A column by Bles Carmona
For the week of Dec. 10-16, 2014
CARING FOR YOUR LOVED ONE WITH A MENTAL ILLNESS THIS HOLIDAY SEASON
Early this year, I was browsing through the offerings of The Book Shop in Hayward, my favorite local bookstore, and came across a precious resource that I promptly snapped up. It’s a book called “When Someone You Love Has a Mental Illness: A Handbook for Family, Friends, and Caregivers,” revised and expanded, written by Rebecca Woolis, MFT, a licensed family therapist with more than 20 years of experience in working with people who suffer from mental illness, and with their families. She is in private practice in Berkeley, CA.
I felt that it would be helpful to approach the topic of mental illness and stress during the holiday season from the perspective of the family, caregivers, and friends of someone with a mental illness. Although statistics says that 1 in 5 Americans suffers from some form of mental illness, a happier flipside interpretation of this fact also means that the other 80% of you are free of any psychiatric symptoms. If you belong to the “sane” and “normal” 80%, please count your blessings. Someone like me with bipolar disorder and my 20% group mates would have to contend with the same life challenges like you do but we have a disability which may impact our coping skills in many ways.
Here is an excerpt from Woolis’ book, a quick reference guide (one among many within its pages) and this is “How to behave around people who have a mental illness”:
1. Treat them with respect, even if you do not understand some of the things they do or say.
2. Be as supportive, accepting, and positive as you can.
3. Be calm, clear, direct, and brief in your communication with them.
4. Engage them in casual conversation or activities with which you and they are comfortable.
5. Do not touch them or joke with them unless you know them well and know they are comfortable with such interactions.
6. Do not ask a lot of questions about their lives.
7. Do not give advice unless they request it.
8. Do not discuss in any detail religion, politics, or any other topic that is highly emotional for them, as these topics may be intertwined with delusional thinking. Explain that these are personal or individual issues that you prefer not to discuss.
9. If they behave in ways that are unacceptable to you, calmly tell them specifically what they can and cannot do. (pp. 106-107)
Now the holidays, for some mysterious reasons, seem to either excite or depress people with mental illnesses. Folks are hustling and bustling all around, making party and family reunion preparations, thinking up gift ideas, shopping, planning a vacation, sprucing up the home, and doing a million other things during this season. These could be positive sources of stress that bring out the best in a lot of people, inspiring them to give their all into this festive, joyous time. However, for someone with a mental illness, facing these situations could be daunting, overwhelming, or downright confusing. The result could either be feelings and thoughts of amped-up excitement as they look forward to all the celebrations, or paralyzing depression at the thought of having to go through what in their minds will be a joyless holiday for one reason or the other. Sometimes the anticipation, the very thought of all that has yet to happen, could rob a person of the appreciation for the present moment. Conversely, if this holiday reminds them of a significant event in the past, then they can get sad, agitated, stressed out. Notice here that in both cases, there is an under-appreciation of today. Who was it who said that today is a gift and that’s why it’s called the present? My sentiments exactly. With a measure of mindfulness, we can ditch the guilt about the past or anxiety about the future and just focus on how blessed we are today, right at this present moment. You may say, yeah, easier said than done, to which I will counter, hey, it’s worth a try.
Now here’s what Woolis suggests in her quick reference guide on “Handling the Holidays”: You can help your relative reduce stress by:
1. Discussing plans in advance
2. Acknowledging any mixed feelings he or she may have. Do not make assumptions about how he or she will feel or act.
3. Keeping expectations realistic, especially regarding whether your relative can tolerate a gathering, for how long, and what kind of participation he or she is capable of
4. Respecting and supporting your relative’s choices and decisions regarding whether he or she is comfortable participating and in what way
5. Accepting your and relative’s limits
6. Helping your relative figure out how to handle some of the stress (e.g., how the person might answer questions, what task he or she might like to focus on, how long to stay, places to go to take breaks), if he or she is willing and able to discuss the event and his or her feelings. It may be important to acknowledge all family members’ needs, preferences, and limits before a workable solution can be reached. (pp. 166-167)
Now let’s talk about “Minimizing relapses.” According to Woolis, you must see to it that your loved one with a mental illness has a “therapeutic day-to-day lifestyle” which includes regular exercise, recreational activities, a daily routine, eating a balanced diet, and avoiding the use of alcohol and illegal drugs. Make sure that you can identify the early warning signs of relapse, such as: any marked change in behavior patterns (eating, sleeping, social habits); absent, excessive, or inappropriate emotions and energy; odd or unusual beliefs, thoughts, perceptions; difficulty in carrying out usual activities; impairment in communication; and any idiosyncratic (i.e., unique to the person) behavior that preceded past relapses.
When warning signs do appear, do the following: Notify the doctor and request an evaluation, maybe an increase in medication is indicated; maintain involvement in any ongoing psychiatric treatment program; responsibly decrease any known environmental stressors; minimize any changes in routine; maintain the “therapeutic lifestyle” described above, especially keeping the environment as calm, safe, and predictable as possible; and discuss your observations with your relative, talk about steps he or she might take to prevent another relapse, hospitalization, or incarceration. To minimize the impact of a relapse, it pays to be prepared: Have a crisis plan ready for yourself; keep emergency phone numbers and procedures in a convenient place; know your limits and how you will proceed if they are exceeded; and tell your relative calmly and clearly what your limits are, what they need to do next, and what you will do if those limits are exceeded. In some cases, you may have to call the police.
Be prepared. But also be kind to yourself. Neither you nor your loved one with a mental illness had a choice about your respective roles. However, from this point on, you know that facts and awareness are now being thrust upon you. Ms. Rebecca Woolis, MFT, in her book, “When Someone You Love Has a Mental Illness,” talks about various other topics which are so crucial in your shared difficult journey with your loved one. Her book is a valuable resource to me personally because I get to appreciate how hard it must be for my family and friends to cope when I am undergoing either the delirious hyperactivity of mania or the energy-less stupor of depression. Now through this book, they can be equipped with the tools to deal with me while at the same time protecting themselves by being urged to set limits.
This year marks my second relapse-free year and I am thankful to Spirit for guiding my thoughts, feelings, and behavior. I thank my family and friends for their love, loyalty, and support. I am thankful for my caring, competent, and compassionate psychiatrist, Dr. Gilda Versales, my doctor since early 2009. To all of you, blessings and light! Maraming salamat po sa inyong lahat!
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