The mentally ill person is not a child. I have had the experience of would-be helpers who treated me so. When I attempted to describe what I needed, they argued and belittled me for needing help. I felt very alone and one result was that I stayed away from the church where this person was not only a member, but an officer of sorts. It was hard for me to treat him with charity. I turned my back when he greeted me afterwards because I could not stand his hypocrisy.
We are sensitive about being patronized because of our condition for the same reasons that African Americans are sensitive about race. No one wants to be excluded on the basis of a condition that he cannot help. No one wants his condition denied. No one wants to feel cut away from the body politic. What we want is for people to take us seriously whether or not we are in episode.
Many of the problems that people have with the mentally ill have to do with communication. Those who wish to help (and those who do not want to help) believe that the objective of interaction is to get the mentally ill person to follow a treatment plan or pull herself up by her bootstraps or realize that it is “all in your mind”. (“Have you tried not being depressed?”).
There are good resources for how to talk to a mentally ill person, but this article focuses on how to listen. Hearing someone out matters more than all the advice in the world. You have to remember that a person in crisis feels under attack by the world. She is scared, frightened of what might happen next. Her mood has found a trough deeper than the Dead Sea. Voices may scream at her night and day, insisting that she is evil and that she should kill her family. Or she may be sure that the next door neighbor is a witch and wishes her harm. In comes the well-meaning friend with a lecture on exercise and eating right. The friend listens to perhaps one or two sentences before he dumps his “cure” on the sufferer. When the patient declares that she is overwhelmed, the common result is that the friend or family member feels angry at the “stubbornness” of the patient and abandons her mid-crisis.
As a caregiver, your job isn’t to fix the problem, but to be there for her. Being there requires hearing her out without judgement and with the best understanding you can muster. The conversation must be open-ended, though you can eventually attempt to direct the person to resources that can help.
Before you suggest cures, you must examine your thinking for any prejudices you may have. You need to eradicate or at least contain beliefs. Mental illness is a brain dysfunction as real as diabetes or cystic fibrosis or multiple sclerosis. The person isn’t just making it up to get attention. The pain and the disorientation are real.
Remember that mental illness does not mean that your friend is stupid or homicidal. The cognitive impairment that afflicts her is temporary and she is very aware that things aren’t as they should be in many cases. Chances are she isn’t a danger to you, but she might be a danger to herself so it is important that you act.
Another thing you must keep in mind is that people are not always in the clutches of their particular Beast. We have lucid and calm periods. These can happen in a rhythm of their own or they can be stabilized by medication. So your next step must to be to assess the person’s state of mind. Stable people have problems, too. The reason why you spend the time with them is so that these problems won’t upset their balance and cast them into an episode.
What do you do for people in a bad state of mind? Find out if they are suicidal. If they are, you must get them to a hospital, either by driving them yourself or calling emergency services. Do not assume that a suicidal person is just trying to get attention. People have died when friends who believed this turned their backs on them. Don’t be that kind of friend.
Now comes the part that most people get wrong. You must sit down next to them and let them tell their story. You can ask questions for clarification, but otherwise just hear what they are saying. Let them take as long as they need. You can take breaks, but be sure to come back.
What the patient needs to hear more than anything else is that they are not alone, that there are people who will see them through the crisis. Avoid threats. Listening to a friend in depression may not be easy or fun, for example, but it is the noblest thing you can do. If a person is paranoid, remember to affirm how hard it is to experience this state. They don’t want to hear that they are wrong, but they will respond positively if you acknowledge their pain.
After they have unburdened themselves, you may encourage them to seek professional help. The message that you want to send is that they have a real condition that can be ameliorated through medication and psychotherapy. Assist them in finding a psychiatrist if they don’t have one. If they do, get them to find their psychiatrist’s emergency number and call. In the worst cases when the hallucinations or the paranoia are more intense than they can stand, get them to a hospital. The situation is not hopeless. Relief is available.
The hardest cases are those people who will not take medication or seek outside help. They may have reasons for this: they fear the side effects; they don’t want their personalities changed; they think Big Pharm made up their illness so it can make a profit. Many of these issues stem from misinformation. Some reasons are products of paranoia. I have known people who did not want to take medications because doing so would label them as crazy. Don’t treat any of these issues lightly, but don’t get in an argument either. Maintain the connection.
For many years, I denied that there was anything wrong with me. The strange thing was that as long as I didn’t have a diagnosis, people tolerated me. But I made my wife suffer through my tantrums and despairs. She hinted, she told me about other people who lived with bipolar. I sloughed these anecdotes off as irrelevant. Prozac had cured me. I didn’t need a change of meds. Eventually, however, I realized that the anti-depressants that I were taking had precipitated me into a mixed state. I needed to be on different medications. I came around.
The moral of this story is: Don’t give up. And don’t abandon your friend when they get a diagnosis, either, like many of mine did.
Finish by encouraging them to pursue avenues of self help. Don’t just recommend a book. Many communities have support groups where they can meet with people like them. NAMI and DBSA are two organizations that offer these venues. Offer to go with your friend to one and keep your promise.
Educate yourself before you give advice. Some of your self help remedies may not be as sovereign as you think. Take exercise. A common mistake is to believe that failure to exercise is a root cause of depression. But recent studies show that not only is lack of a desire to exercise a symptom, but it only has a moderate effect on depression and then only for people with comparatively gentle melancholies. If you do suggest this, go for walks with your friend or family member. If they have trouble tying their shoes and getting out the door, coax them to at least get outside in the sun. Don’t be hard on them if they don’t go very far. (My mother did this. It only made things worse.)
Commit to your friend or family member no matter how long it takes. You can enlist the help of other friends so that the burden does not fall on top of them. Make sure that they all know how to listen so that they truly help the person rather than lay a guilt trip on their shoulders or leave them with a sense of abandonment.
The principles that I have described here are based on a program called Mental Health First Aid. Many areas offer this training. If you have a Red Cross certification, you can augment it by taking this course. Here in Orange County, the classes are offered at the Wellness Center once a month.
In summary, treat your friend like she matters to you. Don’t be unconsciously or consciously abusive or dismissive. Listen. Help them find help.