FreePsychArticles #3:  How Do Those Who Care Deal With The Identified Mental Patient?

I believe this question is one of the most broad reaching questions in the field of mental health.   Even a meager attempt to answer it would require volumes.    In this post I will try to set forth some of the issues involved in a basic structure or overview of the positive approach to this very difficult and challenging sphere of life that really affects countless families.

We will focus on the “identified” mental patient who has been diagnosed and effectively has a relationship with the mental health system.   This person may be aware and accepting of the need for treatment, only partially willing or in denial of the condition (or any combination of these levels of insight).    In fact, often the patient can move through these levels of self-awareness and even, for periods, cease to be the “identified patient” since mental health is really a dynamic and fluid process.   Everyone would accept we sometimes feel and function better or worse than other times.    At the same time,  on a more human level, much of the ideas in this post can and do apply to all of us.   (More about this later.)

Also, the term “identified patient” is important, since mental illness, like all illnesses effects the whole “family system” beyond the individual who’s being treated.   This concept brings a whole new light on the issue.   Families or groups are effected by the status of the individuals who form the group.  Sometimes dramatically.   So, although we realize the mental patient is the carrier of the “illness” the effects can and do spread out into the group in surprising and important ways.

One of the most important things to establish a positive approach to relationships with mental illness is to eliminate fear.   I believe history has proven there has always been a great fear of the unwieldy presence of those that “are different” and don’t seem to function or think or feel like “rest of us.”    Mental patients often respond in unexpected ways.   Sometimes they are all too predictable and seem to adhere to a pattern that seems completely inflexible.   And, in fact,  inflexibility or unpredictability often are basic factors of mental problems.    So it is understandable that people are afraid or bewildered when they encounter the mental patient and the purpose of this article is to offer some ways of understanding the problem and growing, well, in wisdom, which is an important ingredient in dealing with anything beyond our normal understanding.

I’d like to make a suggestion:  ‘Mental illness is not so different from normal states of the mind.’   With a little imagination it can be shown that all the things that go on in the mind and emotions of a “mentally ill person” occur in normal people.    We all have experienced moments of anxiety,  fear,  anger,  and even depression.    We’ve all had visions, even though most of them have occurred while we were asleep and dreaming.   Most of us have felt someone was calling our name when there was no one there.   When we’re in a new environment we have had periods of confusion and may have felt mistrustful or unsure of what to believe.

The basic humaneness of our own experiences is shared by both the mentally ill and so-called mentally healthy.    In fact, the basic difference that defines mental illness is in degree.    Once the symptoms of mental and emotional processes cause impairment in one or more of the major areas of life is when we call someone “mentally ill.”

What are the major areas of life?   Basically we’re talking about the spheres of social interaction, work, financial, physical health, legal, marital, family and psychological health.   Another separate section is the status of his spiritual life.

At any given time, any of us can be set with difficulties in any of these areas.   Our ability to recover without being overwhelemed by mental symptoms is the real difference.    In a way,  the problem is not the symptoms, but whether we can continue to function in societyTo return to the topic of “dealing with the mentally ill,” a major problem people have is the feeling of being different.  When the word “psychiatric” is brought up we think “foreign or of another world” and it’s just not so.    In fact the healthiest people have one thing in common:   they all think they’re a little crazy but just don’t worry about it or make it a big deal.

How do we deal with those who are unable to function in the world because of their mental problems?   Especially those close to us?  Let’s look at some basic issues:

1.  Be genuine and kind.    It’s not enough to be real and honest.   We can be honestly angry or hostile but without being kind we do no good at all.

2.  Remember your own limitations.   We can do very little to change someone else.   We should remember who we are in our relationship with the ill person and be that person.    Be that parent, brother, sister, spouse or friend.    You’re not the doctor but you can help the doctor by encouraging compliance rather than giving your own advice that is not asked for.

3.   Learn as much as you can about the illness.  There are organizations for most of the mentally ill with support groups and educational materials.   There are hidden surprises about the condition and really, new vistas of experience and growth.

4.   Share your experiences and identify when you are able with the patient.    Like any relationship, it should be 50-50.    Think about this one.    You’re the one with the judgement to know how much to say and when to let the other have his turn.

5.   “Don’t do for a child what he can do himself.”    This is a principle for raising strong, independent and self-confident children.    I believe it also applies to most mental patients.    This doesn’t mean you don’t help.   Rather, in most situations, if they need to do something, assess whether they can do it themselves, or need some help.   It’s important in human development to be as independent as possible.    So the general rule is let them try and if unable, help begin the process and let them do the rest or whatever is possible.

The issue here has to do with those contacts who are in a position to help and overdo it. Take care of the basic responsibilities of the patient and rob them of the experience of self-realization within that particular task.

6.  Ask questions about their well-being, especially if they appear different or as if something is wrong.   Free and open communication with others is often limited for people in general but even moreso for mental patients.

You don’t have to be a mental health clinician to notice something’s up.   If they become more withdrawn, less talkative, (or the opposite), you can, and should ask simple,  non-judgemental questions, for example:    How are you doing?   How’s your sleep?    How’s the medication working?    Are you having problems with the medications?   Are you feeling badly?   Are your thoughts bothering you?   Have you been thinking of hurting/ killing yourself?    Is there anything you want to talk about?

Of course some of these questions depend on a certain level of trust or confidence you managed to establish with the person.   If you’ve been too reactive or critical in the past you might need to first admit this to the person and try to assure them you won’t ‘jump’ on them is they answer you.

The basic idea here is that ‘if they are harboring something they perceive  as horrible or intolerable and they are unable to let it out, it will grow and may lead to disaster.’    But showing you are willing and able to hear whatever they are thinking can be very helpful. It can give them a chance to share their suffering and thereby making it less frightening or dangerous.    Allowing someone to bring something dreadful into the “light of day” alone reduces it’s intensity and opens up chances to resolve it in more appropriate ways.

If they reveal ideas or thoughts to do something harmful to themselves or others you should not hesitate to seek professional assistance.    You can have the person call a hospital emergency room, suicide hotline or the therapist OR make the call if the person is too unstable.

7.   Know that you may not understand a person’s behavior or the things they say and that’s fine.    Albert Camus, the writer and philosopher, once said, “Happiness is not having to explain yourself.”    With the mental patient this is even more true especially if they themselves don’t know what they mean.    You might ask, “do you mean such and such…?”    But there is usually no real benefit to pin it down or insist on clarity.    In the absence of overt dysfunctional behavior,  ‘live and let live.’

This refers mainly to severely affected and disabled patients.

There is much more that can and should be said about the relationships between mental patients and the people who care for them.   If you have specific questions or situations please enter them as “comments” and I will try to answer them.

Perhaps, to end this article a story mentioned in another article is worth repeating:

“The Chazon Ish used to stand when developmentally disabled people walked in to his Beit Midrash synagogue.   Once one of his students  asked why ?   He explained that each person is born into the world with a special mission.  G-d provides each with the tools necessary to fulfill his particular mission.

When one endowed with a wealth of tools and attributes, such as intelligence, mobility, speech, financial abundance and the like, it can be deduced he or she has a greater mission of to perform.    The opposite is true.   One born with little or no tools for active achievement has a different type of mission.   Perhaps his ultimate mission is almost complete and his soul is reaching perfection.

Gershon Freedman, MD