We have an office joke that one of the best giveaways to diagnosis someone with psychosis is relying on the sense of smell. When I was new, I didn't get the joke until it made sense after facing my first consult of someone that actually smelled the part.
One of the criteria for Schizophrenia included having disorganized behavior. This includes not taking a bath. I asked the patient what makes them not take a bath and they don't even understand why despite how many times their folks complained about it. It's like having no explanation for why you're awake when you're trying to sleep, it just happens.
So the family has been suffering due to their dad refusing to take a bath. There were hallucinations yes but it was the smell they endured for months that made them to force the patient to finally wash. The patient came in with clear signs of fungal infection on the skin due to several discolorations, dirty nails in corners that couldn't be reached by scrubbing soap, and a distinct body odor of someone needing a deodorant. They were dressed well but the signs of long term poor hygiene couldn't be ignored.
So upon history, the patient did have symptoms of psychosis like hearing voices from people that weren't there, being paranoid as if he was being watched, but these symptoms were tolerable for him except his lack of bathing. And the only thing the family picked up that was odd was his poor hygiene.
This is where the gap in mental health can be for the lay people. Sometimes signs of psychosis are buried in the signs but if they took time to actually listen, they could've picked up on the patient's way of thinking that something was wrong than endure it for years.
And this is my insight when it comes to why most people don't have the tolerance or the capacity to compassionate about other people struggling with mental health problems, it's that because they are sane or don't go through the experience that it gives them a disconnect with the people that do. Why would you argue with someone who is having a psychosis when the patient themselves couldn't even understand what's going on with themselves? I saw their family members losing their shit trying to convince me that their patient was insane and that their feelings enduring this for so long were valid.
True enough, they did need the validation that it must have been difficult dealing with something they didn't understand but some psychoeducation was also warranted to make them understand how to be more compassionate with their family member that is suffering (although in their eyes, the patient didn't look like he was struggling). People with having their psychotic episodes have difficulty developing insight and they would commit poor judgment out of losing touch with some parts of reality. The unrealistic expectation was family members still treating or talking to their patient as if they were on the same sane level. Like talking to someone deaf and screaming at their ear still wondering why the other party can't get the message. That's how I looked at it.
Anyway, the family cares enough that they sought help and was willing to put up with the patient for so long despite how much they claimed they're giving up. When I opened the possibility that this behaviors may change through the course of the treatment, they showed hope in their faces and that's just the start.
Thanks for your time.