Psychiatric advance directives are not something people talk about enough. Psychiatric medication has saved my life and helped me to function and participate in events and daily activities that I wouldn't be able to do without it. It also saved my marriage and allowed me to have successful relationships with friends and family. I believe my medication is why I do as well as I do (which isn't always great, but I have joy-filled days and many accomplishments that I can be proud of, given limitations). I want to communicate these things to doctors because medication is necessary for my treatment. I can do this by formulating a psychiatric advance directive.

I told my therapist that my primary goal was to learn to handle my anxiety so I could turn my focus to managing my symptoms of schizophrenia. In our second session, my therapist put forth a brilliant strategy worth the cost of this add-on to my psychiatric treatment. She said that when I first start to feel anxious, I should start using all the techniques I have learned to deal with anxiety attacks. By managing my anxiety, I can better manage my schizophrenia.

My husband, Tom, and I are celebrating our 15th wedding anniversary in September. He’s been very supportive of me in my struggle with schizoaffective disorder and anxiety every step of the way since we met. Today, I'd like to celebrate my husband.

Schizophrenia anxiety and anxiety can be intertwined with personality. When you have a severe mental illness, it is difficult to distinguish symptoms of that illness from your personality or life experiences (like upbringing, traumatic events, relationships, etc.). It can be hard to tell what is me and what is anxiety or schizophrenia. Some things are easy to pinpoint. For example, when I hear voices or become paranoid, it is clear that those are symptoms of schizophrenia. It is also easy to identify episodes of anxiety because that is so physically uncomfortable and obvious to me.

A lot of worrying comes with my schizoaffective anxiety. I am constantly worrying—ask anyone who knows me. Even someone who doesn’t know me that well knows that I worry all the time. And to top it all off, I blame myself for my worrying, even though it's anxiety-related. Here’s what it’s like.

I consider antipsychotic medication the most critical piece of my treatment. However, no matter how well the drugs work, I'm still human and have other things going on. On my best days, when I have very few symptoms of schizophrenia, I am still in relationships with others. I still have memories. I have habits. I have patterns of communicating, traumatic events that I've experienced, and a connection to myself. For example, I'm living with the grief of my dad moving into a nursing home and the aftermath of a global pandemic. For me, antipsychotics and therapy work together.

I have an extreme case of schizoaffective anxiety, and I’m preparing for major surgery. I’m getting knee replacements in both knees--one at a time. This anxiety spike about surgery is multi-faceted.

I want to make it clear that my identity is not just related to my schizophrenia. For nearly seven years, during my thirties, I lived almost schizophrenia and anxiety symptom-free. It was before I developed an anxiety disorder, and shortly after the period where I became treatment compliant and took my medication every day. I look back at that time as remarkable.

Support groups have helped me a lot with my schizoaffective disorder over the years. Here are some ways support groups have been beneficial. (Note: this post contains a trigger warning.)

Schizophrenia and routines are good partners. As someone with schizophrenia and generalized anxiety disorder (GAD), my mind can often feel chaotic. I might simultaneously experience olfactory hallucinations (smells), paranoia, and cycling thoughts about worst-case scenarios or other symptoms. These symptoms leave little space in my brain for health and wellbeing. That is why when I am at home, I follow a routine to add order and a sense of safety. Routines can give us a feeling that we have something we can count on when we have schizophrenia. They can also offer structure that can help with feeling out of control.