How to help a loved one struggling with a mental disorder. This month, my focus will be on the stigma that goes with mental illness, how families can help their loved one who is struggling with a mental disorder, and finally how people can deal with stress to remain as mentally healthy as possible. The Britannica 2003 offers the following definition of a mental disorder: … any illness with significant psychological or behavioral manifestations that is associated with either a painful or distressing symptom or impairment in one or more important areas of functioning.
In the past, the stigma against people with any kind of mental disorder was so great that families would hide their mentally ill person away. People would not get help for fear of being called “crazy.” While the stigma is decreasing, it is still significant in our society, causing many people to stay away from treatment. Some mental illnesses are organic in nature, that is, there is a genetic predisposition for the illness to develop. It is not a sign of inadequacy or weakness any more than diabetes is.
Other mental illnesses arise from childhood traumas or untenable situations in adulthood. The U.S. Surgeon General in a report in 1999 stated: “Between 28 and 30 percent of the U. S. population has a mental health disorder, substance abuse disorder or both.” This is a very large percentage of the population — too large to hide. In addition, the stigma is costing us as a society, financially as well as in pain and suffering.
The National Mental Health Association sponsors a Web site http://www.nmha.org that lists some of these costs. Here are some excerpts:
• People who have untreated mental health issues use more general health services than those who seek mental health care when they need it. (American Psychological Association, 2004)
• In a typical workplace with 20 employees, four will likely develop a mental illness this year. (National Institute of Mental Health, 2004)
• The total health care costs for workers who receive treatment for depression and have complete remission of symptoms are two-thirds less than the medical costs of untreated individuals. (Journal of Occupational and Environmental Medicine, 2005)
• People who receive treatment for depression are two-thirds less likely to miss workdays because of illness. (Journal of Occupational and Environmental Medicine, 2005)
• Even moderate levels of depressive or anxiety symptoms can affect work performance and productivity. (Journal of Occupational and Environmental Medicine, 2005)
As a general psychologist, I see people with a wide range of diagnoses. Some of these include depression (major or chronic), anxiety disorders (including panic disorder, generalized anxiety disorder, obsessive compulsive disorder and eating disorders), schizophrenia, bipolar disorder (formerly manic-depressive illness) and dissociative identity disorder. These range in severity from uncomfortable but easily controlled with medications and psychotherapy to severely disabling.
The mind and body are one. Some writers use the term “mindbody” to illustrate this unity. Stress makes all physical and mental illnesses worse. Frequently, people with mental illness are treated by a team which includes a psychiatrist and psychologist or master’s- level psychotherapist, and sometimes hospital personnel. I have talked to some of my colleagues and assembled a list of ways families can help in managing the illness:
• Learn as much as you can about the diagnosis. Resources include the Internet (http://www.nmha.org is a very good source), your local library, bookstores, etc.
• “Join” the treatment team (with your family member’s OK).
• Get therapy/support for yourself.
• If you help financially, do only what you can realistically afford (agreeing to help and then complaining about each expenditure is stressful for the patient).
• Keep the lines of communication open with your loved one and with the treatment team. Focus on your thoughts and feelings and not on how bad the behavior is. (For example, “I feel anxious when I hear yelling.” “I hate coming home to a messy house like this.”)
• People who are depressed or anxious often look around for someone to blame. If you recognize that your loved one is blaming you for something, resist getting defensive. Instead, reflect what you are hearing to her or him. (For example, he may say, “You don’t pay any attention to me.” Your response: “You’re saying I don’t pay enough attention to you.”) It might help to take an assertiveness training course or read a book on assertiveness.
• Remember how limited the income of the patient is. Don’t expect gifts, etc., that are financially out of reach.
• Do something good for yourself at least once a week (massage, movie, book, walk in the park, bubble bath, etc.).
• Encourage some kind of structured work (volunteer work or limited employment) for your family member.
• Find a way to encourage medication compliance without nagging. Charting sometimes works.
• Encourage regular physical exercise (do it with them if possible).
• Support using psychotherapy.
• Tell her to “get over it; just pull yourself up by your bootstraps.”
• Give him a car unless you’re willing and able to support it (taxes, licenses, maintenance, gas, insurance, dealing with accidents, etc.) Instead, teach him how to ride the bus.
• Give her a pet and then complain about the accompanying costs.
• Add to stress by criticizing and complaining about expenses you agreed to help with.
• Demean the therapist, psychiatrist, hospital, etc.
• Ask “Did you take your medicine?” every time there’s a flare of emotions.
• Tell him he will do better without any medications. If you are concerned that he is overmedicated, get permission to talk to the prescribing doctor.
MANAGING YOUR STRESS:
Kaplan and Saddock in Volume 2 of their Comprehensive Textbook of Psychiatry/V tell us about the coping strategies that people who manage stress well use:
• They have personal control. They believe that they are in control of their environment, and they have the specific skills to be effective in specific situations.
• They possess task involvement. An absorbing task that is meaningful is selected, and the person is willing and able to sacrifice short-term fun for long-term pleasure.
• They make good dietary choices, exercise regularly and find daily time for relaxation.
• They utilize social supports. They have personal relationships that provide companionship, information or empathic listening.
I add to these: Assertive communication enhances self-esteem and a sense of personal control. It also enriches relationships, allowing for greater intimacy and therefore better support. As a caregiver, remember the directions the flight attendant gives when you board a commercial aircraft. I paraphrase: In the event that there’s an emergency and the oxygen masks drop down from the ceiling, if you are traveling with small children or a disabled person, put the mask on yourself first, before helping your loved one. If you pass out, you’re no good to anyone!
By Rosemary J. Stauber
Rosemary J. Stauber, Ph.D., is a clinical psychologist.