualities to aid our clients in sorting through the dilemmas and distress that brings them into a counseling setting. Together, we identify core issues, set goals, and establish time frames for completion.
Computer Generated Transcript for “Working With Schizophrenia” Episode
Announcer: Welcome to Inside Schizophrenia, a look in to better understanding and living well with schizophrenia. Hosted by renowned advocate and influencer Rachel Star Withers and featuring Gabe Howard.
Sponsor: Listeners, could a change in your schizophrenia treatment plan make a difference? There are options out there you might not know about. Visit OnceMonthlyDifference.com to find out more about once monthly injections for adults with schizophrenia.
Rachel : You’re listening to Inside Schizophrenia. I’m Rachel Star Withers here with my co-host, Gabe Howard. Gabe, today, we’re talking about motivation in schizophrenia. You know, when people hear schizophrenia, they’re always like, “Oh my God. Hallucinations, killers, murderers.” Like, they think really dramatic stuff. And yes, I do hallucinate a lot. Unfortunately, most of time it’s really boring stuff like I’m seeing something wrong, like my cup of water is distorted and I’m like, what am I looking at?
Gabe: And of course, the whole thing about violence killing all of that. That is what people think about. And it’s so sad because like almost never happens. You should listen to our violence episode. If you haven’t already.
Rachel : Oh, absolutely. Yes. I meant just the general population when they hear the word I’m sorry not to. That’s just like you have a stereotype.
Rachel : Yeah.
Gabe: They think that you’re lazy or violent. That’s really that’s what they think. Like, oh, you have schizophrenia. You must be lazy, violent. And definitely you’re causing your family and friends to suffer.
Rachel : Yep. Why aren’t you in a locked up in a mental hospital? Why aren’t you homeless? I’m shocked you can like make whole sentences.
Gabe: And we’re here to dispel all of those myths and the myth that we’re working on today. As you said, is the whole motivation issue, because there’s a big difference between being not motivated to climb a mountain, and not motivated to get out of bed, which is not uncommon for people like yourself.
Rachel : Yes. The biggest thing I struggle with across the board, my schizophrenia has always been the negative symptoms, the depression, the stuff that keeps me down. I struggled with my whole life and to look at me from the outside, you would see I’ve done so many projects, TV shows, radio, podcasts. But I’ve just done so many things across the board that they’re like, “Dude, Rachel, like you’re always up to something.” What people don’t see, though, are the days that I can’t get out of bed. The days that I wear like my pajamas all day. And I can’t tell you what time it is. I realize I forgot to eat that day. I haven’t taken a shower. And, you know, it’s like mentally, I’m gone. I have to set up my medication specifically morning and night, like I set it up once a week, labeled because I forget. Sometimes I just don’t want to do things. It’s like just I don’t know. It’s like a hole in my head. Does that make any sense, Gabe?
Gabe: It does it makes a lot of sense and we know that that is an unfortunate outcome or a symptom of schizophrenia. It’s a symptom of a lot of mental illnesses, not being able to get out of bed, not being able to be organized, to get stuff done, etc. Do you think that sometimes it becomes sort of when you’re well and you’re doing all the things that you need to do? They sort of forget about that when you spend all day in bed or you don’t shower for three days, which compounds the problem. So rather than looking at oh, my loved one is symptomatic, they’re thinking to themselves, Oh, she’s always lazy.
Rachel : Yes, unfortunately, yes, especially when I get stuck in it for like a few months where I’m just a slug. You’re not sure how to explain it and I’m just mentally out of it. It’s like there’s nobody home in my head and just doing the smallest thing, like getting up and taking a shower and washing my hair is like a feat. It’s just a feat in itself. But it’s overwhelming. And sometimes I feel like it’s overwhelming to try and get up and like walk across the room to my desk to take my pills, which are sitting there with water. But it’s just strange. Some days like, yeah, I won’t take my meds until 5 p.m., unfortunately, because I just laid in bed and kind of a delusional state.
Gabe: Let’s touch on that for a moment. There’s two things that have become abundantly clear in what you just said. You didn’t take your medication. I think there’s a lot of talk about people with schizophrenia and not taking their medication. But the second thing that you said is that you want to. You want to take your medication. You just can’t get up the motivation to move from your bed to, in your case, across the room to your desk. And not everybody is as fortunate to have their pills across the room. You know, sometimes it can be across town, it could be a pharmacy, it could be just whatever. Can you touch on that for a moment? Cause I really do think that it feeds into the idea that people with schizophrenia aren’t trying to get better vs. One of the symptoms of schizophrenia is motivation issues.
Rachel : And it’s hard to explain, but it’s like I know what I need to do, which is get up out of bed, walk across the room, just take your medication. Those like few steps just become overwhelming. And it’s like all I can do to like mentally get myself moving, you know, be like big things, little things, as you said, my medication across the room. I’m not going to lie. The other week, I was out of one of my medications for a week because it was sitting at Wal-Mart and I just needed to go and pick it up. But the idea of getting in my car, driving 30 minutes there, I just couldn’t do it. Thankfully, my mom eventually was like, hey, do you need me to do anything? And I was like, if you happen to be going that way, I do have something I need picked up. And she was like, oh, my God, Rachel, you should have said something, but I didn’t even. Like I could have asked my parents at any point and I didn’t. And I can’t really tell you why I didn’t. It was just there was like a hole in my head there where I just couldn’t seem to get myself to do that, to ask.
Gabe: Motivation is difficult for a lot of people. It’s not just the hallmark of people with schizophrenia. There’s lots of people that could be more motivated. I think that that’s just that’s just a fact that we need to accept. But the motivation that you’re talking about is very basic, right? You’re not motivated to ask for help. You’re not motivated to respond to a question. You’re not motivated to participate in your own care. Are these things that are universal for people with schizophrenia?
Rachel : Yes. And it’s almost weird because I think to the outside world motivation. That’s a great word. That makes sense. The actual as far as schizophrenia and other mental disorders is there’s a term called avolition that is a symptom of different ones. From schizophrenia, it can go into bipolar, different types of personality disorders. But it’s a decrease in motivation to pretty much you lack the ability to initiate things like I kind of just said a minute ago, it’s like there’s a whole there’s some reason that you can’t do this thing even though you want to. Like, for instance, some just normal ones you might notice in your friends and family would be like paying bills. For the reason this person hasn’t paid a bill. Thankfully now that’s why all my stuff is automatic. It’s for actually that exact reason.
Gabe: Because you realized it and you were able to work out that. That’s a coping mechanism that you have been able to to work out for yourself. And again, I think that it’s important that people hear you want to. It’s not a lack of desire. You’re not, because I know that a lot of times people with schizophrenia, they don’t want to get well. They’re not trying. They’re happy with the way things are. And that’s not true. That’s what avolition is. Let’s really nail down avolition vs. laziness. Let’s really talk about the difference. It’s not lack of desire. It’s lack of ability.
Rachel : Yes. To fully understand how it’s different from laziness. Laziness is just as I don’t care, I don’t want to do it. I’m just gonna chill. Whereas avolition is more, I know what I need to do. I want to do it. There’s some thing holding me back from being able to do this thing. And it’s like a mental hole in your head of something is stopping me and making this incredibly difficult.
Gabe: And there’s tons of goods examples, you know, failing to show up for a scheduled a vendor meeting, failing to deal with everyday responsibilities with your family. Ignoring the phone ringing and that’s like a really like a really simple one, right? The phone goes, ring, ring. You say hello. That doesn’t seem all that hard, but it can be monumental.
Rachel : Yes, I am terrible about that with even texts, emails. Unfortunately, sometimes I will let emails like pile up for three months knowing like they’re there. I’ve read them, but I just can’t seem to get the energy up to reply. And then when I reply, you’ll be like, Rachel, you literally wrote one sentence. I’m like, I know, but that was I don’t know why. I just had to wait for a good day that I could sit there and bam, bam, bam. I don’t know. And even like text messages, someone will say, hey, do you want to hang out? And fortunately, a lot of times like that just seems overwhelming to me. And I want friends. I want to hang out. I want to make connections. Then the opportunity comes up and I’m like, I don’t know. Oh, you know, that just it’s overwhelming. The idea that I have to get up, get dressed, go somewhere, act a certain way. I don’t know.
Gabe: And I know that a lot of people feel that you’re ignoring them on purpose. I mean, this was a real human to human relationship thing. This transcends one person having schizophrenia. I know that if I text my wife and she does not respond back, I think, oh, why? Why is she ignoring me? This has nothing to do with mental illness. I just I feel like I want my wife to take a moment out of her day and acknowledge the thing that I texted. So the person on the other end, the person who texted or called isn’t getting a response. They tend to see what is happening from that perspective. Why is my friend loved one family member not responding to me? And they believe that it’s almost malicious. But that’s not what’s happening from your perspective. From your perspective. There’s this giant mountain that is answering a text message and you can’t climb it.
Rachel : I see it. I have the tools around me, but I can’t. It’s like my mind. I can’t figure out how to use those tools to climate.
Gabe: And this is specifically a negative symptom
Rachel : Mm hmm,
Gabe: Of schizophrenia? Correct?
Rachel : Yes. So for all of my people out there, in case you didn’t know, negative means lacking. So something that is lacking out what you would call the normal person. And then if you hear positive symptoms. Positive symptoms would be something added to a “normal” person. So like most people don’t have hallucinations, that would be added to. Most people have motivation to get up and brush their teeth. If you don’t, that would be negative. You’re lacking it.
Gabe: So to be clear, you’re not saying that because you have schizophrenia, you can never be lazy. People with schizophrenia absolutely, unequivocally can be lazy.
Rachel : Oh, absolutely, yeah, I can. Many days be lazy. So just because someone doesn’t want to do something. If you are a friend or loved one watching this, you’re gonna have to kinda don’t just let everything slide. Even my like my dad knows that at a certain time, if he hasn’t seen me up and moving around, he needs to step in and help push me. Because honestly, he’s not sure if I’m just being super lazy or there’s something wrong with me.
Gabe: I like how you put that. He needs to help. You didn’t say my father orders me to go for a walk or my friend demands that I do X or tells me that it’s for my own good. He helps you because he’s not sure. So he keeps an open mind. So other examples of avolition versus laziness are.
Rachel : So if I have to go into Wal-Mart and pick up my prescriptions like I did the other week, I know I have to do it. Laziness is ugh, I just don’t want to drive over there and I don’t want to stand in line. Oh, my goodness. I’m going to have to like talk to people. Avolition is OK, I need to do this. I know I need to do this, but there’s something I just can’t seem. It’s overwhelming. The task itself has become overwhelming of me having to put on clothing that would be appropriate to walk outside in. I have to get in my car. I have to drive 30 minutes there. I’ve had situations where like the idea of walking into a store is overwhelming because I know how bright it’s going to be. I know there’s gonna be people everywhere. There’s a lot of sounds and it’s just overwhelming. And I can’t get out of my car and go inside and I can’t really say why. It’s not like I’m scared. It’s just it’s too much. You know, I could easily do it the next day, but there’s something that it all becomes hard for me. It’s like there’s just this this wall that says you can’t go any further. Even though I want to. And with things like that, it takes me having a good day to be able to go and do certain things certain days like you like, whoa, you got so much done, Rachel..
Rachel : Yeah. On good days, I’m like, choo choo choo choo choo. I like it. So I do all the work I can possibly in prep because I never know when it’s gonna go the other way. So it’s one reason I set out all my pills for the week. I set out all the clothing I’m gonna wear for the week. One of the hardest things for me is when I do go to my part time job where I work, I have to look really nice and trying to put together an outfit. Sometimes I can’t do it. And you’re like, Rachel, just these pants and a shirt and you know, but I can’t. It’s like there’s I just can’t. I’ll have the hardest time putting on clothes because I can’t focus. So what I do is I lay them out ahead of time. So I go, OK. I already set these two together. Just put them on. Don’t worry. Just put them on. That’s a little bit of personal-ness about me, what I struggle with. But listeners, I would like to know something about you. Please take a brief three minute survey so we can better understand our audience. If you’ll go to PsychCentral.com/survey19 and fill that out for us. That would be awesome.
Gabe: The goal is to learn about you so that we can make the best possible show for you and you’ll be entered into a drawing to win one hundred dollars from Amazon (void where prohibited). So we really appreciate it. I have a specific question, though. Is this like fear? Are you afraid to answer the phone or you just don’t have the ability to do it? And other things that kind of pop up in my head or like social anxiety or just it’s kind of what it sounds like. But is it different from that?
Rachel : Yes, it’s different. You can totally have social anxiety and have schizophrenia. I mean, I’ve had times where I went to a party. I don’t do well around people. I don’t know. And I was so nervous that I couldn’t get out of the car. And I was just I was terrified of what was going to happen. Avolition and lack of motivation is not that I’m not scared of anything. I can walk in there, you know, and I’m not like gonna like burst into tears.
Gabe: When it comes to avolition, you’re not scared of anything. Whereas with social anxiety, you are scared. But the end result is the same. You don’t do it.
Rachel : Yes, there’s some reason I can’t, you know? It’s not just the reason it’s oh, I’m terrified. I’m shaking. Avolition is just there’s a whole missing and I don’t know what to do. And usually I don’t make it to the party and sit in my car. It’s I don’t even get to the point of wearing clothing to go there. For some reason, with me, clothing is a big issue. And I know it is with other types of people that have certain mental disorders have told me that, too. And if you are a friend or loved one, it sounds silly, but that can really help some people. It’s just being like, hey, you look really good in this outfit. When someone gives me a compliment about an outfit, I like mentally go, okay, these go together really well. I’m going to put this in my lineup for next week. It’s just bizarre, but it’s almost that confirmation I needed to, OK, check. That’s one outfit I have down for next week.
Gabe: Let’s talk about how we can help motivate people with schizophrenia. How people with schizophrenia can get the support that they need and feel more motivated. What’s the treatment for this? Because I don’t think anybody wants to walk away and believe, oh, well, this is a symptom of schizophrenia. Nothing can be done. This is your life now. And that’s certainly not what we’re saying.
Rachel : The treatment is cognitive behavioral therapy. Getting therapy to help you figure out how to get over these holes. The other thing is medication management. And I wish I could be like, oh, there’s a special pill you can take and you’ll be fine as if you’ve been taking medication for any amount of time. You know that it’s not true. It’s an ongoing process and sometimes trying different medication. And there really isn’t a set motivation pill.
Gabe: And it’s really important to understand that this is an excellent example of where medication and psychotherapy really do go hand in hand.
Rachel : And it’s amazing if you’re able to find a place where you can have the therapy and it’s connected with whoever is your psychiatrist doing the medication. That’s one thing is I was lucky to get a counselor recently who is at the same center as the person I see who does the medication. So I’ll be able to talk to her. And she’s like, you know, Rachel, I’ve been hearing a lot of such and such. Are you having issues with your depression? Maybe I should put a note in your chart and next time you might want to bring that up. So that that’s actually worked out really good for me as far as a lot of my management is having those two people, someone who knows me. You know, on a more personal level of me share again therapy and working with me to be able to kind of tell the other one. So very cool if you’re able to set that up kind of situation.
Gabe: Let’s talk about what our loved ones, our friends and family can do to help us deal with lack of motivation.
Rachel : Communicate. Talk to us. Don’t like aggressively push. Don’t holler. Don’t get mad. It’s like we said earlier. Yes, someone with schizophrenia can totally be lazy. OK. So you know it could totally be being lazy on some things, but kind of ask some questions, see if you’re able to start understanding the difference and what it is. So communicate. So if you see, OK, I’m having trouble. I have not taken a shower all week. This needs to change like for a lot of reasons. Just general health reasons. Talk to that person. Figure out where the breakdown is. OK. What is keeping them from doing this task? See if you can help and see. Again, these are little things. So if you know I’m not taking my medication, there’s something going on. Step in like my mom had to with me. OK. I’m going to go and get it. And she said, I’ll go and get it. If you’re able to step in and figure out where is this person having the issue? If it’s bill paying. OK. Sit down and be like, look, let’s get this setup on automatic or let’s have you write out all of your appointments and I’ll put them in my phone also so I can send you a reminder. I can swing by and say, hey, don’t forget, you know, just little things. It doesn’t have to be you take over this person’s life and drag them out of bed and put them in the shower and scrub them. Okay. Just talk to us and figure out where’s this person having an issue?
Gabe: So what you’re basically saying is don’t force them to do it and do it for them, help them do it. But why can’t we just do it? Why shouldn’t we just drag you out of bed and scrub you to use your analogy, why doesn’t that work?
Rachel : Because that person with schizophrenia, and I’m talking about myself, too. You have to be able to do things for yourself and to the loved ones out there if you’re doing that thing for them. You’re not necessarily helping. OK. You’re just kind of taking over my life. And everyone knows, I’ve had my parents interviewed and stuff. And I’ve always told them that the minute they refer to themselves as a caretaker, I’m moving out. I will go live in my car because I don’t like that analogy that somebody has to do everything for me. OK. I’m not a little baby.
Gabe: Because you want to be proud.
Rachel : Yes. And while, unfortunately, there are a lot of things that I can’t do, I can’t work a normal 9 to 5, 40 hour week job. I’ve had to make a lot of adjustments because I can’t do that. I can’t live alone. I get weird. But there’s a difference between that and having someone just take over my life and be like, okay, well, you live with me now. I’m gonna you know, you’re paying rent to me and I’m gonna take care of you. And it’s like you become a parent to them. And no, you’re gonna have someone with schizophrenia really start to resent you, honestly.
Gabe: So you believe that a partnership works better because you’ve described in your own situation that if your parents who love you very much and out of love just took over your life and forced you to do everything you would resent them. That would be traumatizing for you. But more importantly, you’ve said that it wouldn’t work. You specifically said that you would run away. Do you think you would be better if you ran away? Because your current situation of discussing it, being partners, figuring out what you need help with and what you don’t need help with seems to be working extraordinarily well. This this has been working for years.
Rachel : And I have run away a few times. I mean, no, I’ve lived. That’s how we know this works, is that I have lived by myself and had to look around and realize I hadn’t left the house in days. I had gotten off the floor in days. I’d been in the same spot laying on the floor out of it. And yeah, I could not live alone. Did I need someone to come in and do everything for me and feed me and that? No. I did, however, definitely need help at that moment. I needed to be around people because I wasn’t doing anything like on my own. I just kind of like mentally shut off. But at what point I was able to realize, okay, this is not good. I need help. And I called my dad and I said, listen, this is what’s happening. I don’t know what to do. And I moved back in pretty much that next day. And it was great. They didn’t have to do that much to help me because just them being around was able to, just them being around. My dad kind of always checking that I was eating, you know, and knowing that she hasn’t gotten out of bed in the past eight hours and him coming and bringing me food. Or usually it’s, Rachel, I made you lunch, come up here. Making me walk all the way up the steps. So many steps. You know, it it seems like a little thing, but sometimes it was huge and that was monumental. But it got me moving. Not him, like sitting there spoon feeding me soup.
Gabe: I know you use words like he made me, but he’s not actually making you, right? He’s encouraging and asking. Like you said, he. He made lunch and came down and banged on the door. And I suppose what I’m really trying to say is that you have developed an excellent partnership with your family so that they know what you need help with, what you don’t need help with, when they need to step in. And I think here is the key. You all have figured out when they don’t need to step in. And I think that’s really the missing piece for a lot of families out there. They don’t know when to back off. They know when to step forward, but they don’t know when to step backward.
Rachel : And on that note, just because you said banging on the door, one thing that I found and just throwing it out, I’m not saying it will work for everyone. My door’s almost never closed. I always want it open because I can’t live alone in general. I seclude myself off and it’s the same thing with my room. I don’t close my door unless I’m changing my clothes and then it’s back open again. On that note, my parents also just don’t wander in my room as I am a grown woman. But they walk up to the door and like, Hey, Rachel, you know. But for me, that’s important because it lets them check on me without really disturbing me. They’ll just kind of pop their heads in and be like, OK, she’s fine. And it gives me more of a link that if they’re walking by, it helps me be like, hey, what are you doing? And my mom will be like, oh, I’m going out. And I’m like, can I come? I need some stuff from Harris Teeter or from the grocery store and I’ll kind of go with her where I probably wouldn’t have done that before. And that’s exactly what happened yesterday. I really been at a grocery store like a week. And I just kind of hadn’t gotten any. And I really wanted to, but I just I hadn’t. And she she was going to the grocery store. Can I just come along?
Gabe: And the way this really ties into motivation, and I think that’s important, is if you’ve done some preplanning ahead of time, like leaving your door open, setting general guidelines for eating, and these have become sort of house rules. It’s not authoritarian, it’s not caretaker or caregiver. It’s just the rules of the house. And no matter where you live, there’s rules of the house. You know, husbands and wives have general house rules, roommates have house rules. Dorms have house rules. That’s what you’ve established. And it’s a lot less about you being a person living with schizophrenia and much more about keeping everybody in the house healthy and safe.
Rachel : Yes. Mm hmm.
Gabe: So preplanning is also more motivational issues. Expectations are set when everybody as well.
Rachel : Yes.
Gabe: So preplanning is also more motivational issues. Expectations are set when everybody as well.
Rachel : Yes.
Gabe: We will be right back after this message from our sponsor.
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Gabe: And we are back discussing motivation in schizophrenia.
Rachel: One other thing is that I know my big issues, okay. The clothing I talked about. Another one is eating. So I have a lot of protein bars. I always have protein bars. When they’re on sale, I’ll buy like a case. So, so many protein bars because I know a lot of times, I can’t make it up the steps, to the kitchen, but I’ll have that protein bar by my bed. So. OK. OK. At least I eat something. To take my pills, I have to have some kind of food in me. So that’s another reason it gets caught on the pills thing is that, well, I haven’t eaten and I have to go eat before I take my pills and everything just spirals. When it comes to hygiene, I actually read this on a schizophrenia forum and someone said that on the days when they couldn’t get out of bed and shower, they had the little, like you would wipe a baby with, those little wipes. And I was like, that’s so smart. And I went out and got them that day. And yes, some days, that’s what I use, you know.
Gabe: I really like these examples because on one hand, the cynic in me says, oh, you didn’t eat a healthy meal, you didn’t get out of bed and you didn’t take a shower. But that’s not the level that we’re playing on, right?
Rachel : Go with this. Isn’t that. Yeah. I did that thing, but I did something. I did something moving me towards it. All right. That might not have been like what anyone else would’ve done if the goal was to take a shower. I didn’t quite get there, but I did something towards that. I took care of the problem in a way that I could as opposed to just doing nothing.
Gabe: And that’s empowering because previously you had done nothing. So we really have to reward small successes with this illness. We just have to because it’s not ideal. That’s why it’s an illness.
Rachel : Correct. I mean, the protein bars thing, you know? No, I don’t want to be someone who’s like, well, all I had to eat in the past week as protein bars. I’m going to be incredibly, you know, for one sick, because ugh. I also buy really cheap ones, so they taste terrible. But I did something. I’m not just laying there like wasting away. Two or three days of that, we’re having another problem. But usually my parents have noticed that there’s something going on. We haven’t seen Rachel in the kitchen or at all. And they know when to step in, but they don’t have to worry about me just completely not eating or something. They don’t have to worry. I even have like mouthwash for days that I don’t even think I can, like, mentally handle brushing my teeth, which again, like right now that sounds silly to say, Rachel, you can’t brush your teeth like I even have a sonic toothbrush. Like you really just gotta stick it in your mouth and your whole mouth vibrates it loose. But then some days I’m like, I just can’t. And being able to just take a swig of mouthwash, that’s something.
Gabe: Rachel, you had the good fortune to speak to Debbie Breen, who is a therapist who specializes in counseling people to help them set goals and achieve those goals. She’s sort of an expert on motivation, correct?
Rachel : Yes. Yes.
Gabe: All right, well, let’s hear it.
Rachel Star Withers: We’re here speaking with licensed professional counselor Debbie Breen. So thank you so much for being here with us today.
Debbie Breen: You’re welcome. Glad to be here.
Rachel Star Withers: And I think all of us in life, we’re going to have times when we don’t have motivation to do something. When it comes to people, you know, with severe schizophrenia, depression and other type of serious mental disorders, what do you see that, motivation wise, we struggle with the most?
Debbie Breen: Our feeling of a lack of motivation is a signal that something is not right. We’re not in congruence with our value system or something that’s important to us and/or we haven’t resolved past pain. So think of it like this, our feelings are like the instruments on our car dash. They’re not good or bad. They just tell me what the current status is. If I’m almost on empty, it’s I’m assuming you don’t want red. If my engine’s not functioning, I’m going to see that red light flicker. And that just helps me to act. So what we learn is what I’m thinking about is a perception that it’s not the totality of a story or thought. Most of us can’t do this alone. But when we seek professional help, we learn about cognitive behavior and how we are created. We learn to realize, wow, my thoughts are skewed. I am on this habit or passive way of thinking that is negative. It’s like I’m playing a rerun of only the negative things that have occurred. But then that becomes my reality.
Rachel Star Withers: And what about when it comes to working where we’re talking like the issue of like getting out of bed to go to work or just you’re upset with pretty much having to go, period? Like you don’t like what you do in general or just not have the motivation to get up and like pursue work?
Debbie Breen: One of the first signs of maybe depression beginning is how hard is it to get out of bed? And you can have a range from a little bit hit snooze to. I really can’t get out of bed. That behavior is telling me that where the thinking is that I’m feeling depressed. I don’t see a reason to get up. I’m not making a difference. I’m not motivated to go do something or create something. There’s a deficit my life. And I’m being passive with how I’m handling it. And it’s not getting better or going away. So hopefully you’ll get to that point or someone in your life can help you say, wow, I’m saying this and we need to make some changes. I have to be open to trying it another way, learning how to do it another way, maybe shifting medication. But as I move toward that action of trying to solve it, I’m doing something active, which then gives me motivation and hope that life can be different. If I just can’t get up and get out of bed, then we need to find help, we need to find support. We need to find professional help because that tells us our body is just it’s not working and it’s going to take more than self effort because that’s not working. We need someone to walk with us. There may need to be medication management. We need to learn these skills. And again, that’s a choice. The motivation is I don’t like what I’m experiencing right now, and I need to choose to do something different.
Rachel Star Withers: Well, on that note, what you just said about support, that’s perfect. But a lot of times people when we’re in those states have just that kind of deep depression, an episode, schizophrenia, it we don’t see that. What would friends, family, what can they do when you see someone like that who doesn’t realize how bad they are?
Debbie Breen: And that’s a tough thing because if you’re an adult, if you’re over 18, that person’s gotta want to get help. And that’s where it’s difficult as a family, when we can’t make someone get help. But we see them suffering and then we’re hurting with them because we love them. But there’s gotta be a choice with that individual wanting to take the steps. First thing is just we want to be present. Whether it’s mental health, or we could even say, let’s say loss or death, talking is not what’s needed. We need someone just to be present. Quiet. Accept that this is what I’m feeling and thinking. It’s not a fun place to be, but it’s part of life. It’s scary being in that place and feeling like you’re alone. So having someone just there is huge while we’re working through this. The second thing that person can do is they can validate that feeling by saying, you know what, I don’t understand, but I know what it’s like to feel like I don’t care. Like there might not be hope. We’ve all had that. And we’re reminding that person you’re not the first person to go through it. You won’t be the last. This is part of our human condition. And just validate and not judge it. After some time has passed, and I know that’s relative, what we want to do is we want to pull them from the feelings state, which is where they’re drowning in to thinking. We’re just too far on this side and we need to bring some cognition that we need to start changing those thoughts from all negative to what can you do? What is important to you right now? What do you need? So if someone is feeling, what’s the point, hopeless. Then they’re communicating to me that they want to have a desire for purpose. They want to have meaning, but they’re not seeing it in the current moment. So we start with what’s important to you or what do you value? Let’s say if it’s your pet, well, we want you to focus on your pet. I want you to show acts of kindness. Pet him, walk him. I want you to think about your pet and taking care of your pet. Your pet counts on you. Now I’m bringing back into their cognition a positive thought of an important relationship and that is that pet needs them and they do have purpose. I just want them to start thinking about what they can do, which helps put in perspective this imbalance that’s going on. And give room for them to choose. To make things different may take time. Everything is a season, but I need to want to reach out to that resource and then start to participate.
Rachel Star Withers: Debbie, so if there’s someone listening right now who is struggling with motivation, whether it’s something really small or like a major life event, they’re just having a hard time accepting and moving forward. Do you have any advice that you want to leave with them?
Debbie Breen: I understand where they’re coming from. You live long enough, and I’m older in years, and you see things, and you go through things and life is hard. To go through that alone is very difficult. We really need, again, our support, our friends. We need a sense of community who can just be there with us and help care. And then vice versa, when we are out of that, we are then there for them. And there’s a lot of security in that. There’s something about feeling alone, which is where we feel when it’s dark. That’s frightening. It’s easy to want to quit, your brain’s saying it’s always going to be hard. It’s never going to get better. And that’s not the truth. So, that’s a tough place to be. The message is you will get through it, but we have to be active in that. We have to take those steps and it feels really hard.
Rachel Star Withers: Debbie, where can our listeners find you?
Debbie Breen: Our practice is Charlotte Family Counseling, and we’re located in Matthews and in downtown Charlotte, North Carolina. And our website is www.CharlotteFamilyCounseling.com.
Rachel Star Withers: Well, thank you very much, Debbie. It was wonderful speaking with you today and hearing about your advice for us.
Gabe: Rachel, that was really cool. I’m glad that she agreed to be interviewed by you.
Rachel : I really like how she stressed that it was a choice, regardless of how I feel, what’s going on. Choose to do something. Pick something and just focus on it and do it. Kind of what she said with the choice thing. It made me start thinking that if you switch out motivation for the word choice, it really changes a lot in your thinking. So if you’re like, man, I lack the motivation to get out of bed. It becomes I like the choice to get out of bed. And I’m like, well, no, I can get out of bed. You know, I would actually think, well, no, of course I can do it. And it just made me start like thinking. As I mentioned earlier in the episode, one of the biggest things I struggle with motivation is social interaction. I want friends and I know as a human I should have friends. That is a healthy thing people do is interact with other people. And yet I’m so bad at replying to texts and actually talking and making those friendships. A lot have fallen by the wayside. And not because I’m being rude in my mind. But I just, I didn’t follow up. I didn’t stay connected with those people. So I did a little experiment and decided that, OK. My issue is that I lack motivation. What’s something I can do? Something small that is going to help me with that? So I decided to give five people different compliments. Something about me that I would probably think in my head and said, I’m going to actually say it out loud.
Rachel : And, you know, that’s like all original. That’s pretty little. No, I’m going to have to interact with five people that I probably wouldn’t have said anything. But I did. I got all five people. I talked to one of my co-workers who always dresses amazing. His hair is amazing and he’s just incredible. I’m just like, Michael, you always look so amazing. And he got so happy. He’s like, Rachel, it’s so sweet of you say that, you know. And we talked a little bit about fashion. This other girl at my work, she came in with her hair bright blue. This is a very interesting place I work at. I know it already sounds exciting, but I was like, you know, your hair just really I don’t know. It makes me smile. Like it was like Smurf color blue, as she said. Oh, thank you. You know. That’s a pretty big change, like, yeah, that’s an incredibly huge change. But it was just cute, though, like it actually looked cute on her. I don’t think it would look cute on me. I saw this girl who had like a full tattoo sleeve, which I’ve always wanted. I’m nowhere near close to that. But I want to. When I see it on women, I think that, I just don’t know, it looks so cool to me. And I told her that. Of course, whenever you tell someone like their tattoo looks cool, they immediately are going to tell you the backstory. I got this, like, okay. So I heard how she got her next 20 tattoos on her arm. One of my acting students, they’ve come so far. And after classes, I said, Hey, hang back a minute. I just want you know, I’m really proud of you because that today was the best you’ve done in the past 20 weeks. That blew my mind. That is a completely different person. This dude just completely lit up. And then on my way home, I ran out of people. I was at the gas station and the lady across from me at the pump, she had these really cool like cat eye glasses. They would look ridiculous on me, but they looked so cool on her. And I just told her, I was like, you look so neat with those glasses, like eye catching and like she looks like this edgy, cool person. And she just smiled and was like, thank you. I just got them. And doing my little experiment, did it fix all of my problems? No. But my issue was that I’m having trouble with being social. And those five conversations are way more than I would have had if I hadn’t pushed myself to do that. While five seems like a lot every day because some days I don’t leave my house like I don’t have to. So, you know, I decided, though, regardless, every day, Gabe, from now on, I’m going to give at least two compliments to people. And so we’ll start with you for today. Gabe, you are a wonderful host and co-host and interviewer. I’m always impressed by your speaking skills. You’re very clear. And I think that you do an awesome job of like breaking ideas down. So that is my compliment for you, Gabe.
Gabe: Thank you, Rachel. I really appreciate that. And what I liked about your story and you may not have even realized it. You pointed out like what you were thinking. I think you kind of showed your hand a little bit because you were like, I saw these glasses and I thought they were cool, but they would never look good on me. And, you know, I saw the tattoo sleeve and I want one, but but I’m nowhere near there and I’m never going to get around to it. The pessimism, the lack of motivation, the whatever words you want to use, it came through in your own storytelling and yet you overcame it. Instead of sitting with the negative thing and doing nothing, which by your own admission, was your trend. You took the negative and turned it into a positive. Will you do that every time? No, of course not. As you said, to solve all the world’s problems? No, of course not. But it helped. I mean, now that you’re doing it twice a day, obviously you’ve felt that you’ve got a lot of benefit from it. Yes.
Rachel : Oh, absolutely. And it wasn’t. And that’s one thing I was giving the backstories. I didn’t want you to think, Oh, she’s just go around making up stuff to say. Those were thoughts I had. I just, you know, normally would think them. And like, I should tell Michael that I always love how he dresses. He just looks incredible. Just stepped off the runway. And I’m like, what have you done today? And he’s like, oh, I just decided to come here, just woke up. And I’m like, he did so good. But there are things that I think inside, and when I actually said these things, you know, it’s kind of cool to see someone light up. Just like, we all like getting compliments, you know? Yeah, that was a little interaction we had. And all those people were like, I made them happy enough to smile, which made me smile. And I’m like, go, Rachel, you connected.
Gabe: That is that is awesome, Rachel. And I think that everybody should try this experiment. Give one compliment a day. Give two compliments a week or find out what you can do that is seemingly small and insignificant and see what kind of results that you get.
Rachel : Figure out what is something small? And at least do something.
Gabe: I understand what you’re saying about switching motivation and choice, but in my year, what I hear is like, that’s great for normal people. That’s great for people who have, you know, typical problems with motivations. I kind of want to play a little devil’s advocate for a moment and say, well, wait a minute. Do people with schizophrenia have the choice to get out of bed? I mean, can they really just will themselves forward? I think that a lot of people are going to hear this and think, oh, wow, this is the advice of, oh, you should just do yoga and your schizophrenia will be fine.
Rachel : Very good question. With that, I think, no, it’s more changing the thought because whatever is overwhelming, changing it. Social interaction feels overwhelming. What is something that I can break it and make it easier? OK. Getting out of bed and brushing my teeth today seems overwhelming, but, OK, let me break this down. What can I do? Well, I can start by getting towards the end of the bed, standing up, grabbing the mouthwash. Just what can I do? I might not be able make it all the way in there. What is something? And like narrowing down, I get to Wal-Mart and suddenly it seems overwhelming to go inside. I’m sitting there with like, what do I do? All right. What can I do? Sometimes, you know, I can just get out in the parking lot and just doing that motion. I’ll slowly go inside. Sometimes I wear my glasses inside. I don’t know why. It makes me feel like, I feel invisible. You know, I’m not. But I feel that way. Wear like a really low, low hat. And I’m kind of like in my own world. And other days, it’s like, you know, I’ll have to go home. But instead of not doing anything, I’m going to text my mom. Can you help me get my medication? Can you help me do this thing as opposed to just keeping it to myself? Like actually opening up and thinking, what can someone else help me with?
Gabe: I think it’s important to understand that coping skills have a place right. You know, obviously, if you are in the middle of severe hallucinations or if you’re in crisis or if you are very, very delusional, then the help that you need isn’t utilizing a coping mechanism. You need more help then this could provide. So these are skills that you should use it when you’re maybe in the middle of the spectrum. It’s really hard to sort of discuss when these skills will work, but it is a tool to put in your toolbox that you can use when appropriate.
Rachel : And let me always be clear to everyone. I actually am on medication for my schizophrenia and depression. I have been for many years. So I always want to put that out there that no, I didn’t just naturally, yes, use these coping mechanisms and everything was OK. And Rachel got to like skip through the field, happy. I am on quite a few medications which have to be tweaked very often.
Gabe: It’s important to understand, of course, that we need many tools, right? You know, the best painter in the world doesn’t have one paintbrush. But for some reason, when it comes to discussions surrounding schizophrenia, everybody’s looking for that one thing. We want one thing and that will make everything better. This is a discussion about one area lack of motivation. We do have to have this general assumption that other areas of the disease are in a good place,
Rachel : Correct. Yeah.
Gabe: Because obviously, if they’re not, motivation is not your primary concern.
Rachel : Mm hmm. No on days I’m out of my head sometimes I mean it, though, like when I’m hallucinating it, I don’t need to go. It has nothing to it. Rachel needs to get the car and go get her her medication. Rachel’s like in another world. So that’s not the same thing as like what I’m talking about today. The big issue there is I need to deal with kind of the crisis. I mean, not worry so much about my lack of motivation. Hey, listeners, we want to get to know you better. So please take a brief 3 minute survey so we can better understand you. Who’s listening to this? Go to PsychCentral.com/survey19 to complete it now. So everyone who completes the survey will automatically be entered into a drawing for a free one hundred dollar amazon.com gift card (void where prohibited). So Gabe, I assume I can apply, right? I can take the survey?
Gabe: I think that both of us are exempt from both filling out the survey and winning the gift card.
Rachel : Oh.
Gabe: So that just increases your odds and we really want to do this so that we know you better and can make the best show possible. So check it out over on PsychCentral.com/survey19.
Rachel : And as always, thank you for listening to our podcast, Inside Schizophrenia. Please share this podcast, like it, subscribe, comment. And share it seriously with your loved ones. Whoever you know that you’re probably listening to this podcast for a specific reason. Share it with that person that you’re worried about or that you’re trying to help. Or if you’re that person, share it with maybe your people around you so they can understand better. Thank you so much for listening, guys. And we’ll see you next month for another episode of Inside Schizophrenia.
Announcer: Inside Schizophrenia is presented by PsychCentral.com, America’s largest and longest operating independent mental health website. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. For questions, or to provide feedback, please e-mail talkback@PsychCentral.com. The official website for Inside Schizophrenia is PsychCentral.com/IS. Thank you for listening, and please, share widely.