Jan 2, 2013

Families recover from mental illness too

A child’s mental illness can turn a parent into a helpless bystander, a witness, sometimes an enemy. I have heard so many heartbroken people talk about what happened to their grown-up children who saw nothing going wrong with their lives, and no need to talk with anyone about it, let alone a need for treatment.

There is a pattern to this. As parents react to alarming conduct, and as the child reacts to the experience of life, a battle of wills eventually turns into a frustrating tug of war.

It’s a tug-of-war that everyone can lose. People at one end of the rope get dumped in the pit, while those at the other end fall down backwards. When this happens, people disappear. I know one family who spent their weekends looking in shelters and under bridges in cities 100 miles away trying to locate their son. When I worked at Social Security, we had clients who disappeared for months on end, receiving their monthly checks on a stop-start basis. Their parents would come in asking for clues, and workers would listen even though we couldn’t offer much help. And I can’t even begin to count the number of times I have encountered systems failures that ended in overdoses, suicide or murder. That’s when parent-witnesses tend to show up, and tell the hardest stories.

But I have also seen things work out better. I have seen families recover from the effects of mental illness in exactly the same way that any individual does. Imagine calling an end to the tug-of-war. The game ends with nobody in the pit, nobody falling over. And maybe the rope is still worth holding on to.

It takes time, but this is something that families can decide to do, something that pays dividends. Recovery for families is the same as anyone's recovery from a serious illness. The focus is just wider. It becomes a process of building a family’s capacity, empowering every family member to overcome the effects of the illness.

Every family has a mix of strengths, talents and abilities, a variety of vulnerabilities, a certain capacity to withstand stress, and a certain risk of harm when things go wrong. We can build a family recovery plan from these four elements, by answering four questions and considering everyone in our family as we think things through. What helps us make the most of our talents? How can we reduce the areas where we are vulnerable? How can we improve our ability to cope with stress? How can we deal with the risk of something going wrong?

Connect the answers with a little bit of strategy, some basic framework that people have been using for centuries to grapple with difficult challenges. Learn about what we are facing. Recruit allies to help us. Find resources to work with. Plan long term and short-term. Follow the plan.

The first step, learning, is not just aimed at problems. It also pays to think about strengths, and about process. Learn as much about how families work as you do about the challenge you are confronting.

Families are strong medicine, built from years of intimacy, learning, emotions, and shared culture. If you are a parent, your key strength is the relationship you have with your child. Look for areas that you and your child agree on. You love your child, and your child loves you, or at the very least probably wants to love you. Everyone wants each other to be safe. Everyone needs groceries. Everyone wants a way to stay in touch. Everyone wants the others in the family to succeed in the world. Everyone deserves independence, autonomy, freedom of action, a sense of purpose, relationships, faith, future. Everyone should take care of themselves, stay healthy. Everyone knows that families have disagreements. When someone has been harmed, there’s accountability and forgiveness. It’s okay to make mistakes and learn what works. Do what you must to preserve family life, no matter what. This is a goal, not just a tool.

Also be aware of the process of change. Change is a process that moves in stages. There is “precontemplation” (when something is not even on a person’s radar) then “contemplation” (once someone notices a blip) then “engagement” (when a person takes action) then relapse prevention. Your goal is to get the message on the radar (move past precontemplation) usually with very cheap low-intensity messages, since even sirens and shouted warnings will likely be ignored. You might try to focus on safety and remaining connected, or finding something about the future to aspire to. Once the person begins to notice discrepancies or problems (contemplation) you can amp up your efforts to prompt the sort of learning that moves the person to the point where they take action (engagement).

Recruiting allies is another step. Allies provide support and expertise. Line up a lawyer to advise on legal options. Find a medical advisor to advise about a path to wellness. Every medical person counts “restoration of family life” as important. Try to find advisors who will work with the whole family. If everyone has compatible goals, even confidentiality barriers can melt away (with the right paperwork).

Resources are important too. Family relationships are not only important to a person’s identity, and a key goal of health, but also connect with resources. Economic capacity is not spread evenly in families. People have always depended on each other.

You can plan short-term and long-term. For example, you can list things you can do right now to maintain safety and relationships, and you can visit the library or do an internet search to set a goal or figure out what needs to happen later, when the time for action arrives.

The final step in any strategy is to follow the plan. Try to match things you do for now with something that will come in handy later.

Recovery is a tough sell sometimes. It’s a process, a struggle, not a goal. We want the people we love to find relief, but we do not experience the unpleasant aspects of treatment in our own bodies. And we are all capable of actions that hurt or alienate people we love. But the payoff for aiming at a family-supported recovery, or a recovery for our families, is pretty good. We’re no longer witnesses because we are active participants, partners and teammates. For many people whose families have been walloped by mental illness, the simple opportunity to face a challenge together is a victory.

I have been reading up on strategies to connect with people who are experiencing psychosis. Every one of them involves building a relationship, and thinking through issues together. The relationship is as important as the cognitive training process. People learn and feel their way through recovery, and do better when they are not alone.

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