I’ve been watching several YouTube channels devoted to dementia and caregiving, on behalf of a friend whose dealing with a spouse in the early stages of cognitive decline. I’d like to give her appropriate support, but I think many of us also watch these videos, wondering if we will be in the same boat one day.

I’ve noticed a number of instances where there is an overlap between dementia and schizophrenia, with one of the main things they have in common being anosognosia. This describes lack of insight into the illness itself.  While many people assume that a person with these issues is just “in denial” or being uncooperative, lack of awareness about the illness is part of the disease.

Dr. Natali N. Edmonds, a gero-psychologist, mentioned a behavior called “show timing” in one of her episodes and I was struck with how this is so common in the schizophrenia community as well.  The phrase “show timing” refers to a behavior where the ill person displays obvious cognitive decline when alone with a family member or caregiver, but this same person appears very normal and conversant when they are in the company of a doctor, friends, or others.

At the very least, this makes the family member or caregiver appear as though they are over-reacting to their loved one’s current mental state. However, there is much more at stake. This show-timing behavior can mislead the professionals and further delay a person getting the care and attention they need.

Many people know the frustration of trying to get their loved one with schizophrenia hospitalized when they have shown obvious grave illness, even a danger to self and others.  But when the social worker, therapist or law enforcement arrive, this same individual acts normal and not in need of urgent care.  After all, it’s “showtime.”

On one occasion, I was able to sit in with my son for a session with his psychiatrist, where he reported to his doctor that everything was fine and dandy.  Meanwhile, I knew that earlier in the day my son had been given a 30-day eviction notice from where he was living for outrageous antics. If I had not spoken up, the doctor would have been misled into believing that everything he was doing for him was working.

My own son was always very cordial and cooperative when police questioned him. One time, I witnessed him carry on a very normal conversation with a police officer who, after about five minutes of chit chat, asked my son if he was hungry. My son said yes.  Then the officer asked him how long it had been since he had eaten.  Very casually, my son said that he probably “hadn’t eaten in a few years.” The cop looked at me with a knowing expression and shortly after that my son was led away to the patrol car.  And thank God.  Because that was my son’s last hospitalization more than ten years ago. It resulted in him getting conserved and he spent two years in a psychiatric facility.  While that may seem harsh and some might even consider that a violation of his civil rights, it actually led to stability for the first time since his illness emerged a decade prior.

There are many other examples I could give and fellow family members know this experience very well. It’s as if someone who is clearly on the brink of no return can somehow revive themselves and put on a good show, for a limited amount of time.  Now, is there ever any conscious manipulation going on? That I cannot answer.  However, one mental health advocate said in his presentation that patients often refuse to discuss symptoms, or downplay them, so that they do not have to take more sedating medication, often with serious side effects. I can relate to that. He said to the audience, “They may be crazy, but they’re not stupid.”

How to get around this situation? If you have seen your loved one behave this way at least once, and where it subverted their need for a change in treatment, medication, or a new course of action by anyone involved, then it is time to anticipate the show-timing will continue to happen. You can let the mental health professionals know in advance that this is your loved one’s modus operandi when your loved one is not within range to hear the discussion.

If that environment is not guaranteed, you can show up for an appointment with a bullet point one-pager for their eyes only, listing your loved one’s recent concerning behavior and noting that they are not likely to bring those topics up on their own, or accurately describe them if asked.  Giving a doctor or therapist advance warning usually works in your favor. If it doesn’t, then you might need to get better people on your team.

Author: Kartar Diamond, author of Noah’s Schizophrenia: A Mother’s Search for Truth

From the Noah’s Schizophrenia Blog Series