When I was studying social work, I was always fascinated by what we call the ‘family system’.
Essentially this equates to the interconnectedness of each person in the family and their effect on one another. As social workers we understand that families are intricate, complex, and heterogeneous. Families have elaborate patterns, rules, and roles that shape us from inception. With all of these factors coalescing, family dynamics are fraught with dualities that further complicate these relationships. And that’s without the additional ramifications of mental illness, with its affiliated shame, guilt and ambiguous loss.
When it comes to supporting a loved one living with a chronic mental illness, there is a constant ‘push/pull’ that happens. People with depression, bipolar, schizophrenia, addiction, PTSD, and other challenges want to have agency over their lives. However, those with long-term psychiatric disorders often need more extensive support from parents, leading to an imbalance and relentless attempts to manage the need for autonomy with caretaking. Then there’s the over-functioning vs. under-functioning dichotomy. One family member, usually a parent, takes on too much responsibility, control, or emotional labor. Another, usually the person struggling with mental illness, feels restrained, helpless, or defeated. One person works hard to manage stress, while the other pulls back or shuts down, ultimately locking everyone in a rigid, reciprocal trap.
“We could heal the world if we focused on healing the family.” Virginia Satir
For most—if not all—of our families, they’ve spent years navigating the mental health system with their loved one, with frequent inpatient hospitalizations or comprehensive treatment programs. They feel helpless and powerless. They carry ambiguous grief for the loss of a prosperous, comfortable life that they hoped their child would have. They become anxious if their son or daughter misses therapy or forgets to refill a prescription. They end up assuming a caretaking role, making sure their loved one gets to their appointments, follows through with recommendations, takes their meds, pays their bills, showers etc. etc. They have to rationalize their actions when they need to step in or parent their adult child. They find themselves in a cycle of saying, “Yes, but…if I don’t do it then they’ll get worse/need to be hospitalized/stop taking their meds, and then I’ll need to intervene. We’re trying to prevent that. We’ve been down this road so many times.”
For most of our residents, they’ve spent years in a sterile ward or a dimly lit psychiatrist’s office, carrying the shame of a life they didn’t envision for themselves. They feel guilty for the impact of their illness on their family. They feel angry when a parent gets on their case about being more social, frustrated when they don’t have the desire to get out of bed. They hate it when someone tells them to use a coping skill or identify what their early warning signs are. They don’t want to have another conversation about their treatment goals. They want to hide their symptoms for a little longer because they don’t want to worry their parents. They become anxious when the topic of their mental illness is brought up around others. They don’t want people to think their diagnosis is all that they are. They don’t want to relive the past. They hate it when the focus is on their disorder, or when a loved one references “that time you were manic…” or “the last time you were psychotic…,” or asks, “Remember what happened the last time you went off your meds?”
There are no easy answers when it comes to navigating the choppy waters of family relationships. There isn’t a manual or a 1-800 number. So, where do we go from here? How do we sit with the consequential matter of wanting to alleviate the distress of a loved one living with mental illness without depriving them of their autonomy?
Strategies for families:
- Involve them in decisions: Allow them to make choices about their providers and their recovery.
- Allow for small mistakes: Growth requires room for failure. We gain insight and perspective when things don’t go as planned.
- Let natural consequences happen: This is especially difficult for parents. You want to protect them from something bad happening, but it’s important to experience the results of our choices. We build resilience and learn more about ourselves in moments when we are challenged, and hopefully what to do differently next time.
- Respect their right to refuse: Accept that they have the right to have autonomy over their body and treatment.
- Separate the illness from the individual: Remember that their behavior often comes from symptoms, not who they truly are. Keep in mind who they are from before and outside of their illness and what you love about them.
- Protect your own well–being: This one is particularly tough for parents. But you cannot pour from an empty cup. Set clear limits on money, time, behavior, or safety.
- Talk about normal things: Don’t make it about what they discussed in therapy or whether or not they took their meds. Talk about what they enjoy, current events, or hobbies.
- Ask before giving advice: This one SO important. Sometimes your loved one just wants to be heard, not fixed. Ask them how they are feeling or how they would like to navigate a problem before jumping in to try and help.
