How to love someone with serious mental illness

My gut still churns when I see that look in family members’ eyes. The one of desperate confusion and frustration. The fatigue and anger, especially if the symptoms their loved one suffers from has been ongoing for some time or involved aggression. If your loved one has a serious mental illness like schizophrenia, profound depression, bipolar mood disorder, addictions or eating disorders, it is awful. They aren’t the only ones suffering. You are too.

The good news is that improvements for mental illnesses are as good, or even better than, chronic physical illnesses like diabetes or cardiovascular disease. But there is a long road from figuring out what is wrong, to getting the appropriate treatment.

How the family deals with a loved ones’ illness has a direct effect on its prognosis. Studies show that when there are high levels of hostility, criticism or emotional overinvolvement, then there are much higher levels of relapse. This highly emotional way of engaging is called “expressed emotion” or EE.  Over half of the patients who return to high EE environments after discharge, relapse within nine months.

So, for example, to say: “You’ve been lying in bed all week, you are useless” is high EE. To neutrally say: “I’d like you to try to get out of bed today,” is far more effective. To say: “I’d chop my arm off if it would help you get better,” or “I’ll resign from work to look after you,” is also high EE (overinvolvement) and thus problematic.

My patients need you to keep loving them. There is no place for blame or shame

They didn’t ask for their illness and, until treatment starts working, can’t control their symptoms. Similarly, it’s not your fault, and you can’t fix them.

It is normal to be angry when a loved one breaks the contract of how they should be acting. Maybe the family sacrificed to pay for varsity fees, and the patient doesn’t even make it to class. Maybe the patient was aggressive or paranoid about your intentions.

I know that I am asking a lot when I say that you need to grieve the picture of how your loved one should be. Mental illness demands that you see things for what they are now, not of how you always dreamed it would be. New, more realistic expectations need to come into play. Now making it through the day might be considered a win.

The best way of knowing how to act is to educate yourself about the illness. Learn the symptoms, so that you can stop taking them personally. For example, a common symptom of many serious mental illnesses is increased isolation. You can use this as an indicator that things aren’t on track, rather than feeling rejected by it.

There are many resources which you can use – books, the internet, the psychiatrist. Mental health problems are more common than most people realise. There is no need to do this alone, link up with other families on this path. Support groups in your area can be very helpful to this end.

It is hard to respect someone who is behaving terribly, someone who is being irritable, aggressive or erratic. We all need respect; it helps to be mindful that your loved one is still there under all the noise from the symptoms. As much as possible, let the sufferer stay in control. If you have to step in, to administer medication, for example, step back as soon as you can. Maybe use a pillbox until the patient can take full responsibility again. You can show respect by validating their experience. You can acknowledge that it must be scary to hear vindictive voices. You don’t have to say that it’s your reality, nor that it’s rubbish. Acknowledge their gains and courage in the ongoing battle for health.

It is appropriate to set limits, especially around choices which are harmful. If your loved one goes off his meds and gets aggressive, it is necessary to say to him that staying at home is conditional on his compliance with treatment. Try and have it as rules for the whole family: nobody may harm anyone in this household. That way it’s less about singling out the sick one, and more about reinforcing family norms.

Much is asked of you if your loved one has a serious mental illness. You have to stay calm in the face of chaos, brave when you are petrified and hopeful in seemingly hopeless situations. You must be involved, but not overinvolved. You must be supportive, but firm. It’s more than many can bear. So don’t hesitate to get help for yourself. Go to your own counselling and nurture a healthy life. I have seen a “life restored” countless times in my practice. With your help, it’s a possibility for your loved one too.