Part One (of a two part series) – Inside the Illness
When someone has a serious psychiatric illness, one of the most difficult aspects of the condition is that most sufferers cannot see the true extent of their symptoms. Some cannot see that they have symptoms at all, and instead project blame for their distress onto loved ones, other people, or circumstances that are not connected to their suffering. In essence the organ (the brain) that is deeply affected is also the ‘narrator’ of their inner voice and perceptions. How would they know exactly the extent of the symptoms taking over their consciousness? If those suffering in such a manner can see their symptoms, they often deny the impact of their illness on their functioning.
Sit for a moment in that reality. Imagine you had dark, hopeless thoughts, even ideas that ending your life made sense. For days or weeks you feel hopelessness, have no energy, ideas that repeat in loops (we call this perseveration) and you cannot quiet them. All these are being generated by your own neocortex under the influence of too much (or not enough) neurotransmitter and too little (or not enough) electricity.
One of our clients (who is now sober and well) described that state in unnerving terms, “At the beginning of a slide (into illness) I can see my brain is turning; I know that I am getting psychotic again. My head feels different, like cotton, or colors seem a little different. Faster thoughts come; louder ideas; I can’t sit down. I’m not hungry or sleepy. Then drinking alcohol to sleep makes sense. Leaving my house late at night to walk around is a great plan. The next thing I know someone is looking for me or I’m so ill I get picked up (by police).”
It would be impossible as a parent or family member to see the beginning of the illness’s descent. Often the symptoms are only visible after an episode of illness has been expressed for some time. It takes sufferers a long time to see their experience as a psychiatric illness at all, and much longer, after treatment and some relief from symptoms, before they can see warning signs. Family members often react with frustration and anger, as for us, both the symptoms and their impact seem starkly clear.
“Why doesn’t he want help and meds?” parents will ask in anguished tones. “How can they be ok with living like this?” I do not have many answers, but I wanted to share with parents and loved ones what it is that could be going on and what you can do to be helpful to your loved one.
As someone in long term recovery myself from major depressive disorder and comorbid addiction, I can honestly say that my brain often “told me” that I was fine and didn’t have symptoms, or that my symptoms were “caused” by others or specific situations. I also sincerely believed that my serious symptoms were “cured” by cannabis use and alcohol. This was 34 years ago, but I can clearly remember both my symptoms and the distorted cognition I had about the symptoms. It was not until a dear friend died by suicide that I was shocked into recognition that I too was at risk, that she and I shared the same disorder. I have decided to share these deeply personal things because I sincerely want to help others perhaps navigate the darkly seductive patterns of cognitive distortions of many organic brain disorders.
I know this to be the case with many clients we help at Insight Counseling, when they are ‘dragged’ into therapy they most often are angry and resistant, insisting that their family members are critical and overreacting. At times they believe they are functioning fine despite not being employed (or not employable due to the behaviors related to their illness) or facing legal issues. At times, family members have been critical of their loved ones’ behaviors and verbal abuse, substance use and other behaviors that may appear to be completely within the person’s control. This is understandable. However, those who are ill will always lash out and be defensive. It is part of their distorted thinking.
To make things even more complex, family members and clients will often have both legitimate and “projected” resentments of each other’s behaviors and they can become “stuck” in these repeated patterns of anger, blame, cajoling, scolding, punishing, apologies, promises, etc. The real issue at the core of this cycle is that people with mental illnesses are often not thinking, feeling or behaving in rational ways. Their symptoms can be so overwhelming and even so frightening that they want to believe their “projected” anger and blame are actually “true.”
“If you both would just leave me alone and let me stay in my room I will be fine and get a job and move out!” yelled a 26-year-old client (I will call him David), who had symptoms so severe he feared leaving the house, and neglected his personal hygiene and all his other responsibilities. His loving parents would alternate between begging him to do things, being angry at him, leaving him alone and seeking all sorts of outside help that their son refused to use. This young man had experienced anxiety and depression since late adolescence but did graduate college (with a little extra time) and then “collapsed” into his symptoms after being fired from his first two jobs for chronic lateness and other behaviors related to his increasing symptoms. Then his long-term girlfriend broke up with him due to his increasing isolation and odd patterns of thought and behavior.
By the time we consulted with his parents he was rigidly refusing all care and rarely left the house. He yelled at his parents whenever they tried to speak to him. He seemed “willful” and defiant, but he was in fact terrified and lost. We helped the parents craft a plan of care and then created a plan of a home-based intervention that helped David see that he might have biological symptoms that could be helped. After a short stay in an inpatient psychiatric hospital, he lived in a structured residential setting for young adults with serious psychiatric illness. He can now discuss how his thoughts were distorted and how differently he sees his life now.
“When the medicine and therapy started working, I realized that the people who cared about me had been trying to get me to see that I was depressed and anxious. I honestly thought I was OK and that one day I would get a job interview and everything would be fine. I am glad they pushed me for so long to get help.”
The wording that family members use when speaking to a loved one who struggles with symptoms and is unwilling to get help, is key to the process. Professionals can help teach parents to use validating wording AND to add expectations that their child accept outside help. Validation is a type of communication that assumes the best about loved ones who are struggling, that assumes they are suffering and cannot get out of their own way. Validation seeks to be compassionate and firm and direct, it is not enabling. It is an effective way to speak to someone who is not rational.
Here are some examples of validating versus invalidating language…
Typical conversation: “You said you would be up by 9 AM today looking for work and it’s 11:30! You are 26 and we can’t keep doing this!”
Validating conversation: “It looks like even though you intended to get up early and be motivated today, you are not able to. We know there must be a real reason why you are struggling to focus. Can you have some coffee in a little while and talk?”
Typical conversation: “Money is missing from our account again! You left the house yesterday to buy drugs, didn’t you! We can’t take this anymore. You are killing us…”
Validating conversation: “We are very worried because you took money from us again. We know you have values and we believe you meant your promise last time. Please, can we all go talk to someone to help us? We do not want to fight or punish you; we want you to feel better so you will keep your word again. We love you.”
Of course there are so many variations on how loved ones try to reach out to their suffering family member, and many are effective. We are human, and having strong feelings of anger and even shock with regard to your loved one’s symptoms and behaviors is normal. To practice a more validating way to communicate we often have to process our strong emotions with others before we speak to our loved one.
In Part Two I will cover mental health issues with and without substance abuse, providing more specifics on what can be helpful.
If you or someone you know experiences mental health issues, it is important to seek help from a qualified professional. Our Resource Specialist can help you find expert mental health resources to recover in your community. Contact us now for more information on this free service to our users.
About the Author: Elizabeth Driscoll Jorgensen is the owner and director of Insight Counseling, LLC, in Ridgefield, CT. She is a nationally recognized expert in counseling, particularly in engaging resistant teens and motivating them to change. She has received multiple awards and recognition for her work in counseling and community prevention and she was most recently featured in the Netflix documentary, “Take Your Pills.” She is also a guest blogger for www.rtor.org, and was recently featured on our Close to Home blog with a guest post on Dabs, Wax, Vaping Weed, Edibles and the Real Impact of High Potency THC Products: What Parents Need to Know.
Photo by Max Nelson on Unsplash
The opinions and views expressed in this guest blog do not necessarily reflect those of www.rtor.org or its sponsor, Laurel House, Inc. The author and www.rtor.org have no affiliations with any products or services mentioned in this article or linked to herein.
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Liz, thank you again from our team! We are truly grateful for such an informative and incredible guest post. I love the validating language examples. And, look forward to the 2nd part!