Living with mental illness: What about the family?

Living with mental illness: What about the family?

One of the things I learnt as a young practitioner was that none of us live in a vacuum.

As a clinical psychologist, mental health issues were the core focus of my training helping me to understand the signs and symptoms of various mental health disorders, the causes and contributing factors and the treatment of choice.

However, what became clear very early in my career was that for all those clients I treated individually with common presentations such as clinical depression, anxiety disorders, Post Traumatic Stress Disorder and schizophrenia, there were partners and family members that felt the full impact of living with a loved one with a mental illness.  I learnt that often it is very common for the family members to be given minimal support as the person with the illness becomes the focus for treatment and one member in the family is labelled “sick”.

As I extended my training to Systemic Family Therapy, this gave me new insights into an understanding of human behaviour, taking the sole focus off the individual and on to the interactional patterns that occur and repeat within families. I learnt to understand the reaching effect that a diagnosis such as Schizophrenia may have on a family and the intensity of the emotions that this brings forth. It is incredible to watch the dynamics and behaviours shift within a family system as people attempt to get their head around the idea that their son or daughter, partner or sibling has a serious mental illness. As psychologists also trained in family therapy, we are able to provide support to all members of a family if needed and to better understand how certain responses and expressions of emotion may serve to make it harder or easier for everyone.

As Virginia Satir discussed in her work on family therapy, sometimes when one child in a family is given a particular label based on their behaviour, there is a natural tendency for other siblings in the family to take on a complimentary role of being “normal” and unchallenging. Often family members will treat the person who is unwell with kid gloves. Siblings often feel intense pressure to do the right thing, aim to cause no trouble and basically fly under the radar, resulting in a life that is shaped by this perception. It is interesting that intuitively siblings will often understand how family systems work and how family members learn to survive in the face of a traumatic event. What they learn is that playing this role is more likely to lead to the family coping, sensing that if they push any boundaries the status quo will be upset and it may increase the tension within the family relationships to a point that is unmanageable. Unfortunately when this happens, often everyone gets stuck and no one is truly happy.

So , beyond family roles, let’s take a closer look at the emotions and behaviour changes that you may experience as a family member of someone with schizophrenia. It is understandable that when a person you love suddenly behaves unpredictably or aggressively, expresses intense paranoia or starts to pace, that your reaction may change significantly towards them. For some people fear and distance becomes the response.  For others stress and anxiety is a daily occurrence as they worry about the person becoming unwell or try to adapt to the behaviours that are challenging.

For mothers particularly often the response is the frequent self blaming thought “What did I do wrong?”  and the future oriented thought “Will he/she ever achieve a normal life again?”. For friends who have less frequent interaction there may be a general feeling of discomfort and awkwardness and a sense that “he/she is just not the same”, often leading to distance from the situation as a means of coping with something they do not really understand. This leads to the person with the diagnosis feeling more isolated, leaving them more vulnerable and often leading to associated depression, paranoia, distrust and anxiety.

Often I hear my clients tell me that they experience anger and resentment towards their son or daughter and then feel awful when they express it and desperately try to remember that it is the mental illness that is driving the behaviour.  In addition, probably one of the most common hurdles to overcome for families is to face the full reality of the illness and what it means and to reach a point of full acceptance. Generally the family members I see recognise that acceptance is the key to moving forward in a functional way, but the level of grief that I witness in achieving this task is tragic. For many the grief is lifelong as they watch their other children achieve the usual milestones in life while their other son or daughter struggles to hold down a relationship or a job, or become upset and disappointed when a long period of being well is interrupted with another psychotic episode.

It is common to feel helpless in the face of your loved one’s symptoms. You may be worried about the stigma of Schizophrenia, or confused and embarrassed by strange behaviours you don’t understand. You may even be tempted to hide your loved one’s illness from others.

In order to deal successfully with schizophrenia and help your family member, it’s important to:

• accept the illness and its difficulties
• be realistic in what you expect of the person with schizophrenia and of yourself
• maintain a sense of humour

Do your best to help your family member feel better and enjoy life, pay the same attention to your own needs, and remain hopeful.

Tips for helping a family member with Schizophrenia

• Educate yourself: Understanding the signs and symptoms of Schizophrenia will assist you with responding in a useful way and help you work towards recovery and handle setbacks.

• Manage your stress: As stress can cause a flare up of symptoms, take the time to create a structured and supportive environment, resist placing too much pressure on a loved one and be wary of excessive criticism.

• Be realistic with your expectations: Be aware of what is reasonable to expect about the challenges and limitations of Schizophrenia.

• Encourage your loved one: Make sure you encourage independence and be wary of stepping in and taking charge when a person is capable of doing something themselves. The balance of support and the encouragement of independence is the best recipe for a more functional life.

• Encourage your loved one to take their medication regularly to avoid relapse.

• Watch for signs of relapse:  Learn to watch out for the early warning signs and symptoms and contact the treating Doctor immediately if you are concerned.

• Ensure that your loved one has stable accommodation and has the supports in place needed to cope effectively.

Living with mental illness is not easy on anyone. Understanding, empathy and education for all family members is so important.