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.

How to get help for someone who has a mental illness

Many people have received first aid training and know what to do in the event of drowning, choking, bleeding, or broken bone. On the other hand, few people know what to do for one who thinks his food is being poisoned or that aliens are moving inside his body or that the television is reading his mind and broadcasting it to the world.

Here are a few tips to get help for someone who has a mental illness:

1. Begin taking notes on what is going on. When did this start? What has happened? What are your concerns?

2. Express your concerns to your loved one. Express ideas such as, “You have been sleeping more than normal, not coming out of your room, not eating.” Or, “You have been agitated, critical, argumentative, anxious. This is not like you.”  They might be open to the idea of going to their primary care physician to see if anything physical is going on. A physical check up with the family doctor is less threatening than going to a psychiatric hospital. The doctor might then make a referral to a psychiatrist or other mental health professional. This type of voluntary cooperation is ideal.

3. It is a different story when the person is psychotic (out of touch with reality), expresses bizarre thinking, sees things that are not there, thinks he is a famous person, thinks God is speaking directly to him. This person needs help quickly. Most of these symptoms do not improve on their own. In fact, they may get worse over time and cause significant problems. It is important to get a diagnosis and treatment immediately so the brain can begin to recover.

A person in this psychotic state may refuse help and say things like, “I am not crazy. You are the one who needs help.” In this case, the family must intervene, and often must pursue involuntary commitment to a psychiatric hospital.

The criteria for admission to a psychiatric hospital are as follows: threatened to hurt himself or others; or gravely disabled. If any of these threatening, violent, or disabling conditions exist, the family member must do the following:

If there is time, go to the Coroner’s office, 707 B Prien Lake Road and fill out an Order of Protective Custody. Use the information from the notes you have been taking. The form to fill out is simple, quick. Take this paper work to the Sheriff’s office or the police station where plans will be made to take your family member into protective custody.

If there is no time, call 911, tell them you are dealing with a person who has a mental condition, and ask them to call for help – preferably from law enforcement officers who have received special training in dealing with mental illness. They are called “CIT officers.”

Usually they will secure the situation while a family member goes to the Coroner’s office to initiate the paperwork for involuntary commitment.  Your family member will be in good hands with these law enforcement officers.

Pursuing involuntary commitment of your loved one is difficult, particularly the first time. The family needs to know it is a loving thing to do because it insures the safety of the individual as well as others. If no action is taken while your family member continues to decompensate, it is like letting a person bleed to the point of death, making no attempt to stop the bleeding.

For more information on how to get help for yourself or your loved one, call the local NAMI office, 337-433-0219.

How to tell if someone you love has a mental illness

Something seems to be seriously wrong, but there is no bruise, no blood, no swelling, no fever, no rash, nothing that would show in a blood test, x ray, CT scan.

What could it be?

Families often miss symptoms of mental illness exhibited by their loved ones because the signs are not as obvious as those of physical illnesses. Consider the following scenarios that might present themselves in young adults who fall in the typical onset age of mental illness – late teens to early thirties:

1. A daughter was an honor graduate in high school, and after the first semester in college is fearful, anxious, tearful, isolates in her room and will not go to class.

2. A son was a good student, class leader, all-around athlete, is having an impressive career in the military when he becomes agitated, irritable, confused, and has trouble putting thoughts together.

3. A daughter-in-law has been a responsible mother, loyal wife, and efficient office manager when she suddenly starts spending money excessively and behaving recklessly without concern for the consequences of her actions.

What is the source of these mysterious moods, behaviors, and thoughts? The young adults involved are smart, capable, and responsible. What happened? While families try to figure this out, tensions arise. People start blaming. They tell the person acting strangely to SNAP OUT OF IT! They waste valuable time trying to “make sense” of what is happening. They need to get professional help. Research has shown that the earlier the intervention, diagnosis, and treatment of the symptoms of mental illness, the better the prognosis.

For decades psychiatrists have used a detailed diagnostic manual (called DSM-IV TR) to identify mental illnesses according to their “clinical signs,” based on the self-report of symptoms from the patient. A diagnosis is made on the basis of how a person feels, acts, behaves, and thinks. Families who become familiar with some of these basic symptoms have a better likelihood of getting the right kind of help for their ill relative. Not all of these symptoms have to be present.

The following descriptions of three of the major mental illness diagnoses are taken directly from the NAMI Family-to-Family Education Program offered by NAMI, the National Alliance on Mental Illness.

-          Schizophrenia: lack of insight, suspiciousness, unwillingness to cooperate, false ideas, emotional dullness, poor rapport, hallucinations.

-          Major depression: depressed mood (sad or irritable); loss of interest or pleasure in daily activities; too much sleeping or persistent insomnia; extreme fatigue; inability to think, remember, concentrate, or make decisions; feeling of  guilt, worthlessness.

-          Bipolar disorder:  abnormally elevated, expansive, euphoric, and/or irritable; decreased need for sleep – staying up all night; increase in goal directed activity; activities that bring painful consequences (excessive spending, foolish business investments, sexual recklessness); grandiose, excessive talking, rapid thoughts, distractibility.

Parents and other family members should not try to figure this out by themselves. The longer the delay in recognition of symptoms and referral to treatment, the longer the delay in alleviation of the symptoms. To love your family member is to act on their behalf. An immediate assessment by a mental health professional is imperative.

For information on how to get help for you and the family member experiencing the symptoms of mental illness, call NAMI Southwest Louisiana, 337-433-0219.