Helping a Family Member Who Has a Mental Illness

I remember talking to a colleague awhile back about her schizophrenic brother. She sadly described how, as he started to show symptoms in his late teens and early 20’s, their mother became frantic. “She was always hugging him and smiling at him – as if she could hold the illness at bay by pouring on the mother-love. Kind of like loading up with vitamin C to ward off a cold.” She shook her head. “Ah, Freud.”That reminded me of the time I met with a couple to consult about their highly intelligent son, unraveling – even as we spoke – in his dorm room at a highly selective, little Ivy college. Despite the urgency of the deteriorating situation, they both first needed to discharge their anger at each other for the part – each was convinced – the other had played in either coddling or being too hard on their only son.Some loved ones do seem to be looking for validation, even exculpation, when they consult. They make it about themselves – rather than be looking to learn and understand how to interact more effectively and productively. Other family members are more instinctively surefooted in these situations, have the right temperament, while some others more easily succumb to anxiety and self-centeredness in the face of the “pressure.”

When severe mental illness strikes a family it’s impossible to overstate the impact: so poignant, so potentially tragic, so laden with deep and conflicting emotions. I’ve never really been tempted to concocting a bulleted list of “tips” or “do’s and don’ts” on the topic of coping with, and trying to help, a family member with severe mental illness. It doesn’t seem right.

Of course each case is unique, and obviously particular circumstances drive the process and determine likely outcomes far more than any generalizations I might come up with.

But there’s one apparent contradiction I don’t have a problem broaching with families: the world of “medical model” professional treatment of mental illness.

First – obviously – it can be fantastic help to the patient and to the family. Truly. The right dose of the right medication, a solid connection to a therapist, along with reasonable cooperation and compliance by the patient can generate relief, stability, and steady progress. I help families stick to the plan.

But, sadly, it can also feed the chaos – the brunt of which mostly lands on families and loved ones. There are so many twists and turns over time: different diagnoses, multiple providers, school issues, work place problems, changed medications, adjusted doses, substance abuse and addiction, all even more complicated by the degree of patient compliance or noncompliance with treatment. To add complexity, who pays the bills really does matter: private pay, health insurance, the government, etc. Official diagnoses and labels enable services to be provided, but can also contradict and obfuscate a complicated reality. On and on it goes. My point about saying this is straightforward: like iatrogenic illnesses caused by going to the hospital, mental health treatment can exacerbate the complexity, inhibit healing, and make things much worse.

To state the obvious, the family is the primary environment in which all of this plays out. The family is crucial to successful help and healing, but it, too, can be a major source of negativity.

Some family members – out of love, loyalty, and a deep sense of duty – step up and are incredible. Some want to step up, but aren’t sure how to do it and are worried about being trapped and have it all turn out to be futile anyway. They’re already living with the effect the situation has on their lives, and their honest desire is for it to just go away – which they (sometimes) feel guilty about.

Helping loved ones with their struggle is a good thing, and so often it’s also absolutely necessary if the family is to function at all. Sorting out the options and choices in an intelligent, emotionally honest way is the way to go. It’s not always easy, but it’s not that hard to make small changes that improve the current situation – and it sure beats just enduring it and doing nothing.

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