Genetic Influences on Mental Illness

There is more that contributes to the onset of mental illness besides the factors discussed in last month’s article concerning the brain and mental illness. In addition to looking at the biological origins of brain dysfunction, researchers are looking at another major component -genetics. It is hoped that these studies can lead to the prevention of mental illness and/or devising effective medication.

More than half of our genes are responsible for the development and functioning of our brains. Genes contain instructions that carry the code for the building blocks of our mind and body. Unhappily, things can go awry with this hugely complicated biological process-our forebears may be giving us DNA where critical genes are deleted altogether, or we get too many duplications of them, or some of the genes we get “miscode” proteins-all giving rise to genetic defects which will fundamentally compromise the developing brain.

Some research has identified a substantial overlap in genetic risk for schizophrenia and bipolar illness, caused by sub-microscopic mutations –a risk also shared in autism. A “hotspot” has been detected in a single stretch of genetic code, implicating immune system involvement in these disorders. The largest genetic analysis of this kind to date for bipolar disorder has found that a variation in only two genes causes the imbalance of sodium and calcium in brain cells which may be responsible for this illness.

Several studies of schizophrenia identified a wide range of small gene variations, which taken together accounted for 30% of the risk for schizophrenia. A mutation that deleted chunks of DNA increased the risk of schizophrenia eight-fold.

In another startling finding, the studies discovered that the rare occurrence of one extra copy of a gene can cause a sizeable risk for schizophrenia. These micro-deletions can be inherited, but they can also happen spontaneously, which is why some individuals can develop schizophrenia without having any family history of the illness. This could explain why – in spite of the fact that 80% of the risk of schizophrenia is familial - the incidence of schizophrenia remains at 1% of the population even though many people with this illness do not have children.

One of the hottest new areas in brain research is neurogenesis, a still-controversial hypothesis claiming that brain cells can heal, or regenerate. Physical and mental “workouts” are proposed to rejuvenate fatigued brain cells, and even create new ones, while preliminary animal research suggests that anti-depressants and lithium may actually spur development of new cells, and increase neuronal connections in the brain.

Because of research, medication and treatment for mental illness are constantly improving, but there is hope for even more and better.

Now is the time for the reminder: no one is to blame for mental illness any more than a person with mental illness or their family can be blamed for autism, Parkinson’s, epilepsy, diabetes, or other such illnesses.

The brain and mental illness

“What did I do to cause the illness to my loved one?”  This a common question of someone who thinks they are to blame for the mental illness. On the other hand, the person with the illness often blames a family member for their problems. The fact is NO ONE IS TO BLAME.

No one can cause another person to have a mental illness any more than a family member can cause another to have epilepsy, diabetes, Parkinson’s, or any such illness. The research on the brain is convincing that mental illness is not something that one person can do to another. Most of the current research is focused on schizophrenia.

One study shows two “working” brains, one with schizophrenia and one a “normal control.” The brain scan measures blood flow during a planning task. The pictures show that the normal control is able to use the frontal cortex (top of the brain) while performing the task, but the person with schizophrenia has a brain scan that is not “lighting up” in this region at all. Marked sluggishness in circulation and metabolism is typical in schizophrenia.

Other research in cortical dysfunction shows the following:

• Difficulties in working (or short term) memory: People with schizophrenia have difficulty holding information in the mind from moment to moment. This problem is thought to cause the persistent cognitive disabilities experienced in the
• Dramatic reduction in gray matter: A long- term study of teenagers with schizophrenia revealed a pattern of gray matter loss, beginning at the back of the brain and moving toward the frontal cortex. The chief investigator reported, “We were stunned to see a spreading wave of tissue loss that began in a small region of the brain. It moved across the brain like a forest fire, destroying more tissue as the disease progressed.”
• Lack of cortical cell migration: During normal fetal growth brain cells migrate from deep within the brain to the outer layers, and some will undergo natural cell death. Examinations of autopsied brains of people with schizophrenia reveal an excess of cells remaining deep in the cortex. Either they did not ever migrate at all, or they were victims of over-programmed cell death. As a result, the cortex is not well formed.
• Loss of glial cells in mood disorders: Post-mortem brain research has found a severe depletion of glial cells in brains of individuals with depression and bipolar disorder. The study indicated that 40-90 percent of the glial cells were gone.

Research on the size of the ventricles in the brain shows that the size of the ventricle (the fluid-filled cavities in the brain) in those diagnosed with schizophrenia is larger than average compared to normal controls. This means that the brain of the person with the illness is smaller. Individuals with the highest ventricle-to-brain ratio tend to have more sever forms of the disease, have poorer life adjustments before onset, and show a less favorable response to medication. This condition is also found in bipolar disorder and Alzheimer’s disease.

Research on limbic system dysfunction reveals that this powerful emotional processing center is implicated in every major mental illness and accounts for the excess emotionality in depression, bipolar illness, panic disorder, and OCD. This interferes with the normal control of response to anxiety-provoking stimuli.

Studies indicate that people with schizophrenia produce abnormal brain waves; therefore, the brain cannot tone down external stimuli or screen our unwanted stimuli. Nicotine from cigarettes or the patch provide brief relief from sensory overload – even tone down the voices in the head.

Some people who have undergone a psychotic episode say they are left feeling like they were hit by an 18 wheeler. It would be easier to accept the disability if they looked like they had been in an accident: wheelchair, crutches, casts, bandages. However, they still look intact.

This causes a lack of understanding and leads to questions. “Why are you sleeping so much?”  “Why can’t you go back to work?”  “Why can’t you just get it together?”

So……where is the HOPE? With education and understanding – with guidance from the professionals – with medication.

Don't fight mental illness alone

This is one young man’s story of coping with the thought of fighting mental illness alone. It appeared in The NAMI Advocate, Winter 2014, page 25.

“I was diagnosed with schizoaffective disorder in 1999. I was experiencing mood swings, delusions, and hallucinations about evil spirits. I felt like I was very much alone. There are times I still do think I am uniquely singled out to suffer.

But through the help of NAMI and other support groups available to me at my mental health behavior provider, I see clearly that the focus doesn’t have to be on myself anymore. Many people come to the meetings and get to share their difficulties, which are a lot like mine. My meds help me a thousand times over, as well as pastoral care, counseling and case management. When I struggle now with feeling like I am alone, I usually am able to use some of the skills I’ve learned in the support group to realize I am not alone. For example, cognitive behavior therapy (CBT) has rewired my thought processes in a positive way, bringing hope and confidence which bring both balance and happiness to my life.

The fight is real. Those living with mental illness need real intervention-from meds and doctor’s visits to attending NAMI groups and classes to see our own struggles through someone else’s life. Often, counseling should be added to the regiment, because counseling and meds, at least in my experience are the primary means for getting better, being able to copy and to gain confidence over our disorders.

When we think we are alone, we start ‘psyching ourselves out’ and obsessing on top of the original disorder.  Hope diminishes, and despair takes over. Deep depression takes a place in our minds, which adds to the confusion we are already experiencing.

The best places to go from there is some kind of meeting-be it NAMI, support groups offered through your behavioral health office or support telephone lines. I’ve even used the emergency line offered through our behavioral health office just to talk. I think they know me personally.

I always feared as a very young boy that I was going to be affected by a mental illness. I read about it in our old encyclopedias we had at home and the notion just scared me. I grew up and found myself fighting myself all alone, unable to express what was really going through my mind-until the day I got treatment and support. Then I knew I could cope with my disorder.”

Our gratitude goes to this young man who is brave enough to tell his story. It gives us HOPE.

"Just get over" the mental illness?

This story was printed in the NAMI ADVOCATE, Winter 2014, page 23.

For years, I was told by friends and family that I was overly dramatic and overreacting to situations around me. I was told to “just get over it” and “be normal.” For all those years, I tried desperately hard to act like everyone around me. Yet I always realized that they had something that I didn’t have. They were able to process events and not get upset. They weren’t changing from extremely

happy to super sad in a matter of hours. They didn’t think about killing  themselves every moment of the day. They didn’t get relief by cutting up their bodies. Something was different, and I just couldn’t figure it out.

In college, I decided to major in psychology. We learned everything there is to know about the human brain and all of the chemical imbalances that go along with different disorders. My sophomore year, I had my first incidence with suicide. Before I was able to do anything, my friends caught wind of it and called the police. From that day through the next few years, suicide was about the only thing on my mind. The police were called intermittently during these years, but no treatment or counseling was ever sought.  Besides, I had found a different outlet for my pain: cutting and alcoholism.

My drinking quickly evolved into full-blown alcoholism within weeks of taking my first drink. At the time, I knew that alcohol was basically the only thing that was keeping me alive. Then February 15, 2013 happened.

That morning, I went to work chemically altered with a lot of the new anti-anxiety pills that were just prescribed to me. I was going to kill myself that night. I had given away my dog, packed up my house, and got everything all set. Somehow my boss caught wind of it and ended up calling the police. I was sent to a special psychiatric hospital, where I stayed for about a month.

There I was officially diagnosed for the first time in my life with borderline personality disorder and bipolar II disorder. However, I did not want to admit that I had a mental illness. After being told this information, something snapped in my brain and I began getting violent and ended up on four-point restraints.

(After repeated hospitalizations, more restraints, and many more medications, Ashley’s journey took a more positive turn.)

Finally, I was sent to a local hospital with a psychiatric unit after another attempt to kill myself. I was blessed with being assigned an amazing psychiatrist who finally figured out my medication. He took me off the boat load of medications that were basically just sedating me and put me on a mood stabilizer and an antidepressant. Suddenly, life was beginning to feel easier to handle. My moods weren’t swinging from one extreme to another, and I no longer wanted to kill myself every day. He set me up with a community agency that would provide me my medication and therapy on a long term basis. I was able to return to school and pursue psychiatric nursing while obtaining a new job. I was finally beginning to function like those “normal” people that I had admired ever since childhood.

Throughout my journey, I have been hit with many negative views and criticisms about what I was going through. The stigma of having a mental illness began to flood into my life and affect everything. However, thanks to NAMI’S Peer-to-Peer classes, I began to understand that I wasn’t alone in the fight against stigma and that together we can enlighten the world one person at a time.Its danger is not to be underestimated. It is the leading cause of disability in the United States and other developed countries. If left untreated, it can lead to suicide.”

The good news is it is a highly treatable illness.

A closer look at symptoms reveals these characteristics of mood: sad or very irritable; cannot be cheered up; loss of interest in pleasure in daily activities.

Among physical symptoms are insomnia or sleeping too much; change in appetite or a significant unintentional change in weight; being visibly slowed down or agitated; extreme fatigue and lack of energy; decreased sexual drive, catatonia (psychotic stage).

Behavioral symptoms include decreased motivation; decreased task performance; withdrawal and isolation; loss of gratification in effort; lack of attention to hygiene and appearance; no desire to talk, interact, socialize; grossly disorganized (psychotic stage).

Symptoms associated with thinking include accusatory, self blaming thoughts; feelings of worthlessness or excessive guilt; having very low self-esteem; marked indecisiveness or the inability to think, remember, concentrate; recurrent thoughts of death, suicidal thoughts, suicidal plans; delusions (psychotic stage), disorganized, incoherent speech (psychotic stage).

Symptoms involving the senses are hypersensitive to noise, light, stress;

hallucinations (psychotic stage).

Psychosis is a break with reality in which the person sees, hears, or feels things that are not there.  Psychosis can be manifested in bipolar disorder, schizophrenia, as well as depression.

Abraham Lincoln gives a glimpse of the depths of his depression when he said, “I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on earth. Whether I shall ever be better, I cannot tell. I awfully forbode I shall not. To remain as I am is impossible. I must die or be better, it appears to me.”

Because the physical signs of a major depressive episode can mimic other illnesses of the thyroid and adrenal glands, and illnesses like MS and heart disease are known to cause depression, these physical disorders need to be ruled out. It is absolutely essential for people experiencing depressive symptoms to ask for, and get, a complete physical as part of their diagnostic work-up.

It is important to know there is good treatment for depression. A person should not try to “tough it out.” There is HOPE. Treatment works.

Mental illness and terror

The people who live with schizophrenia and other illnesses with psychosis are our heroes. What they have to deal with is terrifying and beyond imagination.

The following is “David’s Story,” an excerpt from Private Terror/Public Life by James M.  Glass.

It’s like all my cells are exploded over the universe, and I live in each of those millions and millions of nuclei shooting in every direction. In the midst of all this, how could I possibly deal with the concrete, even tie my shoelaces, much less find my shoes?

I convinced myself several things were happening: Unrecognizable voices invaded my ears; transmitters had been planted in the ceiling; everyone on the Hall spoke about me; my behavior was watched and discussed by staff; nursing reports, patients’ journals, were filled with hundreds of pages describing my appearance and movements; spies were sent into the Hall exclusively to keep track of me and to report any suspicious behavior to the hospital administration; therapists ignored their own patients and spent hours in endless discussion, looking at the ramifications of my case; TV cameras, hook into the walls taped my facial expressions; every morning, around 3 a.m., three thousand spotlights aimed directly into my eyes; staff prepared elaborate strategies to humiliate me, to expose me and leave me naked in the front Hall; killers hid behind closed doors and waited until night to sneak into my room; food poisoned my insides and rotted out my intestines. Lying down, my body became so brittle I felt it cracking into a thousand pieces; at night, my roommate fed on my blood. Not exactly sane thoughts. In my frame of mind, if I were to stay alive, I had to be attuned to every movement on the Hall.

I hear this voice sometimes. I call it the “maelstrom of manufactured criticism” because it tears at me, rips my identity into shreds, and slices away at everything I am. The verbal abuse never lets up. It goes on and on for hours. Nothing outside touches me when it’s here: I refuse to talk to anyone; I sit, stare, smoke cigarettes until the voice leaves.

Nothing really stops the madness. I rarely change clothes; hygiene and meals become too much. And I have more important things to do than be bothered with my nutrition or cleanliness. Contact with people seems closed off. I lose interest in what happens on the Hall. I forget what day it is. Something as simple as selecting a shirt paralyzes me. That’s what begins my psychotic episodes, little things, nothing more dramatic than trying to find a shirt. It’s like this huge problem overtakes you: moving towards the closet, opening the door, searching through the rack. Each step of the process is like climbing Mount Everest, so you say to yourself, “Why bother, let it be, stay with the one on your back. Little things are magnified a thousand times, and what happens inside your mind takes on much greater importance than your own hygiene or appearance.”

The NAMI Family-to-Family class teaches the importance of patience and understanding in supporting a family member with this illness. They are taught how the brain works and malfunctions. They come to understand that no one is to blame for this illness or its effects. They are given information about how to work with the psychiatrist and are given hope in light of the new medications that can help their family member maintain their mental equilibrium. THERE IS HOPE.

Violence and mental illness

It is hard to focus on the facts about mental illness and violence when the news is peppered with horror stories making one think that mental illness and violence go hand- in- hand. Nothing is further from the truth. The incidence of violence committed by someone with a mental illness is the same as the incidence of violence committed by the general population: about one percent of the population. In fact, a person with mental illness is more likely to have an act of violence perpetrated on them. Let’s look at some facts as enumerated in the NAMI Family-to-Family Education Program, 2013.

• People with schizophrenia and mania who take medication regularly and who do not abuse alcohol or other drugs are no more violent that the rest of the population. Most people with schizophrenia are customarily withdrawn, frightened and passive.
• Similar to the general population, people with untreated schizophrenia and mania are more liable to commit a violent act if they are on street drugs (crack, meth, cocaine, speed, PCP-even marijuana) or if they are abusing alcohol. The use of street drugs or alcohol increases the likelihood that the untreated individual may act on the violent thoughts and paranoid delusions they are having. The combination of major mental illness and substance abuse is a significant predictor of aggressive behavior.
• The likelihood of violence is greatest among males in their late teens or early 20’s.
• The best prediction of future behavior is past behavior. There is good reason to be wary of an individual who was aggressive before becoming ill, or of individuals who have previously been violent when they were particularly disturbed. If your relative has never been aggressive in a period of psychosis, it is unlikely that s/he will become so.
• Warning signs of imminent physical violence that inpatient staff in psychiatric facilities are taught to look for are as follows: impulsivity, talking more about violent ideas, a sudden change in eye contact (staring or avoiding looking others in the eye), pacing, becoming visible angry, yelling, tremors, a rigid posture, clenching jaws and fists, pulsing arteries in the temples, verbal abuse, profanity, and hyperactivity.
• Besides our concern about aggression, we all deal with our dread that our family members will do something harmful to themselves. Some people, especially those with more insight into the damage caused by their illness, may become depressed after a psychotic or manic episode. Many families struggle through the active phase of schizophrenia or intense mood episodes only to be stunned by a family member’s suicide attempt when they felt that things were getting better. Even if these critical events don’t happen in our experience, it is important to know about them. If you have an opportunity to spread the truth about violence and mental illness, you can reduce stigma.

Bipolar, a mood disorder

Kay Redfield Jamison, Ph.D., who has a diagnosis of mental illness, includes this personal account in her book, Manic-Depressive Illness, NY: Oxford University Press. The following is an excerpt:

“There is a particular kind of pain, elation, loneliness, and terror involved in this kind of madness. When you’re high it’s tremendous. The ideas and feelings are like shooting stars,  and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the power to seduce and captivate others a felt certainty……..But, somewhere, this changes. Everything previously moving with the grain is now against - you are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind.

“Credit cards, bounced checks to cover, explanations due at work, apologies to make, intermittent memories of vague men (what did I do?), friendships gone or drained, a ruined marriage.”

The NAMI Family-to-Family Education Program, 2014 lists the following characteristics of a manic episode. The mood is abnormally elevated, expansive, euphoric (high) and/or irritable.  There is decreased need for sleep, insomnia, staying up all night. There could be an increase in goal-directed activity which can include excessive planning of an activity.

Another symptom includes increase in pleasurable activities that risk painful consequences such as excessive spending, sexual recklessness, foolish business investments.

Also there is inflated self-esteem or grandiosity, more talkative than normal or pressure to keep talking, rapid thoughts or “flight of ideas,” distractibility, short attention span, difficulty concentrating. Hypomania can exhibit in the same way but there is not a marked impairment in functioning.

Some 3 million Americans live with some form of Bipolar Disorder.  If your relative is one of these people, there are important things to know.  This mood disorder, formerly called manic-depressive illness, can be profoundly debilitating; the devastating plunge from mania to major depression is terrible to experience. For some, periods of stability do occur between episodes; they and their families are lulled into believing the illness has vanished and will not strike again. However, the time between episodes tends to decrease as the person gets older, creating a life-long challenge of managing the illness, and finding strategies that will sustain periods of stability.

Bipolar I is diagnosed when an individual has had one or more episodes of full-blown mania, usually – but not necessarily accompanied by one or more Major Depressive Episodes. This illness can be a “fooler.” It is not unusual for people to have several depressive episodes (and a diagnosis of Major Depressive Disorder) before a full manic attack occurs. In addition, many people with this illness will be diagnosed with Major Depressive Disorder because they do not recognize (or report) prior episodes of mania. This is why consultation with the family is absolutely essential to insure a proper diagnosis. If the ill family member will not consent for you to speak to the doctor, send the doctor a registered letter with your account of what has been going on.

Lack of sleep is one of the most common triggers of mania. It is a good idea to educate your ill family member about this feature of the illness. If a manic attack is caught early, it is often possible to head off a full-blown episode with proper medication.

Once the manic episode is fully underway, family members will find it very difficult to get their ill relative into treatment. Denial and lack of insight are the norm rather than the exception in this severe part of the illness. It may be necessary to call law enforcement for help in getting your family member to the emergency room. Crises Intervention Training has educated law enforcement to recognize and deal with people in a manic episode. They know your family member needs treatment, not jail.

Schizophrenia, mental illness with psychosis

The following is an excerpt from “Dawn’s Story” published in the Winter 2014, NAMI VOICE:

“Mental illness sneaks up and hits you hard when you least expect it, knocks the wind out of you, beats you to the ground and leaves you wondering what happened.

“In the summer of 2001 my son Matthew graduated high school and was thinking about his future when he was struck by a serious psychotic episode, an almost complete break with reality. In Matthew’s mind, voices and distorted images haunted him. He because convinced that people were after him; shadow people followed him. He talked with the dead who lived under the basement stairs. My beautiful son was disappearing into that dark, terrifying nightmare called schizophrenia, and I was in a panic. My son was so very sick, and I didn’t know how to help him.”

Dawn found a Family-to-Family class where she received education, support, and guidance. Dawn states, “I was able to have an active, positive impact on my son’s care and future. I’ve become the mother my son who is living with schizophrenia needs.”

Schizophrenia is a devastating brain disease whose acute stage always involves a psychotic episode, meaning there is a complete break with reality. It is now evident that schizophrenia involves some fundamental alteration of the brain. A recent article concludes, (quote) “Schizophrenia is a disorder of brain circuitry, not some mysterious demon. Increasing evidence points to abnormalities that arise very early in life, probably before birth, which disrupt the normal development of the brain.”

The general public tends to confuse schizophrenia with “split personality” (which it is not), or with rational thinking that goes in opposite directions (which it is not), or demonizes schizophrenia as psychopathic behavior (which it is not).

Schizophrenia is a common brain disorder which affects 1 out of 100 people, typically striking them down in the prime of their early adult years.

The following are more specific symptoms from the Diagnostic and Statistical Manual (DSM-V), American Psychiatric Association, and Dr. Anand Pandya, MD NAMI.  Two or more of the following symptoms must be present for at least one month: delusions, hallucinations, disorganized speech,  grossly disorganized or catatonic behavior, or negative symptoms such as decreased speech, lack of motivation, flat emotional responses, inappropriate crying, laughing or yelling, inability to relate to others. More significant symptoms include bizarre delusions, auditory hallucinations of hearing a voice providing running commentary or two or more voices talking to each other.

Other symptoms in the early stage include social withdrawal, decline in function, less attention to hygiene, bizarre behaviors, unusual rituals, suspicious, illogical beliefs, odd sensory experiences such as illusions(misinterpretation of a sensation such as seeing a shadow and thinking it is a monster or believing that you are hearing words in the midst of a radio station).

As the disease progresses to the acute phase, they continue exhibiting the early negative symptoms; in addition, they may become more anxious, irritable, agitated.

In the residual phase even with treatment, previous symptoms may continue to exist, but with less intensity.

For a list of books on depression, bipolar disorder, and schizophrenia go to www.namisantaclara.org/books.htm. These books will aid in the patience and understanding needed to cope with the illness. Also search on “hope for schizophrenia” With treatment and education, there is hope for recovery.

Depression, a mental illness

 Depression is often misunderstood. Many people who have never experienced depression think it is “having the blues” are “being down in the dumps.” The further show their lack of understanding by telling the depressed person “snap out of it,” “get a hobby,” “exercise,” “you have nothing to be depressed about,” “cheer up.”

Depression, known as Major Depressive Disorder, is a serious medical disorder. According to nami.org, “It can be caused by psychological, biological, genetic, environmental factors. Its danger is not to be underestimated. It is the leading cause of disability in the United States and other developed countries. If left untreated, it can lead to suicide.”

The good news is it is a highly treatable illness.

A closer look at symptoms reveals these characteristics of mood: sad or very irritable; cannot be cheered up; loss of interest in pleasure in daily activities.

Among physical symptoms are insomnia or sleeping too much; change in appetite or a significant unintentional change in weight; being visibly slowed down or agitated; extreme fatigue and lack of energy; decreased sexual drive, catatonia (psychotic stage).

Behavioral symptoms include decreased motivation; decreased task performance; withdrawal and isolation; loss of gratification in effort; lack of attention to hygiene and appearance; no desire to talk, interact, socialize; grossly disorganized (psychotic stage).

Symptoms associated with thinking include accusatory, self blaming thoughts; feelings of worthlessness or excessive guilt; having very low self-esteem; marked indecisiveness or the inability to think, remember, concentrate; recurrent thoughts of death, suicidal thoughts, suicidal plans; delusions (psychotic stage), disorganized, incoherent speech (psychotic stage).

Symptoms involving the senses are hypersensitive to noise, light, stress;

hallucinations (psychotic stage).

Psychosis is a break with reality in which the person sees, hears, or feels things that are not there. Psychosis can be manifested in bipolar disorder, schizophrenia, as well as depression.

Abraham Lincoln gives a glimpse of the depths of his depression when he said, “I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on earth. Whether I shall ever be better, I cannot tell. I awfully forbode I shall not. To remain as I am is impossible. I must die or be better, it appears to me.”

Because the physical signs of a major depressive episode can mimic other illnesses of the thyroid and adrenal glands, and illnesses like MS and heart disease are known to cause depression, these physical disorders need to be ruled out. It is absolutely essential for people experiencing depressive symptoms to ask for, and get, a complete physical as part of their diagnostic work-up.

It is important to know there is good treatment for depression. A person should not try to “tough it out.” There is HOPE. Treatment works.

Misconceptions and mental illness

“I have no right by anything I do or say to demean a human being in his own eyes. What matters is not what I think of him; it is what he thinks of himself. To undermine a man’s self respect is a sin.” - Antoine de Saint-Exupery

People with mental illness are decent people. They deserve respect like anyone else. Yet sigma, caused by a lack of understanding and knowledge, rears its ugly head and chips away at the person’s sense of self, making them feel isolated and ashamed. People who have no knowledge of mental illness need to be receptive to information so they can “grow up” and “get over” their false attitudes that are pervasive and damaging to the fragile self esteem of someone with a mental illness.

The following is a list of myths collected by NARSAD (National Alliance for Research in Schizophrenia and Depression). There were 102 responses from psychiatrists around the country. “Misconceptions about mental illness contribute to the stigma which leads many people to be ashamed and prevents them from seeking help,” said Constance Leiber, NARSAD president at the time of the 2002 survey.

MYTH#1: Psychiatric disorders are not true medical illnesses like heart disease and diabetes. People who have a mental illness are just “crazy.”

FACT: Brain disorders, like heart disease and diabetes, are legitimate medical illnesses. Research shows there are genetic and biological causes for psychiatric disorders, and they can be treated effectively.

MYTH #2: People with severe mental illnesses, such as schizophrenia, are usually dangerous and violent.

FACT: Statistics show that the incidence of violence in people who have a brain disorder is not much higher than in the general population. Those suffering from a psychosis are more often frightened, confused and despairing than violent.

MYTH #3: Mental illness is the result of bad parenting.

FACT: Most experts agree that a genetic susceptibility, combined with other risk factors, leads to a psychiatric disorder. In other words, mental illnesses have a physical cause. No one is to blame.

MYTH #4: Schizophrenia means “split personality” and there is no way to control it.

FACT: Schizophrenia is often confused with multiple personality disorder. Actually, it is a brain disorder that robs people of their ability to think clearly and logically. The symptoms range from social withdrawal to hallucinations and delusions. Medication has helped many of these individuals to lead fulfilling productive lives.

MYTH #5: Depression is a normal part of the aging process.

FACT: It is not normal for an older person to be depressed. Signs of depression in older people include loss of interest in activities, sleep disturbances, and lethargy. Depression in the elderly is often undiagnosed, and it is important for seniors and their family members to recognize the problem and seek professional help.

MYTH #6: Depression and other illnesses, such as anxiety disorders, do not affect children or adolescents. Any problems they have are just a part of growing up.

FACT: Children and adolescents can develop severe mental illnesses. In the United States, one in ten children and adolescents has a mental disorder severe enough to cause impairment.

MYTH #7: If you have a mental illness, it will go away. Being treated for a psychiatric disorder means an individual has in some way “failed” or is weak.

FACT: A serious mental illness cannot be willed away. Ignoring the problem does not make it go away. It takes courage to seek professional help.

With a little knowledge about mental illness, one might be willing to extend a hand, give a smile of recognition and rekindle the inner light of self respect in a fellow human being. We need each other. There is hope.

Substance abuse and mental illness

Dual diagnosis, co-occurring disorders, and co-morbidity refer to a condition in which a person has two brain diseases at the same time: one an addiction and one a mental disorder. Unfortunately, this condition is all too common. According to reports published in the Journal of American Medical Association (JAMA):

Roughly 50 percent of individuals with severe mental disorders are affected by substance abuse.

Thirty-seven percent of alcohol abusers and 53 percent of drug abusers also have at least one mental illness.

Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.

Having a mental illness is rough on the person with the mental illness and their family members. It becomes even more complex and difficult if substance abuse is involved. The consequences are numerous and harsh. There is statistically greater propensity for violence, medication noncompliance, and failure to respond to treatment than a person with just substance abuse or a mental illness. In addition, having both conditions frequently leads to overall poorer functioning and a greater chance of relapse. They experience more episodes of psychosis. They are in and out of hospitals and treatment programs without lasting success.

Socially people with mental illnesses often are susceptible to co-occurring disorders due to “downward drift.” In other words, as a consequence of their mental illness they may find themselves living in marginal neighborhoods where drug use prevails. Having great difficulty developing social relationships, some people find themselves more easily accepted by groups whose social activity is based on drug use. Some may believe that an identity based on drug addiction is more acceptable than one based on mental illness.

People with co-occurring disorders are also much more likely to be homeless or jailed. An estimated 50 percent of homeless adults with serious mental illnesses have a co-occurring substance abuse disorder. Meanwhile, 16% of jail and prison inmates are estimated to have severe mental and substance abuse disorders. Among detainees with mental disorders, 72 percent also have a co-occurring substance abuse disorder.

Research has strongly indicated that to recover fully, a person with co-occurring disorder needs treatment for BOTH problems at the same time. Focusing on one does not ensure the other will go away. Dual diagnosis services integrate assistance for each condition, helping people recover from BOTH in ONE SETTING, AT THE SAME TIME.

In spite of research that supports its success, integrated treatment is still not made widely available. This is an idea that has been slow in coming. It involves a paradigm shift in philosophy and attitude. It necessitates changes in the programs and training for both substance abuse treatment and treatment for mental illness.

Families should protect their ill family member from being bounced back and forth between services for mental illness and those for substance abuse. With continued education on co-occurring disorders, hopefully, more treatments and better understanding are on the way.

Heroes and mental illness

“Heroes are made by the paths they choose, not by the powers they are graced with.” -Brodie Ashton

There is something catastrophic going on in the family. Constant tension and nervousness permeate the home.  Chaos and shock rule their lives. Something has gone awry with the family, or is it coming from just one family member? The family member who normally has good insight and understanding has become irritable, critical, and even abusive. In addition, this person displays unpredictable over-reactions to ordinary events. This person who has been warm and thoughtful is now rude and hostile. They no longer have the ability to express joy, becoming withdrawn and isolated. A responsible student can no longer concentrate, cannot cope with even minor problems. Something is wrong.

Which path will the family choose? Will they hope against hope that the situation will go away? Will they make up logical excuses for illogical behavior? Will they fight and scream at the family member who is exhibiting bizarre behavior and getting in trouble with the law?  Will they allow the situation to spiral down to the depths of despair? Will they turn their back on the offending family member – let them” hit bottom?”

The heroic family will struggle to come out of denial and face the fact that something is wrong. They choose to reach out for help. They get their family member to a physician or psychiatrist. They choose a path that leads to education, comfort, support, and understanding for them and a path to recovery for their family member. . It takes more courage to reach out for mental and behavioral problems than it does for the more familiar problems all around us – problems like asthma, diabetes, digestive problems, crooked teeth, skin problems.

In the meantime, what has happened to the person who has been exhibiting symptoms of mental illness? They have “lost themselves.” Their ability to function has declined. People see them as odd or peculiar. Their thoughts and speech become disorganized. Their life plans are not working out. They see and hear things they have never experienced before. They are losing friends, can’t maintain a relationship, can’t keep a job.

What are their choices? The doctor says treatment works and gives medication that causes weight gain, drowsiness, clumsiness, decreased sexual functioning among other unpleasant symptoms. If they refuse medication, the consequences are dire and harsh. Some will choose to self-medicate with alcohol and drugs which can have devastating results. They may become violent. They might end up in jail. One of the most difficult things about some types of mental illness is the inability to recognize that they have a mental illness. Sometimes repeated hospitalizations are a blessing because the person is put on meds often enough to see a glimmer of hope – maybe they can recover.

The hero chooses to work with the doctor to find the right meds that will help restore their life. The hero decides to lead a new life- a life of recovery, a life which embraces their disability combined with their personal gifts and talents. They respond to that inner glow, that desire to have a purpose, that desire to be the wonderful person they were created to be. Some heroes even see their disability as a gift. They realize that there are so many organizations, professionals, and volunteers whose mission involves improving the lives of those with mental illness.

So maybe being a hero does embrace, not only the path they choose, but also “the powers they are graced with”- the power to know that things can be better.

Panic disorder and mental illness

When people have attacks of anger, screaming, shaking, dizziness, rapid heart beat, they are often thought of as being “high strung,”  having “high blood,”  having a bad “case of the nerves,” having a “nervous attack,”  having a “fit.” These cultural attitudes can be a deterrent to a person getting proper psychological diagnosis and treatment for an Anxiety Disorder.

In fact, the term “anxiety” does not quite do justice to the terrifying sensations of fear, apprehension, worry, and dread that affect people living with these disorders. These are brain disorders in which internal sensations and everyday happenings are interpreted as dire events – so threatening that individuals with these illnesses will create elaborate, debilitating patterns of avoidance to handle them.

For the sake of clarity, the Anxiety Disorders are as follows: Panic Disorder, Obsessive Compulsive Disorder, Post-Traumatic Disorder, Generalized Anxiety Disorder, and Phobias.

Panic Disorder affects 1-2% of Americans and about half of the time it strikes before the age of 24. Women are twice as likely to be affected as men. Because the physical symptoms are so prominent in these attacks, many people who live with this disorder never seek any kind of psychiatric help. They may go to the emergency room because the first ten symptoms are “alarm signals” of the body which come with a sudden paralyzing sense of fear. Many think they are having a heart attack because they have palpitations, pounding heart, or accelerated heart rate, sweating, trembling, shortness of breath or smothering, feelings of choking, chest pain, dizziness, numbness, chills or hot flushes. In addition to the body symptoms, the symptoms of the senses are feelings of unreality or being detached from oneself, fear of losing control of one’s mind, fear of dying. Panic attacks usually peak within ten minutes, and then dissipate within a half an hour.

For Panic Disorder to be diagnosed, a person must experience recurrent, unexpected panic attacks followed by concern that the attacks will “strike again,” worry that these attacks imply life-threatening issues or losing one’s mind, or avoidance of situations related to the attacks.

A Panic Disorder can be disabling when the dread of the recurrence becomes so great that they become phobic - too terrified to leave their home, use an elevator, attend social events or go anywhere in public. This condition, called agoraphobia, occurs in 1/3 to ½ of the victims of Panic Disorder.

Panic Disorder can be controlled by psychotherapy, self-help, and medication. There is HOPE.

OCD and mental illness

OCD (Obsessive-Compulsive Disorder) is America’s “hidden epidemic.” One person in 40 will develop OCD in their lifetime, one-third of these by the age of 15. Over 400,000 children have OCD. Also, many people with OCD have co-existing disorders: 66% have Major Depression, 26% suffer from panic attacks.



Thanks to Howie Mandel, “America’s Got Talent,” for being forthcoming about his Obsessive- Compulsive Disorder and Attention-Deficit Hyperactive Disorder. When a well-known person comes out about his mental illness, stigma is reduced. The public sees a talented, successful person who happens to have a mental illness. Howie is a comedian who likes to have fun, but this does not diminish the debilitating effect these illnesses have had on his life. On www.lifescript.com, Howie states, “If I didn’t take my meds, I wouldn’t be here. I would be locked up in a room somewhere.” In his book, Here’s the Deal, Don’t Touch Me (Bantam), he writes honestly about his mental health issues and how they have shaped his life.



What is an obsession?

What is a compulsion?

What conditions have been added to the new official diagnostic manual for OCD?

Obsessions are recurrent thoughts, images and impulses which invade the mind, causing INTOLERABLE ANXIETY. These preoccupations make no sense, or are repulsive, or revolve around themes of violence and harm. The most common obsessions are fear of contamination, excessive concern about objects “having to be” in a certain order; thinking you have injured someone, or left something on (or unlocked); horrible impulses to hurt a loved one; gross sexual imagery; hoarding.

Some people who are excessively neat and orderly often refer to themselves as OCD; however, this is far more serious,intrusive, and debilitating than being a “neat freak.”

Compulsions relieve the UNBEARABLE ANXIETY related to the obsession. The person is driven to perform specific repetitive ritualized behaviors calculated to reduce his/her discomfort. These behaviors take on a life of their own, literally imprisoning the individual in a pattern of peculiar activities: hand washing or showering, compulsive house cleaning, excessive ordering and arranging; incessant checking and re-checking; repetitive counting, touching and activity rituals; excessive slowness in daily activities like eating and brushing teeth; constant demands for reassurance that the perceived threat has been removed.

People with OCD are usually not delusional, nor are they having hallucinations. But they cannot control their compulsive responses to the impulses driving their anxiety. Most victims of this illness try to hide and cover up behaviors they believe are totally “off the wall.” This capacity to recognize their behavior as “excessive and unreasonable” is one criteria for the diagnosis of OCD. However, a significant number of individuals with OCD lack this insight, particularly during the throes of an episode, or if they suffer from the severe form of the illness.

The ritual compulsions of OCD vary from mild (known only to the sufferer), to constant and extreme (occupying hours a day and involving family members in ritual activities). A diagnosis of OCD is made when obsessions and compulsions become so marked that they interfere with social and occupational activities, or cause intense subjective distress.

Other disorders included in the recently published Diagnostic Manual V under the category Obsessive-Compulsive and Related Disorders are as follows: Hoarding Disorder, Excoriation (Skin Picking) Disorder, Hair Pulling Disorder, Body Dysmorphic Disorder, Substance/Medication-Induced Obsessive- Compulsive and Related Disorder Due to Another Medical Condition.

According to the National Institute of Mental Health, Schizophrenia and Bipolar disorders are the major mental illnesses, yet OCD is two to three times more common. It is truly America’s “hidden epidemic.”  Medication and therapy BRING  HOPE.

Setting limits and mental illness

The mentally ill family member is out of control: rude, irritable, uncooperative, has no respect for order or cleanliness in the home, does not abide by family rules, intrudes on other family member’s lives. The mother and father are against each other about what to do. The siblings do not want to come home. There is so much tension and nervousness in the home. They settle for anything just to keep the peace.

On second thought, the mentally ill family member is not OUT OF CONTROL; he/she is actually IN CONTROL of the family and is being allowed to destroy the family peace. Is there any hope to turn things around?

The following are limit setting concepts:

1. Goals. Regain authority over the household. Create an environment that is comfortable and manageable for you and other family members.

2. Attitudes. Effective limit-setting requires a spirit of determined toughness, not kindly persuasion or angry criticism.

 3. Tactics. Focus your efforts on one or two aspects of behavior that especially trouble you. (Defining and limiting the problem are key skills taught in Family-to-Family.) Ignore other matters until you have these issues under control. Focus on behavior you can consistently monitor and influence: smoking in the house, clothes on the floor, loud and intrusive talking, dirty dishes left on the table, intruding in other’s business, excessive ordering online, cursing, bringing strangers to the home. Determine consequences for non-compliance that will inconvenience your ill relative yet will not be too onerous to administer. Or determine rewards for compliance. Obtain help from friends, relatives, the family member’s therapist if necessary.

 4. Communication. Clearly state expectations for appropriate behavior and consequences for non-compliance. Expect that these limits will be tested, and you will administer consequences. Inform him or her that you will do A if they do B.  Do not engage in lengthy discussions of the appropriateness of your expectations. Going on and on is futile. Learn to say what you mean and STOP. These communication skills are taught in the NAMI Family-to-Family course.

 5. By-products of effective limit-setting. Besides establishing a more livable family environment, effective limit-setting greatly enhances the credibility of family members and can lead to more productive discussions of other issues. It can also motivate your ill relative to work toward independence in order to escape from rules they do not prefer to live under. Learning that one must conform to the expectations of others in order to enjoy satisfying social relations, people with mental illness often behave more appropriately outside the home. Often they are more amenable to rules when they are very sick and confined in a psychiatric hospital.

 Words of caution: Be aware that the general rules of limit setting will not apply to families coping with severe Anxiety Disorders, particularly agoraphobia and Obsessive Compulsive Disorder. Most families must have professional help in making contracts to alter ritual avoidance behaviors.

Also one must examine the issues of setting limits on a parent or spouse.

Effective limit setting can lead to a more peaceful home. There is HOPE.

Coping with mental illness

Many people do not understand that they can set limits for someone with a mental illness. After all, the ill family member might have a thought disorder. How is it possible to reason with someone who has trouble thinking? How is it possible to deal with someone who might have a mood disorder, who swings between severe depression and mania over the least obstacle. Could this limit setting lead them to thoughts of suicide? So, many families are paralyzed. Their lives often become dominated by the ill family member. To get out of this dilemma, the family must learn about recovery, how to communicate, and how to solve one, specific problem at a time in order to set limits.

Many problems that arise for families originate in their misunderstanding of the “biology of recovery.”

 After psychotic breaks of any kind, the usual period of recuperation can take as long as two years. This fact often surprises families. They reason that because the episode is over, it’s time “to get on with it.” Therefore, many families believe the residual effects of the illness are “failures of will or character.”  Their relative just isn’t trying hard enough. In other words, they tend to blame the victim. Actually, families learn how to slow down, give them space, simplify and moderate demands and wait until the ill family member can be more resilient and can do more. Now it is time to avoid confrontations and try to stay aware of our loving feelings for the individual whose spirit has been crushed. At the same time it is important to protect the other members of the family. In mental illness, this means to be able to firmly and explicitly communicate about boundaries.

It is important to learn the do’s and don’ts of communication before attempting to set limits. How to talk to someone who is hearing voices, how to make “I” statements, the ineffectiveness of “you” statements, how to use reflective statements are some concepts that are taught and practiced in the NAMI Family-to-Family education course.

Finally, with the tools of communication, it is time to tackle

Problem Solving. The family must learn how to choose a specific problem, hear other people’s ideas, identify personal feelings about the problem, rehearse options, find a solution, and come to terms with setting limits. Knowing how to set limits will be easier the more one is educated about the predictable course of the illness and the more one can distinguish between legitimately “ill” behavior and behavior that cannot be tolerated. There is much a family needs to know before attempting to set limits. Many mistakes can be made trying to discipline a family member without the background information.

With the proper background about mental illness, how the brain works, how to communicate, and how to solve problems, families need to establish a baseline of behavior that they expect from their mentally ill relative. People with mental illness may not be able to control their symptoms, but they do have some control over their reactions to them. Providing consistent, reasonable limits improves the relative’s sense of security.

It is important not confuse an “understanding” atmosphere with a permissive atmosphere. The basic idea behind limit setting is to find a system of reasonable and durable rules. The family cannot expect that their relative will like or appreciate the rule-making, but they must not dominate the household or family members’ lives. This is easier said than done, but it is an essential philosophy to cultivate as a “lifetime” point of view. There is HOPE.

Next month. . . . more on Setting Limits.

Helping hands for mental illness

Mental illness is a life long journey. It does not go away; however, a person can recover by rising above the circumstances. They must learn to manage their symptoms. They must have a reason to get up in the morning. They must have a sense of purpose. Those struggling with mental illness know that this is easier said than done. Helping hands are needed.

There are many available services to help someone understand and manage their symptoms. People new to the system are often puzzled. What are these services?  How can I find these services? Who can help?

 No one person with mental illness needs all the services so the bits and pieces must be collected from various places to meet individual needs. Education and support for the person with the diagnosis and the family members is essential. A united aggressive and assertive effort is needed to find out what is available. The following scenario is offered as an example of how a person finds out about some services during hospitalization, at discharge from the hospital, and after discharge.

 During hospitalization it is common for the patient to receive information about the illness and the importance of staying on medication. Some hospital social workers offer to begin the paper work to apply for disability, if appropriate. Many psychiatric hospitals include the family to get a complete family history and invite the family to treatment team meetings. Some include family nights where the family is educated about mental illness. More and more professionals are realizing that an educated family helps prevent relapse and facilitates recovery. Some recommend NAMI courses and support groups for the person with mental illness and for their family.

Often hospital programs invite the family to the discharge conference.

Frequently the discharge plan includes valuable information and suggestions about housing, day programs, entitlements, medication, and managing symptoms.  It is never wrong to ask the hospital if these services are available to you and your family member.

After discharge, the patient might need a long period of rest and sleep

to recover from the trauma inflicted on the brain by a psychotic break. In the meantime, family members can investigate available help. One agency will come into the home and provide a variety of services including how to prevent another hospitalization. Day treatment programs provide transportation to outpatient programs that assist in the transition from hospitalization to home.  The many services the day treatment programs offer are all geared to helping the patient develop and improve their ability to function. Upon discharge, there are free apartments for a limited amount of time for those who are homeless or not allowed back into their homes. Positive Connections, a Calcasieu parish school, is exclusively for children with mental illness. Other programs have case managers that provide long term support to help the individual in living independently in the community.  When the individual is ready to go to work, there is an agency that assesses their job skills, finds them additional training, places them in a job, and supplies a job coach if necessary.

Call, ask questions, tell them what you need. These professionals are in a “helping position.” Their jobs are devoted to helping people get better.

For more information on these services, call or look on line for the following: Assertive Community Treatment, Volunteers of America, MMO Behavioral Health Systems, Bridgeway Psychiatric Center, Positive Connections Calcasieu Parish, Louisiana Rehabilitation, Resource Management, the National Alliance of Mental Illness of Southwest Louisiana. In addition, call 2-1-1 which is a centralized, consolidated, ever evolving, and continually updated information and referral system for Southwest Louisiana.

Recovery and mental illness

Consider Jonathon Livingston Seagull by Richard Bach in the light of someone who is struggling to recover from mental illness.

After so many attempts to fly faster and higher, having so many smashes and crashes, Jonathon thought, “There is no way around it. I am a seagull. I am limited by my nature.” Jonathon gave in. He decided to be just another one of the flock, thinking, “There would be no more challenge and NO MORE FAILURE.”

But Jonathon had that special quality it takes to recover: try, try again. So he did continue trying until he eventually succeeded going beyond the expectations of the ordinary seagull – only to be called to the Circle of Shame to be admonished. He was told that “we are put into this world to eat, to stay alive as long as we possibly can.” That’s it?

Jonathon objected. He knew there was more. “There is a reason to life!” he said. “We can lift ourselves…we can find ourselves as creatures of excellence and intelligence and skill. We can be free!”

Patricia Deegan, Ph.D, is a clinical psychologist who has a mental illness. She is a leader in the recovery movement. In her words, recovery is “a decision to meet the challenge of disability…People experience themselves as recovering a new sense of self and purpose within and beyond the limits of the disability.” This is something only the self can do; it is a decision to lead a hopeful life and to make a contribution in spite of the limitations imposed by illness.

A further definition of recovery comes from Steven Kerkser, former head of the Florida Consumer Action Council (quote):

“Recovery is not remission, nor is it a return to a preexisting state. The idea that we can be ‘cured’ is counterproductive to recovery…

Recovery is the development of new ego and identity structures to replace those damaged by our illnesses. Recovery is about wellness, that is, the redevelopment of a new and healthier personality and lifestyle; an independent personality that is strong enough to stand on its own. Recovery takes place through creation of new patterns of behavior that make our lives more satisfying and productive.

People in recovery like themselves as they are, accept their disability, and enjoy the life they have. Acceptance of one’s disability can lead to greater appreciation of one’s own strengths and new levels of self-esteem. Recovery is based on personal choice, responsibility, self-determination and self-esteem.”

The concept of “choosing to live again” is as meaningful for family members as it is for the person with the mental illness. It asks us to come to terms with the trauma that has beset us. It asks us to give up unrealistic expectations, and put away our shattered dreams of what might have been. It demands that we replace loss and grief with action; it insists that we embrace the people we love the way they are now, and work to give them brighter hope for the future.

It asks us to look beyond what might be the bleak picture of our family member just sleeping or sitting around, smoking endlessly, watching TV, going nowhere. Next month we will see what is offered in the community to help them realize, as Jonathon did. “There is a reason to life!”

Crisis and mental illness

Sooner or later, if a family member is diagnosed with schizophrenia, bipolar disorder, or major depression, a serious crisis (psychotic episode) is likely to occur. What should you do? How can you avoid a disaster?  Ideally, you need to reverse any increase of the psychotic symptoms  and provide immediate protection and support to the individual with the mental illness.

Sometimes well-meaning, uninformed family members do and say things that they regret. “If I had only known better,” they frequently say as they come to an understanding in the NAMI Family-to-Family Education Course. The course material frequently and gently reminds them, “You can’t know what no one has ever told you.”

First, let’s put this episode in perspective. Seldom, if ever, does a person suddenly lose total control of thoughts, feelings, and behaviors. Look back a few days, a few weeks before the episode. Was there behavior that caused concern: sleeplessness, ritualistic preoccupation with certain activities, suspiciousness, unpredictable outbursts. Sometimes, with experience and knowledge, family members become aware of the early signs and can avert a full-blown crisis. Often the person has stopped taking medication. A visit to the doctor should be encouraged. However, the more psychotic the loved one is, the less likely they are to cooperate. Learn to see the early signs. If you feel the fear and panic of an impending crisis, do what you can to help your loved one regain control. Do nothing to further agitate the scene.

You must remain calm. If you are alone, get someone to stay with you until professional help arrives.

In the meantime, the following guidelines might be helpful:

Don’t threaten. This may be interpreted as a power play and increase fear or cause assaultive behavior by the patient.

Don’t shout. If the mentally ill person seems not to be listening, it could be that other “voices” are interfering.

Don’t criticize. It will only make matters worse..

Don’t squabble with other family members over what to do or who to blame.

Don’t bait the patient into acting out wild threats; the consequences could be tragic.

Don’t stand over patient if he or she is seated. Instead, seat yourself.

Avoid direct continuous eye contact or touching the patient.

Comply with requests that are neither endangering nor beyond reason. Or ask your loved one gently, “What do you need?” This provides the patient with an opportunity to feel somewhat in control.

Don’t block the doorway. However do keep yourself between the patient and an exit.

It will help you to know that the patient is probably terrified by the experience of loss of control over thoughts and feelings. Furthermore, the “voices” may be giving life-threatening commands; messages may be coming from the light fixtures; the room may be filled with poisonous fumes; snakes may be crawling everywhere.

Accept the fact that your loved one is in an “altered reality state.” In extreme situations the patient may “act out” the hallucination, e.g. shatter the window to destroy the snakes.

In the final analysis, the family member may have to be hospitalized to be safe, comfortable, and stable. If you cannot get your loved one to go voluntarily to the doctor or the hospital, you can call law enforcement or 911. Explain that your relative or friend is in need of a psychiatric assessment. Ask for officers who have had Crisis Intervention Training. Your family member will be safe with these officers, especially if they have been trained to handle someone with mental illness.

This information is based on or directly comes from material in the Family-to-Family Education course.

For more information contact the NAMI SWLA office at 337-433-0219 or email us at namiswla@bellsouth.net

Psychosis and mental illness

“What do you need?” she asked her son who was in a bizarre state of psychosis. “Solidarity,” he replied. He needed unity of self, unity of family. He was coming apart, having disorganized thoughts, drifting away from the person he had always been.

For many years, a person with psychosis was diagnosed with schizophrenia. Today the mental health professionals know that psychotic features are not limited to schizophrenia. People in acute stages of mania and depression also can experience psychosis.

The following are symptoms of schizophrenia that can also be characteristic of psychosis in depression and mania.

DELUSIONS: These are disturbances in thought involving the misinterpretation of perceptions and experiences. These false beliefs usually have a theme of one or more of the following: persecution, religion, feelings of being cosmically important.

HALLUCINATIONS: Most commonly, hallucinations involve hearing one or several voices which make a running comment on the person’s behavior and thoughts. The voices are perceived as distinct from the person’s own thoughts, and are often experienced as critical or threatening. Hallucinations can also occur in the other senses (bizarre interpretations of sight, smell, taste, and touch).

DISORGANIZED SPEECH: This is totally illogical thinking as evidenced in the person’s speech. Answers to questions may be totally unrelated or severely disorganized (incoherence, “word salad,” loose associations).

GROSSLY DISORGANIZED OR CATATONIC BEHAVIOR: Disorganized behavior ranges from childlike silliness and inappropriate reactions, to totally unpredictable agitation. There are problems in goal directed behavior and great difficulties in performing the activities of daily living. Behavior is often strangely disturbed (posturing, grimacing), appearance disheveled, with frequent untriggered agitation, particularly swearing, shouting, and negativism. Catatonic motor behaviors involve a marked decrease in reacting to the environment (stupor, muteness, rigidity), or excessive, purposeless motor activity (catatonic excitement).

NEGATIVE SYMPTOMS; These appear as affective flattening or blunting (face is immobile, unresponsive, expressionless); difficulty expressing oneself (short, empty replies, lack of fluency); inability to initiate and persist in goal-directed activity; little interest in participating in work and social activities; inability to relate to others.

All of these characteristics do not have to be present to constitute a psychotic state.

When psychosis strikes, it is difficult to reason with the person on the basis of shared understanding. This will frustrate the family member’s efforts to aid and assist their ill loved one.

It is important to know that these delusions and hallucinations are real to the person in psychosis. It is futile to argue with them about their perceptions; however, there are some actions one can take to help or avoid the potential for disaster. The idea is to reverse any escalation of the psychotic symptoms and provide immediate protection and support to the individual with the mental illness. There will be more on this next month.

Why can't someone just tell us what the diagnosis is?

Did you know that . . . .

1. Mental illnesses occupy more hospital beds than heart disease and cancer combined?

2. A recent study reports that people with bipolar disorder consulted more than 3 physicians over a period of 10 years before their illness was correctly diagnosed.

3. There can be a lag between onset diagnosis and treatment of schizophrenia that can last for years.

4. The vast majority of depressed people are misdiagnosed.

5. Schizophrenia, bipolar disorder, and depression can have psychotic features such as paranoia, delusions, auditory and or visual hallucinations. There was a time when these symptoms of psychosis were only associated with schizophrenia.

6. Some medical diseases, in addition to their physical symptoms, can present behavioral symptoms that mimic mental illness;

7. For many decades mental illnesses were seen as the result of character disorders or family dysfunction.

Why can’t someone just tell us what the diagnosis is?

1. There are no blood tests, x-rays, or scans that can definitively diagnose mental illness. There is exciting research being done in these areas, but there is nothing yet that can give an exact diagnosis; therefore, psychiatrists continue to include the patient’s report of symptoms based on how they feel, act, behave, and think.

2. Often a person with an untreated mental illness is not able to perceive that they have an illness.

3. Sometimes a person will present symptoms not previously manifested. For example, a person with bipolar disorder might begin exhibiting symptoms of schizophrenia and subsequently be given a diagnosis of schizoaffective disorder.

4. It is not uncommon for a person to have several different psychiatric diagnoses at various times in their life, or simultaneously.

Rather than doubting the mental health profession because of this lack of certainty, it is important to focus on the fact that something is wrong with your family member – no matter what label is put on it. Sometimes the method of treatment is also uncertain, but there is HOPE! In most cases TREATMENT WORKS! However, it takes time, patience, and persistence.

This information comes from NAMI Family-to-Family Education Program, a course offered by the National Alliance on Mental Illness.

For more information, call the local NAMI office, 337-433-0219.

Stages of emotional response to mental illness

What does one do when a beloved  family member, who has always been competent, begins to have ideas such as: “My thoughts are being transmitted out into the world” or “People are putting bad ideas into my head” or “Everything I see and hear has some special meaning, cosmic importance and makes  reference particularly to me” or “The voice of God is giving me commands” or “I am sick, sinful, everybody is after me” or “I am Jesus.”

To further complicate matters, it is no longer possible to reason with the loved one. They cannot be convinced that these ideas are not real.

How do families respond to this catastrophe? This is a crises. There is chaos, shock, trauma. There is disbelief, denial. In the meantime, their family member gets more bizarre. He might be extremely paranoid, thinking that the CIA is after him. Or he might be moving so fast and talking so fast that he becomes confused. His thoughts and ideas are loosely connected. He often becomes argumentative, making embarrassing scenes at home and in the public.

Even if the family is lucky enough to work with a psychiatrist when these signs first appear, they often cannot, will not believe what the psychiatrist tells them.  They hope against hope that this is not a mental illness, that this will never happen again. They try to normalize life, get things back to the way it was before these strange things appeared. They want their family to return to the way things were.

What does the family need during this initial stage of dealing with this catastrophic event? They need support, comfort, empathy. They need help finding resources, such as Crisis Intervention, housing, Social Security disability. They need to know the prognosis of this illness. They need to know about NAMI.

When the family enters the second stage of the emotional responses, they may be learning to cope; they must learn how to deal with the anger, guilt, resentment, and grief about what has happened to their lives and the life of their loved one. They need help recognizing what is going on. In addition, they need

a safe place to vent their feelings. Education about mental illness will give them hope. They will learn to take care of themselves, how to empathize with their mentally ill loved one, how to communicate and problem solve. They will learn about the mental health system and will have an opportunity to network with others who have been down this same road. They will learn how to “let go.” They will learn about NAMI.

Finally, with education, family members will come to a life changing understanding and acceptance of mental illness. Hopefully, they will move into advocacy and action to improve the lives of those with mental illness. They will restore balance in their life.

No fault mental illness

When mental illness strikes an adolescent or young adult in a family, there is shock, denial, and GUILT. Where did we go wrong? How can this be happening to our child?

Then the blame game begins. The mother thinks the father was too strict, too harsh on the child. The father thinks the mother was too soft on the child. If she would have just let me handle it my way, the child wouldn’t have these problems. Relatives, family members, and neighbors often think the parents enabled the child’s behavior.  Think of all the times they got their child out of jail, Remember the child’s continued reckless behavior without regard for the consequences.  Or they seemed do nothing about their child’s sadness, failing grades, and lack of motivation.  If they had been better parents, this would not be happening.

When parents come to the NAMI Family-to-Family Education class, they often come with feelings of shame and guilt. When they begin to learn that mental illness is not something you can do to your child, they are relieved. They may still have regrets for the way they treated the child and the things they said to the child in an attempt to control their ways of thinking and behaving. However, they are continually reminded in the course that “you can’t know what no one has ever told you.”

As the course continues, they become convinced that mental illness is caused by brain disorders, disturbances in brain chemistry, genetic predisposition, and that mental illness is NOBODY’S FAULT. A parent cannot give a person a mental illness in the same way that one cannot give a person Diabetes, epilepsy, or an autoimmune disease, to name a few. These are illnesses that are caused by physical conditions beyond the control of the parent or the person with the condition.

 A father cannot mistreat a child and cause the pancreas or nervous system to malfunction. A mother cannot control epilepsy by demanding that the child  “stop shaking.” There is no point in the parent stomping their foot and telling the child to bring their blood sugar down “right this minute or you will be punished.”

Parents and the person with the illness need to have this atmosphere of shame lifted. They should understand that they haven’t done anything wrong to cause this mental illness. Once they realize that mental illness is a No Fault Illness, they can be free to work toward recovery.

Announcements will be forthcoming about the Family-to-Family course to be offered the first part of February and the Peer-to-Peer course for the person with the mental illness, which will be announced at a later date.

The holidays and mental illness

Congratulations! You have managed to conquer a reasonable “to do” list: the house is clean and decorated; the presents are wrapped; the food is cooked; you have managed to create some “Christmas Magic” for family members; family and friends are on their way.

There is one more important thing to consider - your family member who has been recently diagnosed with a chronic, severe, and persistent mental illness. How will they react to the holiday celebration?

Hopefully they are on a medication that is working. Their feelings and thought processes have improved. Their negative symptoms are not so obvious.  However, they might still be experiencing some uncomfortable side effects of the medication such as nausea, confusion, drowsiness, nervousness, loss of energy, weight gain, and hand tremors.

In addition to the effects of medication, there could be some residual symptoms of the mental illness that are noticeable: isolation, irritability, fear, loss of interest, sadness, inability to experience pleasure, low self esteem, no desire or ability to talk, interact, socialize. This creates stress when family members who have not been seen since last year descend on your family member with hugs, kisses, and questions. To complicate matters, some guests are uncomfortable and do not know what to do around someone with mental illness; therefore they ignore them and avoid them making the situation even more awkward.

What should we do? One key to surviving this situation is to have expectations for ourselves and our loved one at realistic levels. We should be flexible and let go of the idea that this has be a perfect traditional holiday for our family member. We must accept ourselves and our loved ones without judging, criticizing, and advising.

The following comments have been made by family members in NAMI classes and support group:

“My family member retreats to his room a few times during the day.”

“My family member enjoys the young children. There seems to be less pressure.”

“We don’t have family in town so my son and I go to the casinos.”

“We go to a community holiday celebration. Sometimes we help serve.”

Mental health ministries.net suggests that before the big day, we should include our family member in baking, decorating, and gift wrapping. These are usually less stressful situations, and the family member gets an opportunity to make an important contribution to the holiday celebration.

REMEMBER: We keep expectations of ourselves and our loved one at realistic levels.