Have you ever gone 24 hours without sleep? 48 hours? How did you feel? How did you look?
Dozed off for a second, awakened with a start and didn’t know where you were? Lost your sunglasses or car keys and no matter what you did, you couldn’t find them? Gone driving down a road when your sense of direction got mixed up? Had a song stuck in your head that would not go away? How would you feel if that song stayed for a month or more?
Now let’s put three or more of these items together. Say you’d hadn’t slept for three days, you heard the same music going on and on in your head, and you couldn‘t find your keys. How would you feel?
That thought experiment gives you just a hint of the inner life of a person with mental illness. Even in remission and even when properly medicated, chronic mental illness leaves its sufferers in a devastating limbo.
Many people with mental illness are effectively cut off from the predictable, rewarding, self-fulfilling live involvements that make existence meaningful. They suffer deeply from their inability to be competent and successful in their daily lives.
This threatens our loved ones’ psychological integrity. It sets up a process where they feel they must protect their “core self” at all cost.
Many behaviors that result – refusing medication, rejecting family support and community programs and disrupting family life, for example – don’t make sense to us. Yet they are directly related to their struggle to maintain some dignity and self-respect in the face of stigma, failure and shame.
Psychological traumas are associated with any serious chronic illness.
Whenever a person has a serious chronic illness …. COPD, emphysema, chronic heart disease, or a mental illness … two things happen to the sense of self.
First, they lose their protective belief that they are exempt from harm. Much of our sense of safety and willingness to take risks rests on a belief that serious harm or real trouble will never happen to us. Young people especially still have this sense. Second, they lose their sense of a predictable, dependable future.
This results in some common defensive coping strategies.
These are self-management techniques that are basically maladaptive. They don’t help people get what they really want, but they do provide temporary psychological refuge when confidence and self-image are taking a nose-dive.
- Abusive criticism of others
- Anger and attack
- Blaming others
- Controlling or manipulative behavior
- Doing nothing
- Drug and alcohol abuse
- Excessive sleeping
- Quitting a job
- Refusing help or services
- Refusing medication
- Rejection of family and friends
- Resistance to change
- Running away
From time to time in daily life, all of us will use one or more of these behaviors. If we are criticized at work … snubbed by someone we thought was a friend … having a fight at home … we may use one of these behaviors if we feel momentarily crushed. We complain or attack. We “need a drink.” We get fed up and call in sick.
For us, these responses happen when we feel temporarily defeated. We normally pull out of them quickly. We turn to our social and personal life structure, finding comfort and reassurance.
The situation for people with mental illness is drastically different. Their social and personal life is vastly diminished. They often face poverty, stigma, disability, joblessness and social rejection. They are trapped in a runaway train going the wrong way.
The negative coping strategies become a familiar and reliable way to protect themselves from becoming even more diminished.