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.