Helping Those You Love Who are Sick

Supporting a friend with mental health difficulties

Someone who is experiencing mental health difficulties is usually able to live a successful full life, particularly if they are receiving help to manage their illness.

However, it is not uncommon for stigma to be attached to experiencing mental health difficulties. This often causes people to feel embarrassed. Often people with mental health difficulties worry that people will tease them or treat them differently.

There are some things that you may want to do to help your friend feel more comfortable, these are:
Avoid being judgmental

Being aware of the stigma. Keeping an open mind may help to create a safe environment for your friend which may mean they are more likely to relax and enjoy themselves.
Talk about what they find helpful

Make conversations about their mental health difficulties easy and open. Try asking about what helps them when things are tough. By talking openly, you are letting the person know about your love and support for them. You may like to talk about what you have read and ask how they feel about it.
Respect your friend's limits

There may be times when your friend says they are not able to do something because of their illness. It is important that you respect this and don't put extra pressure on them. Often those who are taking medication are not able to drink alcohol (and shouldn't take any other drugs either). This may make it hard for your friend in certain social situations. If you know that your friend is unable to drink, it may be a helpful that when you do hang out to choose to do something that doesn't involve alcohol and/or drugs.
Encouraging your friend to stay with their medication

It is likely that someone with a long-term mental illness will be on regular medication. This may have side effects, which mean your friend may not enjoy taking the medication. However, medication is often an important part of managing the illness, and your friend may need your support to stick at it.

If your friend stops using or changes the amount of medication they use without getting the OK from their psychiatrist or doctor, encourage them to make an appointment quickly.

If they are experiencing side effects that weren't expected they should also contact their psychiatrist or doctor.
Ensure that you have contact numbers

Having the contact numbers of people like their psychologist, doctor or psychiatrist is often important in helping your friend through a crisis. It means that you can contact someone who knows your friend should they be in a situation where they are unsafe.
Getting help for your friend

For those who have a mental health difficulty, there may be periods of time when things are not manageable. Harder times may be triggered if your friend has been over-stressed or there has been a traumatic event or a change in medication. These things can trigger the characteristics of the mental illness they experience. This is often called an 'episode'.

If you are concerned that your friend is not behaving as they normally would, then it is important to encourage them to talk to someone they trust like their doctor, psychologist or psychiatrist. If you think that your friend is likely to hurt themselves or someone else find some help immediately even if they don't want you to.
Looking after yourself

Sometimes when we are helping a friend we forget to look after our ourselves. It is important to also take care of your own needs as well as helping your friend. Make sure that you don't give up things that you enjoy, and if you are feeling tired or overwhelmed take some time out and relax.

What to say and do and what not to


Do

* remind them of what's good about them.
* smile and make eye contact.
* offer help with children or shopping.
* say:
o "Do you feel like talking? Or would you rather go do something?"
o "That sounds really bad. I'm sorry."
o "I can't fix this, but I will be there so you don't have to go through this alone."
o "Tell me how I can help."
o "You're making progress; you've accomplished so much."
o "Just do what you can today. I'll help you."



Don't

* get angry
* avoid them.
* judge them.
* talk about it all the time.
* offer unsolicited advice
* promise what you can't deliver
* say:
o "Just snap out of it.' They can't.
o "I know what you're going through.' You don't.
o "Things aren't that bad.'

Living with bipolar disorder can feel like riding a mood roller coaster. The “high” of mania is the flip side of depression. But, what is hypomania?

The hypomania of bipolar II, according to the DSM IV, psychiatry's diagnostic bible, is characterized by at least three symptoms from a list (the same list as for bipolar I mania) that includes inflated self-esteem, decreased need for sleep, racing thoughts, distractibility, increased drive and risky behaviors. The DSM IV also says that hypomania doesn't last as long as mania and doesn't create significant impairment in one's life or work, as bipolar I mania does.

Many of those living with bipolar II would disagree.

This official diagnostic definition leaves many living with the illness confused and frustrated. The square peg of their debilitating symptoms doesn't fit into the official round hole. The DSM, the latest version of which was published in 1994, uses narrowly-defined, standard classifications that leave little room for variation.

Man holding his hand to his foreheadBut, many mood experts today, says psychiatrist Jim Phelps, author of Why Am I Still Depressed?, recognize that the degree to which hypomania can cause impairment in work or relationships varies widely.

The "good" side of hypomania can be increased energy, improved performance, enthusiasm and creativity, although it isn't likely to include the "euphoria" of classic mania.

The "down" side: The individual's judgment may be impaired. They may be unable to concentrate on any one thing, irritable or argumentative, even agitated, unaware of the needs and feelings of others. Or they may be ultra-sensitive to criticism or perceived rejection. See chart.

"I usually don't recognize it until afterward,” says a woman who experiences hypomania. “I can be paranoid, defensive and angry. ‘I know what you meant by that,’ I’ll snap. He’s bewildered. And, so am I."

Individuals who experience the highs and lows of bipolar disorder may chalk up their moodiness to personality traits. They may not report their symptoms to a doctor, especially when they're "up," which makes an accurate diagnosis difficult. Those close to them, however, recognize their mood swings.

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Symptoms of hypomania
Someone who is hypomanic may be:

* outgoing
* talkative
* creative
* productive
* enthusiastic
* energized
* taking on several projects at once



* impatient
* unable to concentrate
* distracted
* irritable
* offensive
* defensive
* hostile

An individual with bipolar II also experiences episodes of depression. And when depression occurs together with hypomania, the resulting "mixed state" can cause the person to swing rapidly from feeling “up” to feeling sad and hopeless, then irritable and agitated.

Bipolar disorder, says Phelps, is becoming more commonly viewed as a spectrum disorder with a range of symptoms. It’s commonly misdiagnosed or overlooked.

If you think you may be experiencing hypomania, see a doctor. Without treatment, hypomania can spiral into severe mania or depression

When the one you love is living with depression or bipolar disorder, your relationship, no matter how strong, will be challenged. You can’t make the illness go away, but you can offer practical support as your loved one works on recovery.

Dan W. has had electroconvulsive therapy (ECT) to treat his depression, and it has caused some memory loss. His mood stabilizer meds slow his ability to concentrate. When he drives, he sometimes gets disoriented and forgets the route he needs to take, even if it’s a familiar one.

Under their conversation, his wife Kerry quietly and gently gives him directions. “I think you’ll want to make a right at the next light.”

He feels more confident and appreciates her patience and acceptance.

The most important thing a spouse can do is to make your partner feel connected, respected and worthwhile, writes Claudia J. Strauss in Talking to Depression. The things you say and do can make a big difference in the way your partner feels. A smile, a hug, being patient. Taking them on an outing or helping with a chore. Asking how you can help goes a long way toward making your partner feel accepted.

Since her diagnosis and treatment for bipolar disorder began, Diane L., who receives Social Security Disability payments, has had trouble keeping track of her bank account.

Her husband Kevin helps make it easier for her by having her Social Security check deposited into an account he maintains for her. Payments for her bills, such as car insurance, are paid through automatic payments. He transfers the remainder into her personal account each week for her to manage on her own.

Sometimes Diane feels resentful or embarrassed about the arrangement, but she appreciates the boundaries that now allow her to better manage her money.








Smiling couple It’s not always easy to live with someone who has a mental disorder and it takes work. You will struggle with issues of control. You will feel loss, anger and frustration. But, it’s important to take care of yourself while you’re taking care of your loved one.

“Sometimes I deal with her illness well, sometimes I don’t," says Dave M., whose wife Chris is living with bipolar disorder. “Sometimes I need to step back and tell myself, it’s not her, it’s her illness.” But when episodes of manic or mixed states last for days or weeks, he says, it’s tough. He sometimes waits until she’s calm, then tells her he needs to go out with friends or have some alone time playing a video game. “I have a support system I rely on,” he says. “I can talk to my friends, my parents.”

Dave is an active partner in his wife’s treatment. He accompanies Chris to her doctor appointments. “It helps to match up what I’m seeing with what she’s feeling,” he says. “She can have rose-colored glasses, thinking things have been fine, when I’ve been seeing irritable and depressed behavior.” Together they monitor her medications.

He works at creating a nurturing environment. “I try to maintain regular routines,” he says, “and to keep as little as possible on her plate, keep stresses on her to a minimum.”

Loving someone who is living with mental illness stretches your commitment. But by working together to solve day-to-day problems, along with having realistic expectations, communicating your needs and defining your boundaries, the two of you can grow and heal together.

How to help someone with a mental illness


A family member, friend or coworker who cares about someone who is living with a mental illness can help in many ways. Your commitment to them can help them to feel supported in their recovery efforts, feel safe and begin to enjoy life.

Depression, anxiety and bipolar disorder can make people feel isolated and alone and they withdraw from family and friends. They may feel hopeless at times, finding it difficult to do things they once enjoyed. You can provide encouragement.

How can you help?
Consider your strengths and the time you have to give. You could call every other evening to check in or meet with them once a week. You could offer to do grocery shopping or take children to activities. You might help her complete insurance forms and explain benefits. If you’re a good listener you can offer much needed emotional support.

Let your friend or family member know they can count on your help. Tell him or her, "You don't have to go through this alone. I'm here if you need me."

Educate yourself

* Accept the fact that the person has a legitimate illness.
* Learn all you can about their disorder and its treatment so that you can more effectively cope, help, and keep your expectations realistic.

Communicate effectively

* Be understanding. Let him know that you care. Engage her in conversation and listen carefully.
* Use humor when appropriate.
* Try not to become angry at your friend or family member. Don't get stuck in talking about the past - stay in the present.

Help your friend or family member stay active.

* Invite her for walks, to the movies and other activities.
* Encourage participation in activities he once enjoyed, such as hobbies, sports, or cultural activities.
* Do not push her to undertake too much too soon. Too many demands can increase feelings of failure.

Offer Practical Support

* Cook dinner once a week.
* Run errands.
* Arrange a regular time to walk or go to the gym together.

Help with medical needs

* Encourage him to maintain professional medical help.
* Help her identify emotional and physical symptoms.
* With your friend's or family member's cooperation, help her with tracking medications.
* Talk to him about what you will do if there is a crisis and what will happen, such as hospitalization. Put the plan in writing.

Help them recognize recovery

* Point out small signs of progress, by saying things like: "You laughed tonight more than you have in a long time," or "I see you're working in your garden again."

Take care of the caregiver

* Spend time with other people you care about.
* Take time off, if you need to.
* Talk to other people who are struggling with similar situations, perhaps in a support group.

Protect against suicide risk

* To determine if someone is having thoughts of suicide, try asking: "Are you thinking about giving up?" "Do you need help to keep yourself safe?"
* If you feel there is a risk, seek professional help immediately.

Dealing with friends or relatives who are very sick (or fear they might be) is a challenge. What do you say to them? Do you try to cheer them up? Reassure them that things will be all right? Help them to see that they may grow even stronger through experiencing the illness? Should you ask them for details of their condition? Or just ignore the whole matter and act as if nothing serious has happened?

The most important thing to remember when someone you love is seriously ill is that THEY are the ones in pain (physical and/or emotional), and that your attention should be focused on what THEY need. "What could I do that would make you feel better?" is an excellent question to ask, although it may be a hard one for your friend or relative to answer (after all, most of us are taught not to burden others with our problems). It may surprise you to learn that, most often, what they need is simply someone to listen sympathetically, thereby sharing the burden of their suffering. Illness carries with it a whole gamut of feelings: fear, anger, disappointment, hopelessness, grief, perhaps guilt or even shame. Someone who can be a loving witness to all of these feelings usually will be greatly appreciated. If you're curious about details of their situation, ask them if they feel like talking about it, rather than proceeding with twenty questions.

What if you're NOT a particularly good listener, or you find the expression of deep emotions somewhat uncomfortable? A professional therapist is trained in precisely these areas, and may be of great help. But the contribution YOU can make is avoiding the mistake of ignoring the situation, glossing over or changing the subject. Few things in life disappoint more than when someone we love "isn't there for us" when we really need them. And there are few times in life when we need our loved ones more than when we're sick.

If children have the ability to ignore all odds and percentages, then maybe we can all learn from them. When you think about it, what other choice is there but to hope? We have two options, medically and emotionally: give up, or fight like hell. ~Lance Armstrong

Words of encouragment are just too cliche. After one week, you heard them all. Actions speak louder than words. Take the kids out, go shopping for them, bring them a dinner. Offer to clean the house. The worst feeling is looking around and seeing things that need to be done, and don't have the energy to do them.

Some specific things you can do to help a loved one who is ill.

Do you want a neck rub?
Can I bring you something special to eat that sound good?
Can I help you with your housework?
Can I drive you to your next appointment?
I love you and will be here for you.
Offer to do something specific, don't just ask if there is anything you can do. We always answer "no" trying to be strong or unable to think of anything at the moment. If you do offer be sure to carry through! Don't tell them it will be all right unless they ask!
One of the other things I found helpful was for someone to come over once a week and help me weed and water my flower gardens!
(written by someone who has been through illness)