Understanding and Supporting Someone with Mental Illness - advice from multiple perspectives

It recently occurred to me that I am in the unique position of being a student, supporter, and sufferer of mental illness. I do not pretend to be an expert on the topic.

What I present is based on four years of college study, countless hours of self-study, and 30+ years of living with mental illness of my own and in my family.

It is my hope to lend some advice and understanding to those who have never experienced mental illness and are now confronted with it, or those who are still trying to come to terms with it after far too long.

Odds are if you are asking yourself this, your friend or spouse or whoever you are concerned about is more than a little quirky. Whether or not they want to tell you this, or even have acknowledged it themselves, is a very personal thing.

I am very open about my issues after far too many years of denial and faking health. Not everyone is the same. Mental illness carries a great deal of stigma, even the "popular ones" like ADD and Depression with all their new ads for the latest medications. For this reason there can be great deal of denial and secrecy. They might not want anyone to know "what they have". Or they might not be ready to seek treatment and diagnosis. Respect that. They will tell you when they are ready.

More important than "what they have" is "how they are". Something has bothered you about them. That is why you are reading this. Perhaps they are doing things harmful to themselves, friends, or family. Perhaps they seem unusually unhappy, or overly happy to the point of it being disturbing.

I would not recommend flat out asking them "Are you depressed?" or "Are you bipolar?". As stated earlier, they might not want to tell you or they might not even know. Instead, express your concerns to them. Do this at a time when they are stable, or at least not in the throws of rage or mania or a particularly unfocused ADD moment. You want them to listen.

Be as non-confrontational and supportive as possible. Make it about them and your concern for them. Telling your friend "You can really be a psychotic bitch for no reason. What's the deal?" Is not the best approach. Perhaps something like, "You seemed to get really mad over that the other day. Was it really that big of a deal? Is everything ok?" If they want to share, then it is time to listen. If they blow you off, let it go, give it some time, and try again.

If you are still concerned and getting nowhere it is time to consult another friend, family member, or professional.

If you are fortunate enough to have a name to go with your loved-one's behavior, it can help you to learn a little more about it. Many advice columns recommend education to sufferers and supporters alike. I agree. But I don't think a lot of them do a very good job of telling how to get that education. Many will refer to things like the National Institute of Mental Health. A reputable resource, if you can understand it. They will list symptoms that can be attributed to anyone, or one's that you might not understand. You might know what it is to be irritable, but you have no idea what that feels like to a bipolar person. You can look up the definition of hypersensitivity, but you will never begin know what that feels like until you hear it from someone who has felt it.

I was a psychology minor in college and have studied these diseases. I have also experienced most of these symptoms at one time or another. Even I didn't fully grasp many of the symptoms of bipolar and ADD listed on these types of sites. They are simply too academic to be of use to the average reader. I was in complete denial that I was "one of those people" or that I had "that symptom".

It really hit home when I started reading blogs, articles, and newsletters. These provide more than a list of words and dry descriptions. These include the subtleties and details that make it real. They are also written in plain terms.

If you have been researching and getting no closer to understanding than someone trying to teach them-self calculus, try some of the links that I have provided along with this article. As you do your research, remember that everyone is different: different symptoms, different treatments, different outcomes. Use the education as a guide, not a bible. Again, more important than "what they have" is "how they are".

Don't neglect another powerful resource. Your loved one. If they are open about their condition they might be able to help you to understand it. Use the same cautions here are mentioned above. You do not want to ask your friend to explain her medications to you in the throws of an episode of bipolar depression. Odds are she will tell you they are a useless pile of crap. When she is in that place, you need to just be there to support her. Save the lesson for another day.

So many people confuse helping with fixing or curing. You cannot fix or cure someone with a mental illness anymore than you can cure an alcoholic or a diabetic. Nothing you can do is going to make them magically normal. If it were possible to be cured, don't you think they and there doctors would have jumped all over that by now?

Many times, the most that can be done is management through medications and/or behavior modification like avoiding triggers that aggravate symptoms. Some people experience one period of depression and make it through the other side to lead a perfectly "normal" life. It happens. Unfortunately, there are many people that will be haunted by symptoms of their illness for the rest of their life. This does not mean that there is nothing you can do.

There is a world of things you can do to help you loved-one live a more normal life. And really, that's all most sufferers want. Some degree of normalcy.

Believe Them and Try to Understand

Just because they don't seem bipolar or don't fit your idea of someone with ADD does not mean that they don't suffer from it. Remember what I said before. Mental illness does still carry a stigma. Don't believe me? Try having one. So why would someone tell you they have one if they don't? Maybe you think they are doing it for attention? Well if they are, newsflash, attention seeeking like that means something is wrong and they need help.

Besides not denying their illness, do not deny their symptoms or treatments. Don't respond to them telling you about a symptom by pointing out that everyone does that or everyone feels that way. It is most likely they don't. Even if they do feel "like other people", it is obviously causing your loved one a serious problem. Do not try to get them to convince themself that they are fine when they are not. They want to be supported, not belittled.

Just because you don't agree with their treatment plan doesn't mean that it isn't working. You do not know how many times I have heard from my mother that I should stop taking my antidepressants. She doesn't think I need them. I get the sense that she doesn't believe in them. She continues this even after admitting how much better I was after I started them. It hurts that she denies my progress. It hurt me tremendously when my boyfriend flat out denied that I needed to take half a day one Sunday to prepare myself for the work week (being sure I have clothes and food for lunches and dinner) or else I would fall apart. He simply said that it is not possible and people don't do that. Trust me there are other things I would like to do with my time. If one more person tells me I should lose weight and I will feel better I might scream.

As much as you want to make light of a situation or tell them that they are exaggerating, don't. Because they aren't. Even if they really are being irrational, it makes perfect sense to them at that moment.

Take Bipolar disorder as an example. In the throws of bipolar depression it seems like the world is closing in, everything is horrible and wrong, and things are never going to get better. That is completely untrue. Things aren't much different than they were yesterday and they always gets better. But that is not how they see it. Don't agree with their flawed logic. But don't tell them they are acting crazy and stupid and make light of it. Certainly don't tell them to snap out if it! If you can help them to lift their spirits then do it. But if you can't, simply be there for them. Make sure they feel supported and stay safe until they make it through. The same goes for for a period of mania. When your friend is in the best mood in years and feels like they can do anything, you might not want to waste your time calling them crazy and pointing out all of their shortcomings and reasons that they will fail. It won't work. They truly think that they are making sense. Gently try to get them to use some rational logic, if you can, and keep them from doing anything harmful. After its over you can tell them what a nut job they were being. They will most likely agree. When they are having a fit of rage over the smallest thing, do not yell and argue or shout for them to calm down. Its just going to make it worse. Believe that they at that moment are feeling anger so intense that they can barely keep it together. Why over something so small? They don't know any better than you do. Stay calm and rational. If there is immediate danger to yourself or another do not be afraid to call the police. If they say they want to hurt you, at that moment they might mean it. The more you learn about their illness, their stressors, what helps them and what hurts them, the better you will be at understanding and the better you will become at helping and supporting. This will come with time. Or again, you can ask them when the time is right.

Support Them

Sometimes someone to listen is all the support your loved one needs. Its called venting. It's therapeutic. Thoughts that swirl around with no outlet can add to anxiety and depression. If they want to talk, listen. If you truly cannot, either because of the subject matter or for whatever reason, don't just tell them to shut up and go away. Do not criticise them for whining. Explain yourself. Maybe even suggest someone that they can talk to instead. Think of the last time you had great news that you wanted to share. Now imagine you try to share it and the person doesn't care and doesn't listen. Not a good feeling, right? Don't do that to your friend.

Support their goals and successes. Setting any sort of goal is a big deal for someone with bipolar disorder, ADD, depression, etc. The unpredictable nature of the illness makes any sort of planning difficult. So when they come to you exited to be working towards something you do without any effort at all, don't laugh at them. Don't make them feel inadequate or childish.

Encourage them. Be genuinely happy that they are moving forward and let them know. It will mean the world to them. The smallest achievement can be the biggest deal to someone with mental illness. It took me two years of therapy to learn how to keep my room clean and to understand what a positive impact it has on my life. I believe this is something most people learn in childhood. Well, I am proud of my clean room like it is one of my greatest accomplishments. So when your friend or spouse comes to you with their latest achievement, congratulate them. Do it sincerely. And encourage them to keep it up. They will need it. Set backs can be common and they will need help to get back on track. I said encourage. Do not push, do not nag, do not berate. All of these are incredibly destructive to someone with a mental illness. Nothing is going to crush their spirits faster than you griping about them slipping up, again.

Be patient. There are going to be setbacks. Don't make them permanent by adding negative energy. They are trying. It might not seem like it to you, but it feels like it to them. If they don't seem to be getting anywhere, you can point out the issues, objectively and without yelling or belittling. Point out how much better they felt when they were on track. Then help them get back on track by asking how you can help. It is about support and guidance. Not being a Drill Sergeant. Unless of course, and I will repeat, they are doing something seriously harmful to themself or others.

This might be the most often ignored yet most important piece of advice. Take care of yourself! You are going to be no good to anyone else otherwise. Do not feel like you have to exhaust yourself or sacrifice everything to help your loved-one. That is not your job. You should support them because you want to and you should help them because you can. If you do choose to offer help and support, only do what you can.

If you need a break, take one. Explain it to them. Do not blame them or make them feel guilty. Be very clear that you still love and support them and you are not abandoning them. And know that they appreciate everything you do for them. Even if they don't say it. Even as they are yelling and screaming at you in a fit of rage, or giving you the guilt trip of a lifetime in a bought of depression. Remember that it has nothing to do with you. It is the illness. It doesn't make the behavior ok, but it might help you to understand and to weather that storm.

If it is too much for you, get help. For both of you. Encourage them to seek therapy or to join a support group. If they are in denial and refuse to seek help, do not feel like it all falls on you.

Do not let caring for them mean not caring for you. They do not want to be a burden on you. Seeing you suffer is only going to make them worse. There are support groups for caregivers that you can go to if you have trouble coping. You doing well is going to contribute positive energy to the whole situation and will help them in the long run. And that is the goal after all.