“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.
Friday, October 3, 2014
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.
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.
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.
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.
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.
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.
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.
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