Tag / caregiving

a photo showing how delusion might feel
by karentwinem

Dealing With Delusions and Hallucinations

Handling the Symptoms of Mental Illness

Note: The information is from NAMI, Mental Health America, “When Someone You Love has a Mental Illness” by Rebecca Woolis,  “The Complete Family Guide to Schizophrenia” by Dr. Kim T. Mueser and Susan Gingerich, and the Palo Alto Medical Foundation. It also reflects what I have learned through personal experience.

Some questions that I have heard in our support group include:

  • “What do I say when she says someone on television is sending her secret messages?”
  • “What do I do when he gets the locks changed because he thinks the FBI is trying to get into our house?”
  • “What do I do when he disassembles the pipes to find out where the voices are coming from?”

All these questions are related to delusions and hallucinations, which are symptoms of schizophrenia, bipolar disorder (in some cases) and other forms of mental illness. Three factors that can influence symptoms are inadequate medication, substance abuse, and high levels of stress. About half the people with schizophrenia have symptoms most or all the time, even with medication. Symptoms also can be signs of relapse coming.

Of course, we always point people to the experts.  When problems develop, call the treatment team. But it can be hard to get in touch with a social worker or a psychiatrist, whether you have a HIPAA release or not. So I’m providing the information that I have collected and used in real-world situations as support.

Responding to Delusions and Hallucinations

People vary in their sensitivity about their delusions or hallucinations.  Previous medical history is a fairly good predictor of this. Some signs that a hallucination is taking place include when your loved one is:

  • Talking to themselves as if responding to questions or comments, but not in a conversational way, such as: “Where did I put my purse?”
  • Staring into space, or being distracted or preoccupied.
  • Laughing for no apparent reason.
  • Appearing to see something that you can’t see.

Hallucinations and delusions often start out as benign, but can become more troubling over time.

People can learn to deal with hallucinations through therapy (including cognitive behavioral therapy), medication, ignoring the hallucination, telling the voices to leave them alone or playing music loudly. Shifting attention to music or television can help.  Working toward acceptance through prayer also helps.

Principles to Keep in Mind

When you are dealing with a loved one who seems delusional or may be having auditory or visual hallucinations, there are some basic principles to keep in mind.

While the things they say that they see, hear or believe are not apparent to you and may not make sense, they are very real to that person. They actually hear voices and see images.  They believe the things they are telling you. Do not dismiss or minimize the impact of this. Do not get into an argument about whether the voices are real.

Research shows that confronting people about their delusions may result in an initial decrease of belief in them, followed by a rebound that makes the belief in the delusion stronger.  This discredits you. If you are forced to take a stand on this situation, just say that you know the experience is true for them.

People, particularly those who have been in treatment for some time, may not be entirely convinced that the delusion or hallucination is true.  They know that this can be a symptom of their illness.  If they check with you to see if what they are seeing or hearing is true, you can tell them that it is likely that this is a trick that their mind is playing or whatever term is comfortable for them.

Respond to the Emotional State

A variety of emotional states accompany delusions and hallucinations, ranging from pleasure to terror. It’s more important to respond to the emotional state you detect than to the content of the delusion or hallucination.  Use listening skills like paraphrasing and asking clarifying questions to reflect what you hear. Ask: “What can I do to help you feel safe?”

You can ask if the person is seeing or hearing something. Try to get enough information to determine how they are feeling and focus on that.

Do not make fun of the person or try to have a lengthy conversation about the content of the hallucination.

Keep in mind that your statements may be confusing to the person as well.  If a voice is saying that you are going to kill him, and you are saying everything is fine.  You see the problem.

This is the second of a series on handling the symptoms of mental illness with your loved one. Next time: responding to agitation and hypomania. As always, if you can get advice from the medical team treating your loved one, use that advice instead.

handling bizarre behavior and anger in people with mental illness
by karentwinem

Handling Anger, Bizarre Behavior and Negative Symptoms

Information is from “When Someone You Love has a Mental Illness” by Rebecca Woolis, “The Complete Family Guide to Schizophrenia” by Dr. Kim T. Mueser and Susan Gingerich, and the Palo Alto Medical Foundation.

The best answers for how to respond to the symptoms of your loved one’s mental illness come from their treatment team. However, I’ve found it can be hard to get answers from the team quickly. This information below is from respected sources and my own experience to help when you need to respond immediately.

Responding to Anger

First, if you are angry or upset at your loved one, separate until you can calm down. To deal with their anger, you need to remain as calm as you can, and stay in control of yourself. When your loved one is angry:

  • Do not approach or touch your loved one without permission.
  • Give your loved one an escape route out of the situation.
  • Don’t give into angry demands that violate your boundaries.
  • Do not argue with irrational thinking.
  • Acknowledge the person’s feelings.
  • Protect yourself from injury.

If necessary, call 988 to get connected to a mental health team. If you feel you are in immediate danger and can’t get a rapid response, call the police and ask for an officer trained in dealing with the mentally ill.

If angry outbursts become routine, you need to discuss this when everyone is calm and can agree to some steps.  This could include:

  • A medication review
  • Venting energy via exercises, such as hitting a punching bag or yelling in a place where it won’t bother anyone.

Dealing with Bizarre Behavior

Bizarre behavior is a symptom and is often related to delusions. This can include strange rituals and OCD-like activity and unusual beliefs acted out.

If the behavior is harmless, you can ignore it if you wish.  (For example, if your loved one can’t go get ice cream because everyone can read his mind at Graeter’s). Focus on positive behavior, and ignore bizarre behavior.

If it constitutes a problem (running around the neighborhood naked, doing dangerous things, damaging property, etc.), you can ask the person to stop.  They may or may not be able to do this.

Focus on the consequences.  Tell the loved one that the behavior may end up with them being in jail or the hospital.  You can remind them of previous experience, if applicable.

If necessary, call 988. If you feel you are in immediate danger, you may need to call 911 and ask for an officer trained in dealing with the mentally ill.

Dealing with Negative Symptoms

Blunted Affect is a facial expression that’s almost blank and conveys no emotion.  The person still feels emotions, but they don’t show them. Ask how they are feeling.

Poverty of Speech means that the person barely speaks. The person cannot help this.  Do things together where the focus is not on talking: shopping, nature walks, movies.

Apathy and Anhedonia are when your loved one no longer enjoys activities or things. Apathy is a symptom, and not under the person’s control.  At the core of this is a belief that activities will not be fun.

  • Acceptance is the first step. “I know he’s doing the best he can.”  “He’s not lazy; this is a symptom of his illness.” “Difficulty doing things and following through are part of this illness.”
  • Invite the loved one to join you in day-to-day activities (grocery shopping, going to the dry cleaner, etc.).
  • Regularly schedule enjoyable activities (going to a museum, going to get pizza, going to a park).  Lower your expectations.
  • Take baby steps and praise progress.
  • Increase daily structure. 
  • Focus on the future, not the past.

This is the first of a series on dealing with symptoms. More to come soon.

photo of God on Mute cover
by karentwinem

Resource: “God on Mute: An Answer to Unanswered Prayer”

Pete Greig began writing “God on Mute: An Answer to Unanswered Prayer” as a paper manuscript he gave to friends. Today it is one of the most helpful books on the issue of unanswered prayer. One of the latest editions of the published book includes a 40-day Lenten study that I did last year.

I recommend it to anyone struggling to find peace when they feel God has not answered their prayers. This includes many of us who have a loved one dealing with severe and persistent mental illness.

I know, as one of my friends noted, there is no such thing as unanswered prayer. It’s either yes, no or wait. Still, as Justin Welby, 105th Archbishop of Canterbury writes in to introduction, Grieg comes from a Christian tradition “that expects the intervention of God.” When God does not visibly intervene, Christians in that tradition have predictable reactions. You can even see the difficulty when meditating on Jesus in the garden of Gethsemane.

Grieg is a man familiar with this grief. A British pastor, he cofounded the 24-7 prayer movement, now a worldwide ministry. His struggles with unanswered prayer focused on his wife’s affliction with a disease that gives her chronic convulsions. She still has the illness although she has outlived predictions for her life expectancy.

Citing many examples of unanswered prayer among his friends and other respected Christians, Grieg spends a good part of the book explaining why God cannot answer some of our prayers as we wish. The appendix reviews his 16 different reasons and how we can react to them.

The 40-day Lenten guide also walks gently through the book’s content as Grieg examines the problem of unanswered prayer within three contexts: God’s world, God’s will and God’s war against evil.

If you are struggling with anger, sorrow, bitterness or despair over your prayers, this book would be a wonderful addition to your Lenten routine. It has five stars on Amazon and four stars on GoodReads. So others agree with me: It’s a helpful read. Please let me know if you find it helpful.

statue of women screaming in sorrow
by karentwinem

How to Write Your Lament

“It seems to me that we do not need to be taught how to lament since we have so many models in Scripture. What we need is simply the assurance that it’s OK to lament.”

Michael Card

He’s right. It is OK to come before God in sorrow through a prayer of lament. Many major figures in the Bible did. David, Job, Jeremiah and Habakkuk, for example, each poured out misery and fear as a pathway to God in bad times.

Before the pandemic, we rarely heard about this type of prayer. When we were locked down, some church elders talked about lament as they tried to help the frightened and angry reach out to God. That moment passed. But it hasn’t passed for all.

Lament remains a necessary prayer for families dealing with severe and persistent mental illness. It is the prayer of perpetual grief, of the dark night of the soul.

Yet lament also expresses faith. We face the pain as we face God himself. We lay the truth and our reality before Him. And we worship Him.

Lament doesn’t change God, but it does change us.

Get Help from the Holy Spirit

Graham Cooke wrote that the Holy Spirit (who is not called our Comforter for nothing) works with us when we lament. He aligns Himself with us and helps us to will to worship God.

One of the most famous laments came from Horatio Spafford in the 19th century. This successful attorney and real estate investor lost everything in the great Chicago fire of 1871. So he and his wife decided to recover in France. His wife and their four daughters left first, by ocean liner, while Horatio stayed behind to finalize some business. The ship sank. And Horatio got a heartbreaking telegram from his wife: “Saved alone.” On his way to meet his wife in France, Horatio passed over the spot where his beloved daughters drowned. Then he wrote this: 

When peace, like a river, attendeth my way,
When sorrows like sea billows roll;
Whatever my lot, Thou hast taught me to say,
It is well, it is well with my soul. 

Originally a poem, it was set to music. And it has inspired millions.

Cling to God in Despair

Does writing a lament sound like complaining? It’s not. Because we refuse to let go of God. We are honest and open our hearts to Him, begging for understanding.

Job prayed deep prayers of lament. After he lost everything, he wrestled with God as he sought meaning. Job did not let God go. He said:

“I know that my Redeemer lives, and that in the end He will stand upon the earth. And after my skin has been destroyed, yet in my flesh I will see God.”

Job 19: 25-26

Musician Michael Card commented, “Finally, we see in Job one of the most fundamental lessons we can learn from lament: that protesting and even accusing God through the prayers of lament is, nevertheless, an act of faith.”

Write Your Own Lament

You may want to write your own lament. One solid formula is the “though/yet” pattern found in Habakkuk. It begins by explaining the circumstances and ends in a solid statement of faith in God.

“Though the fig tree does not bud and there are no grapes on the vines, though the olive crop fails and the fields produce no food, though there are no sheep in the pen and no cattle in the stalls, yet I will rejoice in the Lord. I will be joyful in God my Savior.”

Habakkuk 3: 17-18

Just follow these steps:

  1. Find a quiet place with God. Set aside a block of time. Laments do not come quickly.
  2. Ask the Holy Spirit to guide you.
  3. Be in God’s presence.
  4. Write down the “though” circumstances in your life. What challenges are you facing? What pain or grief do you feel?
  5. Offer these things to God. Don’t ask for anything.
  6. Worship God by completing the phrase: “Though these things have happened, yet …”

Praising God in the midst of difficulty is powerful because God stands in the moment with us.

Try to create your own lament. It is a powerful prayer that God treasures.

mother grieving mentally ill child
by karentwinem

Experience God’s Comfort in Ongoing Grief

Bless are those who mourn for they will be comforted.

Matthew 5:4

Grief is always hard. But it doesn’t always involve death. Families dealing with mental illness have an ongoing grief that needs God’s comfort. This type of grief is hard for others to understand. The person you love is alive, but your hopes for their future are not.

This is a situation that only God can truly comfort. It is often too hard for other people to understand.

Let’s take a look at the differences between grief due to death and ongoing grief.

Classic Stages of Grief Due to Death

You may have experienced the classic stages of grief due to death:

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance

Each person goes through these phases in their own way. You may go back and forth between stages, or skip one or more stages altogether. Reminders of your loss, like the anniversary of a death or a familiar song, can trigger the return of grief.

Experiences With Ongoing Grief

Again, the grieving process you may experience when your loved one is diagnosed is different from the grief you feel when someone close to you dies. For example, you may experience:

Shock and fear

  • Loss of our beloved person’s true personality
  • Loss of our own anticipated future
  • Loss of our loved one’s future
  • Stigma
  • Fear of the unknown

Guilt and struggle

  • Did I do something to cause this?
  • Why him or her? Why me?

Denial, often merged with anger

Isolation and sadness

Can you relate to any of this?

Common Ways to Run from Grief

One way of dealing with ongoing grief is to hide from it. Yet, if we do not fully grieve, we can get stuck. This may create emotional havoc. Some common ways to run from grief include:

Postponement: Delaying and setting aside feelings and expressions of grief, while hoping feelings associated with grief will go away over time.

Displacement: Transferring unwanted or difficult feelings onto other people or things, deeming them the cause of the feelings. This could include being self-critical, fixating on minor issues and blaming others unrelated to the loss.

Replacement: Investing in an activity, such as overworking, intense and obsessive pursuits, or a new relationship.

Minimization: Not allowing ourselves to feel the full weight of the grief, even using faith to avoid it.

Physical illness: Experiencing bodily symptoms, illness or pain that may or may not be connected to real illness.

Three-Step Process for Dealing With Ongoing Grief

No. 1: List the losses that you have not fully grieved. Yes, write out your loss history, starting at the beginning of your life.

No. 2: Lament those losses. Lament is a passionate outpouring of our grief to God. A good example is Psalm 88. The entire psalm is a lament to God. Here is the Message version. 

God, you’re my last chance of the day.
    I spend the night on my knees before you.
Put me on your salvation agenda;
    take notes on the trouble I’m in.
I’ve had my fill of trouble;
    I’m camped on the edge of hell.
I’m written off as a lost cause,
    one more statistic, a hopeless case.
Abandoned as already dead,
    one more body in a stack of corpses,
And not so much as a gravestone—
    I’m a black hole in oblivion.
You’ve dropped me into a bottomless pit,
    sunk me in a pitch-black abyss.
I’m battered senseless by your rage,
    relentlessly pounded by your waves of anger.
You turned my friends against me,
    made me horrible to them.
I’m caught in a maze and can’t find my way out,
    blinded by tears of pain and frustration.

I call to you, God; all day I call.
    I wring my hands, I plead for help.
Are the dead a live audience for your miracles?
    Do ghosts ever join the choirs that praise you?
Does your love make any difference in a graveyard?
    Is your faithful presence noticed in the corridors of hell?
Are your marvelous wonders ever seen in the dark,
    your righteous ways noticed in the Land of No Memory?

I’m standing my ground, God, shouting for help,
    at my prayers every morning, on my knees each daybreak.
Why, God, do you turn a deaf ear?
    Why do you make yourself scarce?
For as long as I remember I’ve been hurting;
    I’ve taken the worst you can hand out, and I’ve had it.
Your wildfire anger has blazed through my life;
    I’m bleeding, black-and-blue.
You’ve attacked me fiercely from every side,
    raining down blows till I’m nearly dead.
You made lover and neighbor alike dump me;
    the only friend I have left is Darkness.

You also can write your own lament. This process can take hours or days. Speak directly to God. Do not be afraid to express anger or disappointment. God already knows how you feel and loves you anyway.

    Finally, ask Jesus to heal your broken heart. This is the sort of heartbreak that only God can heal. I find that sitting before the Lord in silence for 20 minutes or so on a daily basis can open a source of comfort only God can deliver.

    by karentwinem

    Dealing With Your Own Anxiety

    Sources for this article include NAMI.org , va.gov (U.S. Department of Veterans Affairs), adaa.org (the Anxiety and Depression Association of America) and caregiver.org. Other sources included the U.S. Department of Health and Human Services, “Identifying and Addressing Family Caregiver Anxiety” by Karen O Moss, PhD, RN, CNL; Colleen Kurzawa, MSN, RN, MFA; Barbara Daly, PhD, RN, FAAN; and Maryjo Prince-Paul, PhD, RN, FPCN. The article “Hidden from view” in Breathe magazine, issue 57, also provided insight.

    Are caregivers vulnerable to anxiety?

    More than one in five Americans today are caregivers, providing care and support to an adult or child with special needs. That is 21.3 percent of the population.

    A study of family caregivers cited above found roughly 38 percent find their situation extremely stressful. Caregivers are a vulnerable population for psychological distress, including anxiety. In fact, the caregiver’s anxiety can even exceed the levels that their loved one’s experience. This study covered caregivers of people with cancer and dementia, but I’m sure the statistics for families dealing with mental illness are similar or even worse.

    How anxious are you feeling? Are you managing too many responsibilities? Strain because you can’t control your own life? Fear for a loved one’s well-being? Deal with financial and healthcare coverage stressors? As a caregiver, you may spend many more hours a week providing care than in a regular job. Caregivers report employment problems, health issues, lack of sleep and little time to do the things they enjoy. 

    What is anxiety?

    Anxiety is the most common form of mental illness in the U.S., affecting 14% of the population. That includes 18% of adults and 8% of children and teenagers. (These figures are from the National Institutes of Health.)

    It is a common emotional response to a perceived threat, often accompanied by tension, worried thoughts and physical changes like high blood pressure and insomnia.

    Severe and persistent anxiety typically has these aspects:

    1. Extreme fear and dread, even when there is nothing to provoke it
    2. Emotional distress that affects daily life
    3. A tendency to avoid situations that bring on anxiety

    How is anxiety different for mental health caregivers?

    As we see above, anxiety can be extreme fear without reason. Caregivers for people with mental illness have plenty of reasons to experience fear and ongoing grief, including:

    • Fear of living life without the personality we loved.
    • Grief over our loved one’s lost potential and possible future.
    • Fear of being overwhelmed by the issues surrounding mental illness.
    • Fear of future pain.
    • Fear of losing your own identity and life.
    • Grief over lost plans for retirement.

    Once my primary care doctor said to me: “If you weren’t anxious, I’d be worried that you didn’t understand the situation you are in.”

    While some caregivers probably do have generalized anxiety disorder, many caregivers are just plain anxious. The study I read was focused on caregivers for people with cancer and dementia, but many of the aspects are the same.

    I once attended a retreat for mothers of children with severe mental illness led by Kay Warren. She said: “We receive wounds of many sorts. Some forms of pain and loss we just don’t get over. A soul wound damages the architecture of the soul. What is grief, if not love persevering? The “natural order of things” and the depth of the love impact the grief.”

    What are the symptoms of anxiety?

    sleepless man

    Signs and symptoms of anxiety are similar to the symptoms of depression. They can co-exist.  Among caregivers, the symptoms are:

    Neurological: Trembling/shaking, restlessness, headaches, dizziness, apprehension, numbness, tingling, fatigue, poor concentration, nervousness.

    Cardiac: Increased pulse rate, chest pain or discomfort, palpitations.

    Respiratory: Dyspnea

    Digestive: Diarrhea, loss of appetite, nausea, dry mouth, indigestion.

    Mood: Nervousness, irritability.

    Musculoskeletal: Muscle tension.

    Sleep: Insomnia

    Skin: Sweating

    Urinary: Frequency, urgency.

    Do you have high functioning anxiety?

    Daily anxiety can affect your health long before it affects your productivity. High functioning anxiety means that you suffer internally from anxiety without it affecting your productivity. People with high functioning anxiety may become more irritable, withdraw socially or self-medicate through alcohol use.

    See if these questions reflect things happening to you:

    • Do you worry every day?
    • Are you a perfectionist?
    • Do you suffer from sleep disturbances and muscle tension most of the time?
    • Do you find that your mind is always “on the go,” preventing you from living in the present moment?
    • Are you tired or mentally exhausted most of the time, even after a good night’s sleep?
    • Do you sometimes forget what you were saying or doing?

    How to manage your anxiety

    Be sure that your doctor knows that you are a caregiver for a person with mental illness so they can test for and monitor anxiety. Many caregivers do not seek out help for anxiety because they are concentrating on their loved ones, giving themselves little or no care.

    Remind yourself it’s normal to have fears and anxious thoughts in our situations.

    Talk to others who understand. Sharing your fears to a support group helps us realize we are not alone. Therapy can help with marital problems, changed relationships or family issues as a result of the change.

    Take care of your body. Caregivers should exercise, get enough sleep, eat healthy meals, take their own medications and get regular check-ups. Walking, biking, yoga, swimming and running can reduce anxiety.

    Rest in God. God wants you to experience his compassion during this time. Jesus himself was overwhelmed and deeply shaken as he faced his coming suffering and death at Gethsemane. He said, in Mark 14, “My soul is overwhelmed with sorrow to the point of death.” He knows.

    Increase your times of prayer, maintain regular church and small group attendance, and read uplifting materials. “Humble yourselves, therefore, under God’s mighty hand, that he may lift you up in due time. Cast all your anxiety on him because he cares for you.” (1 Peter 5:6-7)

    So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand. (Isaiah 41:10)

    Peace I leave with you; my peace I give you. I do not give to you as the world gives. Do not let your hearts be troubled and do not be afraid. (John 14:27)

    people in a revolving door
    by karentwinem

    What Is Assisted Outpatient Treatment?

    Assisted Outpatient Treatment is an attempt to stop the revolving door of hospitalization-release-hospitalization-release for some people with mental illness. This court-ordered treatment is usually for individuals with mental illness who have a pattern of noncompliance with medication.

    The first Assisted Outpatient Treatment law, called Kendra’s Law, was in New York. It became law after a person with untreated several mental illness killed Kendra Webdale by pushing her in front of a subway train in 1999.

    Some form of this law is on the books in 47 states and the District of Columbia, but it’s not really available everywhere that it’s legal. Connecticut, Maryland and Massachusetts do not have Assisted Outpatient Treatment at all. If you live in any other state, the Treatment Advocacy Center can provide information about your state’s resources.

    Since I live in Ohio, I am going to quote from my state’s Civil Commitment criteria (State law 5122.01 (8) (1) to (5). Mentally ill individuals can be subject to court-ordered treatment if they:

    • Represent substantial risk of physical harm to themselves or others OR
    • Are unable to provide for their own basic physical needs OR
    • Have behaviors that create grave and imminent risk to the rights of themselves or others.
    • Are unlikely to survive safely in the community without supervision.
    • Have a history of treatment non-adherence that has led to either:
      • Two hospitalizations in the last 36 months spent in the community OR
      • An act/threat/attempt of serious violence in the last eight months spent in the community
    • Are unlikely to voluntarily participate in treatment
    • Need treatment to prevent relapse or deterioration likely to result in substantial risk of serious harm.

    A judge orders Assisted Outpatient Treatment in civil court. The judge also becomes the primary motivator due to the Black Robe Effect. Because they command respect as a symbol of authority, the judge motivates both the treatment system and the individual. Treatment usually takes 12 to 18 months.

    If either the treatment professionals or the individual do not adhere to the treatment plan, the judge can:

    • Extend the length of time in the program.
    • Increase the frequency of appearance in court.
    • Order reviews of the treatment program.
    • Pick up the individual for evaluation.
    • Rehospitalize the individual.

    Pathways to Getting Assisted Outpatient Treatment

    The best way to get someone into the Assisted Outpatient Treatment program is to start talking to doctors when a loved one is in the hospital, especially if the loved one has had an involuntary hospitalization. Ask the doctor to file an affidavit with the court requesting Assistant Outpatient Treatment. Family members also can file an affidavit for mental illness treatment at the probate court.

    Another good time is during a transition from jail or prison to the community. Ask the doctor at the jail to initiate this.

    Assisted Outpatient Treatment works. The program began in New York, where it is used most extensively. Study results show that those in the program has a 87% decrease in incarceration, a 74% decrease in homelessness, an 83% decrease in arrests and a 77% decrease in rehospitalizations. More information is available from the Treatment Advocacy Center.

    ear poking through yellow wall paper
    by karentwinem

    Listening to People Who Have Mental Illness

    Good communications with people who have mental illness starts with listening well. Really hearing someone’s feelings and thoughts is a great gift of love and respect.

    People with mental illness could be experiencing auditory hallucinations, overwhelming feelings of depression, intense anxiety, and cognitive disorganization. So we need to avoid arguments and heated communication.

    They may feel lonely, inferior to others and disrespected. You may be able to have an influence on these feelings when you demonstrate your positive regard for them. When you show that you accept them and have compassion for them, you offer hope and understanding.  As a positive benefit, they may respond better to your requests.

    What Not to Do: Types of Bad Listeners

    This list is from Listening for Heaven’s Sake – Class Notes by Equipping Ministries International. Do any of the listeners below remind you of you? Particularly when you are under stress?

    Type of ListenerCharacteristics
    The InterrogatorAsks lots of questions
    Focuses on the details
    Satisfies their own need to know
    Focuses on facts rather than feelings
    The GeneralGives orders
    Takes command or control
    Assumes responsibility
    Focuses on the outcome
    The PhariseeBlames and shames
    Condemning outlook
    Focuses on the person being “bad”
    Says “You should” or “You ought to” often
    The LabelerOversimplifies problems
    Pigeon-holes people
    Believes that putting a name to it equals a solution
    Has a quick-fix mentality
    The Casserole PersonTries to cover over pain with food
    Avoids the unpleasant
    Expects kind actions to remove pain
    The HistorianFocuses on the past
    Can’t remain in the present
    Speaks triggered memories
    Loses focus on the speaker
    The Bumper StickerGives trite answers
    Oversimplifies problems
    Is quick with clichés

    Steps Toward Being a Good Listener

    • Relax and be calm.
    • Minimize distractions.  (Can I turn off the TV?)
    • Make eye contact unless it is threatening.
    • Discuss one topic at a time.
    • Ask for opinions and suggestions.
    • Don’t take it personally when it’s the illness talking.
    • Avoid bringing up the diagnosis.
    • Don’t use sarcasm.
    • Speak simply and directly.

    Next time we’ll discuss the basics of therapeutic communications: using reflective listening and I statements.

    cartoon of person with upset brain relating to a caregiver
    by karentwinem

    Helping Them Cope

    Note: This post is adapted from information I learned in the NAMI Family-to-Family program. We highly recommend attending this program to learn more about mental illness.

    Having a mental illness and dealing with the world takes enormous courage and determination. As we have previously written, many people develop defensive coping strategies.

    These negative behaviors are actually typical for any person with a life-changing or life-threatening illness. (They include irritability, denial, abusive language and resistance to treatment.) For people with mental illnesses, the behaviors are even more counter-productive. This can be very upsetting to you.

    So what’s the best way to react? Here are some suggestions from NAMI:

    • Respect and protect your loved one’s devastated self-esteem. Don’t criticize them. Keep nagging and negative remarks to a minimum.
    • Punishment, argument and pressure make things worse.
    • Ignore as much negative behavior as you can. Praise positive behavior as much as you can. People with mental illness are more likely to improve when they can see behaviors earn them approval and recognition.
    • Accept the symptoms of the illness. You don’t punish a child with a stomach virus for vomiting. Know what the symptoms of the illness are, and try to separate that from the person’s behavior. You cannot argue someone out of a depression or delusions.
    • Accept that your loved one may not be able to fulfill a normal role in the family. Reduce your demand for emotional support and “carrying your weight.”
    • Make these allowances, yet treat the person as a regular member of the family.
    • Encourage independent behavior. Allow them to do what they can, which can vary from time to time. But, again, don’t push.
    • Live in the present. You have a right to grieve, and you may need professional help to do so. But don’t live in the past or focus on “what could have been.” One of the best things you can do for your loved one is to accept that they have an illness that makes life harder, but not impossible. This is how it is.
    • Be patient. When our loved ones take steps toward more independence, it’s very scary for them.
    • Be kind to yourself and the rest of the family. This is hard. Don’t criticize yourself or others when you make a mistake. Give everyone in the family some grace.