Tim discusses various options for getting started with medical treatment once you’ve decided to go that route. Should you see a psychiatrist, a therapist, an internist, or all of the above? Or none of the above? It can all be so overwhelming, so tune in for a bit of sanity as you try to start the treatment journey.
It can be awfully hard to know how to help someone with mental illness! Take me for example: Saturday morning, I was comatose with depression on my couch for four hours, hoping for a stray meteor to find its way to me. Today, I’m overflowing with so many exciting ideas for how to solve the world’s problems that I would challenge Steve Jobs to a Battle of Creativity. This, my friends, we call Bi-Polar (type 2 to be exact). You can imagine what fun my wife and kids have playing the “what mood will daddy be in ten minutes from now” game (for now, Ann has a small lead over Josiah, and for some reason Ellie Ruth isn’t very good at the game…she’s way behind, but I’m starting to develop some special signals for her so she can catch up).
So perhaps I’m the wrong person to write this post, since I haven’t had to be the supporter in any substantial way. Thus, what follows is simply the advice of someone WITH mental illness(es) to those who, thanklessly, painfully, fearfully…are supporting someone with mental illness.
A friend of mine recently called looking for advice on how to support his deeply depressed wife. Like many people who are NOT mentally ill, he was frustrated and baffled by his wife’s behavior and her unwillingness to listen to reason. He continued attempting to have conversations with her about how he could help, but he was thwarted by her erratic answers – sometimes she simply told him, amidst sobs, that she didn’t know how he could help; other times, the “saner” moments, she was reluctant, even embarrassed to discuss her previous behavior and couldn’t/wouldn’t offer much in the way of advice to her husband about what she needed when she was in “that place.” My friend was stumped, scared, and frustrated.
Perhaps you’ve been there if you’re reading this…You want to help, but you don’t know how, and the person you are trying to help behaves so inconsistently that you never know if you should leave them alone, hug them, take them to the hospital, or tell them to snap out of it. I’m quite sure my amazing wife, Ann, would understand your frustration as she has felt it with me (but not for at least an hour or two!).
I certainly can’t speak for everyone with mental illnesses, but I’d like to offer a few pointers that might be of help:
- Take charge lovingly. Recognize that you are the one who is seeing the world more clearly than your mentally ill loved one, and take charge of the situation lovingly with that in mind. For example, my young children wear me out mentally. I’m just not cut out to be with small people for prolonged periods of time without becoming extremely overwhelmed and ultimately depressed/angry. But I want to be a good dad/husband, so I often am with them for long periods of time, thus becoming overwhelmed, depressed, and/or angry. My wife knows when I’ve had enough based on how I speak to the kids, and she is usually kind enough to ask me, “Do you need a break?” But here’s the problem: My broken brain can’t see straight in those moments, so guilt usually wins out over my mental health and I say, “No.” The truth is, and I’m not saying that this is fair, that I want Ann to say to me: “Tim, you need a break. Go take 15 minutes of alone time and then we can reassess.” I would take her up on it 100% of the time, but when I’m left to make the choice for myself, I’m not able to think reasonably, “You know, I do need a break, and yes, my wonderful wife, I’ll accept your offer!” Again, that’s not necessarily fair, but if you, the healthy one, will take charge of the situation, I for one would appreciate it, and I suspect others with a mental illness want the same thing.
- Don’t expect them to be reasonable. Once again, I’ll use my children as an example. When one of my children throws a temper tantrum, I, of course, get frustrated by their behavior. Despite having plenty of evidence that you can’t reason with a small child who is throwing a tantrum, I continue to try to reason them out of this behavior by saying things like, “You’re not helping the situation” or “You’re making your own life worse by acting this way.” Any reasonable person would understand what I mean, right? Of course! But a tantrum-throwing child isn’t in a reasonable state of mind, and “fighting” a tantrum with reason will only lead to frustration for both parties. The best solution when a child throws a tantrum is to literally put them in a safe place so they can “process” their anger without hurting themselves, your dog, their sibling, or your eardrums. It’s the same thing with a mental illness: Help the person get to a place, literal or figurative, where they can feel what they’re feeling safely and productively. Having dealt with OCD my whole life, I am well aware that my obsessive thoughts are unreasonable…that’s why they’re so disturbing! But that hasn’t enabled me to stop them from running through my mind. This is where this piece of advice ties back to #1: You, the sane one, need to lovingly take charge. If someone is in the throes of depression, don’t tell them to look at the bright side. Instead, gently insist that they go do the thing(s) that tend to help them improve. For me, it’s time to myself to think and write…it almost always helps. If not that, then working with my hands on a tangible project will sometimes do the trick. Sometimes, there’s nothing that helps, but when I’m in the midst of depression, it’s virtually impossible for me to stand up for myself and to take what I need. I can’t be reasonable, but if someone around me can push me in the right direction, it might help me get back to a good place more quickly.
- Set boundaries about how you will respond to their struggles. As you probably know if you’re reading this, it’s exhausting to support someone with any illness, especially one that is unpredictable and turns your normally-rational loved one into an irrational mess. The friend I mention above confided in me that his wife is not above a little melodrama, so he’s never sure how much of her behavior is attention-seeking and how much is authentic. My advice to him was to tell his wife that he had no choice but to take her at her word…the stakes are too high. Thus, if she says she’s suicidal, he should tell her that he will take her to the hospital because he can’t take the chance that she’s just being dramatic. Another important boundary involves the mentally ill person taking his/her pain out on the care-taker. I’ll use myself as an example here: When my OCD regarding my wife (see my book for more on this) is raging, one of the natural compulsions is to think that talking to her about it might help me get to the bottom of my concern. It won’t! Ever. And it’s entirely unfair for me to talk to her about my negative thoughts about her. All that will do is to hurt her deeply. In this case, we have a boundary that when I’m obsessing about her, if I need someone to talk to, I need to pick one of the other close friends (or a therapist) to discuss this stuff with. The scenarios are endless for what boundaries you might need to set, but start paying attention to yourself, and know that the best way to love someone is to be the healthiest version of yourself so you can be there for them when they need you most. It might take time to figure out the appropriate boundaries, but don’t feel guilty for needing to set them. It’s ONLY by setting them that you can help your mentally ill loved one thoroughly.
- When they’re feeling good, ask them how they want/need to be dealt with in the bad moments. Most people with a mental illness have their good days and their bad days. As someone who offers support to a mentally ill person, your best resource might well be that very person, but only when they’re in a good place. This will have to be an ongoing conversation about what is and is not helpful to your loved one, but every day, week, and month you gather more data that can be used to help both you and the other person move forward to a more healthy place. As I’ve mentioned before, one thing I need when I’m in a bad place is for my wife, who is quick to recognize it these days, to take the lead and tell me what to do. In my case, she needs to tell me to take some time away to hit the reset button. When I’m in that bad place, I’m nearly incapable of taking care of myself, but by staying physically present with my wife and kids when I’m not doing well can cause a lot of unnecessary damage – a lot more damage than would be caused by my taking a “time out” to get my head clear. Your loved one might not know how you can best help them right away, but tell them to ponder and pay attention to what they need when they’re not doing well. Maybe it’s a hug; maybe it’s a time out; maybe it’s a trip around the world on a Disney Cruise ship…who knows? But let your mentally ill loved one be your most helpful resource when they are in a healthy enough state to think clearly about what they would want/need in their bad moments.
- Take care of yourself. This goes back to #3, but I can’t say enough about it. If you’re not healthy, you can’t be of very much help. Think of it this way: If you were taking care of someone with the flu, you’re not much good to them if you run yourself so ragged that you get sick, too. Not only do you endanger their health further, your own ability to respond to the sick person promptly and thoroughly is diminished if you aren’t healthy. The same goes for mental health. Figure out how to fill up your own gas tank so you can help the person you care about. If your tank is empty, you’re of no real use to them.
- Give grace…to yourself and your loved one. Start with yourself. This shit is hard! It ends friendships, marriages, and even lives. Don’t fall into the trap of blaming yourself for not always knowing the right thing to say or how to be of the most help. Instead, literally say this to yourself, “I’m doing the best I can, and that’s all I can do.” It sounds corny, but having been forced by a therapist to do this myself, I can say it actually works: Look in the mirror and affirm yourself for trying, for loving someone who isn’t always easy to love, and for demonstrating the truest version of love – the unconditional kind. And don’t forget to give grace to your mentally ill loved one, too. Hopefully, they’re trying as well, and some day down the road, we’ll be better and figuring out exactly what part of a person’s brain is malfunctioning. Those x-rays or images will make it easier to understand that the person isn’t necessarily choosing to be an erratic ass. Most likely, they’re similar to a person with a broken leg trying to walk without a cast or crutches. If the bone was sticking out of their leg, it wouldn’t be hard to give them grace for going a bit slower than normal or yelping in pain every few steps. But mental illnesses aren’t visible…yet. So whatever metaphor helps you recognize that they’re dealing with something that really is physical and that really can’t be just wished away, try to remind yourself that you can’t expect someone with a broken brain to process life the same way you do. And once again, when you fail, give yourself grace. Then try again. That’s the best you can do.
**People often ask if it’s okay to share what I write with others, as if I am trying to keep it private. Uh, yes, it’s okay since I do publish this on the interweb. But really, I’d be most appreciative if you share this blog (or post) with others. Who knows where it will lead? Thanks for your help!
Other articles you might enjoy:
Amy Glynn reflects on Robin Williams’s suicide in a compassionate and helpful way, acknowledging that we should wish our friends who commit suicide had been equipped to stay around longer, but we should never simplify their behavior as “selfish” or “a permanent solution to a temporary problem.” A refreshing piece! http://www.pastemagazine.com/articles/2014/09/twenty-five-years-after-dead-poets-society.html
“7 of the Most Helpful Things You Can Say to Someone with Depression” An excellent piece that “gets it right” about how to help someone who is depressed.
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