Holidays, Hope, and Hard Choices: Caring for a Loved One With Severe Mental Illness

By Dr. Xavier Amador

The holidays have a way of stirring up memories — of what our families used to look like, of traditions we cherish, and of the years when life felt simpler. But for families who love someone with a severe mental illness, like schizophrenia, the holidays can bring something else: hard decisions, private grief, and the heavy question so many families ask themselves quietly:

“Should we invite them this year? And if we do, will it go okay?”

If you’ve ever wrestled with this – if you’ve ever worried about whether your loved one might become overwhelmed, withdrawn, paranoid, or disruptive during a holiday gathering – you’re not alone. I’ve been there myself, with someone I loved more than anyone. And I’ve talked with thousands of families who carry the same fears, the same guilt, and the same longing to make the right choice.

There’s no perfect answer. But there are compassionate ways to navigate the holidays using the principles of LEAP – Listen, Empathize, Agree, Partner®. Below are reflections and practical steps that can help.

When You’re Considering Not Inviting Your Loved One

This is one of the most painful decisions a family can face. It’s never about not wanting them. It’s about wanting everyone – including your loved one – to be safe, calm, and emotionally protected.

If your loved one is actively psychotic, paranoid, manic, or prone to volatile behavior, a crowded, noisy holiday event may genuinely overwhelm them. But telling someone they’re not invited –especially someone who already feels marginalized – is heartbreaking.

That’s where listening is a valuable first step. Ask, “What are you hoping the holidays will be like? What would make it feel good or comfortable for you?”

Let them talk. Even if their answers are shaped by delusions or mistrust, the feelings underneath are real. Reflecting and empathizing with those feelings – without arguing or correcting – is an enormous act of compassion:

“I hear how important it is for you to feel included. Anyone would feel hurt or left out in that situation.”

When you explain your decision, do it with love and humility:

“I care about you. And I’m worried that the big gathering might feel overwhelming this year. I want us to spend time together in a way that protects you and helps everyone feel at ease.”

Then offer something real – a smaller dinner, a quiet visit, a walk, opening gifts together, or a video call. The message is: You are still part of us.

If You Do Invite Your Loved One – and You Want It to Go Well

For many families, including your loved one – even when they’re symptomatic – feels important. It’s a reminder that they are still in the fabric of the family. But it’s okay to want some predictability, peace, and safety too.

Have a conversation in advance

Not a lecture. Not rules. A conversation.

Ask:

“What would help the day feel comfortable for you?”
“What kinds of situations feel stressful?”

Then gently share your hopes:

“I want you there. I also want everyone, including you, to feel relaxed and safe. Can we talk about things that would help the day go smoothly?”

With my brother Henry, this kind of partnership was essential. When he was actively psychotic, family gatherings could be unpredictable. Sometimes his comments were bizarre, or his sense of humor, something I genuinely loved, made other family members uncomfortable.

But Henry and I developed a trusting rhythm. We went into gatherings as a team. Before we arrived, I’d let him know:

• I was there with him
• I wasn’t going to argue with his beliefs
• If he felt overwhelmed, he could just look at me and we’d step out together

And I’d prepare the family, gently and without shaming him, that he might say things shaped by his symptoms. I asked them to respond with kindness, not confrontation.

Have a plan for breaks

Henry and I always took breaks – sometimes a walk, sometimes just stepping outside for air. Or yes, I confess, a cigarette for him These breaks were not about controlling him – they were about giving him relief from overstimulation.

Often during these moments, he’d tell me how much he appreciated the quiet. And frankly, I needed the break too.

A plan like this can make the entire day calmer. Decide together:

• What a “take a break” signal looks like
• Where your loved one can go to decompress
• Whether they want someone (you, a sibling, a cousin) to accompany them
• Whether leaving early would feel better than pushing through

This isn’t about restriction. It’s about collaboration.

Avoid arguing with delusions

If your loved one says something delusional or paranoid, stay with the feeling, not the belief:

“That sounds frightening.”
“Let’s take a moment—I’m right here with you.”

The goal is connection, not correction.

Prepare the family (gently)

You don’t need to share clinical details.

You can say:

• “He may need a quiet space now and then.”
• “If she steps away, she’s just taking a breather.”
• “Let’s steer clear of debates about politics, treatment, or the past.”

A little preparation goes a long way.

Let go of ‘perfect’

Your holidays may look different than they did before your loved one’s illness. That’s a grief we don’t talk about enough. But different doesn’t mean empty. Families often create new traditions — quieter, softer, more mindful — that still carry warmth and meaning. A holiday doesn’t have to be perfect. It just has to hold love, kindness, and connection — whatever that looks like for your family.

Give yourself permission to feel everything

Loving someone with schizophrenia is love mixed with ache. Hope mixed with fear. Joy mixed with exhaustion. Especially during the holidays. If you feel guilty, you’re human. If you feel relieved when things go smoothly, you’re human. If you feel sad about how things have changed, you’re human. Be as gentle with yourself as you are with your loved one.

Above all: Protect the relationship

Whether your loved one is there for the celebration or not, your relationship is what makes future help possible. This is not about winning arguments — it’s about building trust.

The holidays can be an opportunity to strengthen that trust in small but meaningful ways:

• A quiet moment
• A shared laugh
• A gentle conversation
• A reminder that they are loved

Some years will be harder. Some will surprise you. But connection – steady, patient, compassionate connection – is what carries us forward. And that, more than anything, is what makes a holiday a holiday.

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