When a loved one is diagnosed with a mental illness, it can throw the whole family into a tailspin, rife with self-doubt, suspicion, guilt, and helplessness. How we respond to the illness of a family member can make all the difference to their recovery and the rebuilding of the family’s foundations.
Through many years of practice, we have evolved some trends and guidelines for families with a member with mental illness.
- It’s a marathon, not a sprint. Mental illness often proceeds from one crisis to another with periods of apparent quiet in between. Don’t be fooled, and avoid the temptation to only “swing into action” when a crisis blows up. Positive support and check-ins are important all year ‘round. Don’t focus on “solving” each crisis with the hope that the sufferer will experience some kind of epiphany and function well once the crisis is over. If you do only pay attention when the person is in a crisis you may inadvertently be rewarding negative behavior with extra attention…
- Don’t reward negative behavior with extra attention. If your goal is to get a person to stop doing something self-destructive or hurtful, the insight of Dr. Kevin Leman in his series “New [spouse, kid, teenager] by Friday” is that it is best to disengage when the person is exhibiting negative behavior. This can be tricky. How can you tell if it is negative behavior or a shift in mood that the person doesn’t control when someone starts calling you at all hours because they are feeling suicidal? You often can’t, so you may have to provide basic support to help the person through the crisis, while trying not to get emotionally caught up in what is happening. We teach the residents in Psychiatry to be detached while helping someone through this kind of crisis. An example of this would be to direct the person who is calling you at all hours to contact a suicide prevention hotline, or to go to the hospital if the suicidal thoughts become too strong. Don’t try to explain why you don’t like the behavior or what the consequences will be, just don’t give it the “reward” of more attention than is absolutely necessary. Rewards are for positive behavior and progress.
- Try not to get angry. Punishment is not effective. Which is why we recommend aiming for emotional withdrawal if you are feeling overwhelmed by a constant set of crises.
- In particular, don’t support self-destructive behavior. So, you don’t want to give someone money if they have run out because they spent it on alcohol or drugs… If the person is financially dependent on you, it may be necessary to set up lines of credit at grocery stores and pharmacies, rather than giving cash to a person who is not able to handle it. You are not being “cruel” if you don’t keep rescuing them from their own problems.
- Your positive presence and engagement really matters to a mentally ill person, even if it doesn’t seem (on the surface) to be helping. Giving attention to progress and expressing your hope for their ultimate recovery is what will be remembered, even when your child, spouse or parent is unable to respond appropriately.
- Consider working with a family coach. As you can see, this stuff is hard. It is easy to get wrapped up in your fears and frustrations. Having someone who can provide you with an outside perspective on what is going on, someone who is familiar with working with people and families of those with a “serious mental illness,” can make a big difference. It’s not always easy to find the right person who has time available in their practice, but it can be a very worthwhile investment.
It is not uncommon in our practice for us to receive frantic emails and calls from parents, spouses or other loving connections of a patient asking for help. “I know she’s started drinking all day long”; “he said he’s seeing a new psychiatrist, but I’m not sure if I can believe anything he says”; “if you were in my shoes, what would you do?” We wish we could solve all these problems, but then we would get overwhelmed ourselves. We can sometimes help if you are trying to get a family member engaged in psychiatric treatment and sense there may be an opportunity to do so. In that case we often recommend starting with a family consultation before seeing the patient.
Pacing yourself and hanging in there is the hardest and most loving thing anyone can do.
Nancy
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