How to Talk To Your Mentally Ill Loved Ones

So you love a person with mental illness. Maybe they have depression, social anxiety, or even schizophrenia or obsessive-compulsive disorder. I can’t help you help them with a specific disorder, but that’s okay. You shouldn’t try to help them with their specific disorder either. You are not a therapist.

That is to say, you shouldn’t be a therapist. Maybe you’ve found yourself falling into that role: You try to help them figure out ways of beating their disorder, you try to ask them just the right questions so that they’ll feel better, or you look up therapeutic techniques and see if they’ll play along. As a long-time sufferer of all sorts of crazy shit, allow me to kindly say: Cut it out.

I know you just want to help. In fact, you may have had some successes along the way, and now you feel like you should press forward and help even more. That’s nice, but you need to stop before it’s too late.

Love and Therapy

Why? Because you’re muddying the waters. You’re putting yourself into a dual relationship with your loved one where you’re both a friend and a trainer.

Let’s say that you have a boyfriend with schizophrenia. His name is Jimbly (I’m no good at coming up with fake names), and he’s growing increasingly depressed, he’s agitated all the time, and he’s full of weird ideas. You, trying to be a good girlfriend, are constantly asking him probing questions about why he thinks the way he does and what his depression is all about. You try to guide him into positive activities, and talk to his friends to get their help, and all sorts of well-intentioned manipulation.

Over the course of months, you eventually stop being his girlfriend and start being his nurse. You start finding more effective ways of short-circuiting his brooding, but your relationship is getting…  weird. Maybe he’s growing a little submissive, or maybe he lashes out at you sometimes and spends more time away from home.

You are training him. You’re training him to deal with his problems, but you’re also training him to resent you a bit. This is not healthy for a loving relationship, and it’s certainly not what you signed up for when you met him at that Waffle House three years ago. God, he was so dashing in his cargo shorts and Tapout t-shirt.

Photo credit: Andres Rodriguez

In acting as both friend and trainer, you may have found yourself growing detached from him. You have formed a bit of clinical distance so that you can help more, and so that you’re not swept away by his daily crying bouts. You no longer default to caring.

You cannot be both father and shrink; friend and social worker; or lover and therapist. You’re putting yourself in a position where you’re compromising your primary role (loving, supporting, accepting) for one that you’re not qualified for (deciding, depriving, judging).

I’m not great at the relationship thing, but I do know one rule: Don’t fix. When we set out to fix someone we love, they change from person to project.

So What Can You Do?

First, you can take care of yourself. If your loved one is depressed, it’s taking a huge toll on you. Yeah, I know they’re suffering directly, but your life is growing increasingly chaotic and painful. You probably feel a bit helpless. Take that urge to fix and use it for your own wellness and happiness.

Read books. Go on walks when you need to. See your friends, even if your loved one sees it as a betrayal. Mentally ill people can be dicks. They don’t own you, and you can’t just cloister yourself in your house and suffer along with them. How the hell is that helping?

Second, you can suggest psychiatric care (see my post “Feel Depressed A Lot? Please Go Get Medicated, You Jerk“). If someone is mentally ill, they can probably benefit from a medication regimen. And by “probably” I mean that “science has proven that medication has a high probability of helping to some extent.” There are very few exceptions, such as in the case of certain personality disorders.

Their psychiatrist can refer them to a counselor, who can do all that fiddly fixing stuff that you’d desperately like to do. They’ll suggest daily habits, coping skills, journaling, meditation, all that crap that you’ve read about online but can’t make them do. It’s better when it comes from a professional. These people are paid to be detached, they’re trained to tease out the little parts of the depression that you’ve never been able to reach, and they’re supposed to make clinical judgments.

Oh, and if you’re having trouble coping, go see a counselor yourself. It’ll help, and they might help you find positive ways of dealing with your loved one.

Quick note: Psychiatrists and counselors are not all created equal. Try to get a referral from your general practitioner rather than playing yellow pages roulette. If you can't afford any of this stuff, there may be programs set up in your area that can help.

Third, you can listen. We’ll talk about that in a second. First…

What Not To Say

I might sound a little harsh in this section, but it’s only because I’ve been on the receiving end of all of these and… they sting. Please realize that these are all natural things to say, and I totally get it. Just don’t be a dumbass.

“We all feel sad sometimes.” Off to a bad start! You have failed the empathy test, please turn in your test booklet and answer sheet.

Sure, we all feel sad sometimes, but you know what this sounds like to your loved one? “Why are you being such a baby?” You’re trying to let them know that you understand, that they’re not alone. What you’re really doing is revealing your complete lack of insight into their problem. Their “sadness” might be your abject fucking despair.

“You’ve got so much going for you!” or “You’ve got such a great life!” Indeed. That’s why it’s called a disorder.

By saying this, your loved one will hear that you don’t consider their suffering valid, as if they don’t deserve to feel pain. Damn right they don’t deserve it. That’s kind of the whole problem.

“At least you’re not [undergoing some example of true suffering].” Some kids are dying in a ditch right now. Your friend has cancer. Soldiers are being tortured. A fifth of the population of Sudan lives in what we’d consider a sewer.

Okay great. Now what? Is your loved one supposed to leap out of bed like Charlie’s grandpa in Willy Wonka & the Chocolate Factory? Getting some perspective might help, but leave that to the therapist to draw out over the course of a few sessions. When you say it, again, you invalidate their genuine suffering.

“Shake it off!” Eat shit.

“Have you prayed about it?” This one, out of all of the above, hurt me the most. It let me know just how completely my friend or loved one misapprehended the nature of my torment.

When religious folks have a mental illness, they pray. You feel helpless, you realize that you’re not acting how your god or gods want you to act, and you find yourself slipping further and further from a feeling of rectitude, of Christ-likeness, Buddha nature, the Rede, or what have you. Of course they have prayed.

If you’re of a religious bent, feel free to offer to pray with someone (if you’ve got that kind of relationship). Just don’t insult them by, in essence, questioning their faith and devotion.

All of that said, don’t feel like you have to walk on eggshells. I know I just got a little spooky, but I don’t want you tiptoeing around the house, afraid that you’ll slip up and ask something offensive. You certainly don’t need to pretend that there isn’t a problem. Just try not to assume, try not to minimize, and realize that there is no perfect thing to say.

Truly Listening

Hell, sometimes there’s not even a right thing to say. Every little word will get you in trouble, and every innocent comment is received like a pot roast at VeganCon (I am not sure if this is a real thing).

So, let’s have a talk about listening. You see, there are different kinds of listening.

  1. Not Listening. They’re gabbing, you’re thinking about how your left pinky toe has a really weird nail.
  2. Competitive Listening. Oh man, stop talking so I can finally talk! My story is way sadder!
  3. Problem-Solving. That’s really sad. Here’s what you should do…
  4. The Inquisition. What was that like? What did you do next? Do you think this is really about your parents? Have you tried this or this or this?
  5. Listening.

Notice how that last one didn’t have any, like, stuff after it.

Truly listening is a skill, and it doesn’t necessarily come naturally. It means not getting your turn to tell a story. It means withholding judgment for the whole time they talk. You don’t think about what they should do next, and you won’t have any recommendations for them. You don’t even have a follow-up question ready by the time they’re talked out.

You allow their words to wash over you. You pay attention to the feelings behind their words, and the many layers of meaning poured into them. You consider this person, this injured creature in front of you, and you allow them to tell the story of their pain. Sometimes they may even search for a word (depression is hell on memory), and you don’t supply it, you just wait.

Once they’re done (truly done, not just collecting their thoughts), then you can process. Then you can think about what you might like to offer (a question, a caring touch, even a suggestion). Maybe nothing needs to be said at all.

Imagine that. Someone listening to you and, instead of trying to fix you or say just the right thing or ask the right question, they just pay attention. How refreshing would that be? How much of a burden would that remove from your shoulders as the speaker, to not have to perform, to not “feel better” at the end? To just be heard.

Nothing’s Ever Easy

This won’t fix them, but it can be pretty great. It takes some of the weight off of your shoulders as well. You don’t need to fix, or to be on your game, or to say just the right thing. You can just be there. You can have the one relationship rather than trying to play therapist. You can connect despite mental illness trying to drive a wedge between you.

I want to repeat this before you go: Take care of yourself. You deserve good things, you deserve relief and sunshine and time with your friends. You can help your loved one in certain ways (listening, helping them into therapy), but you can’t take their pain away by being in pain yourself.

Have you found any of this to be true, from either side of the situation? Have you fallen into the dual relationship trap? I’d like to hear your stories.

Featured image credit: Brandon Warren

8 thoughts on “How to Talk To Your Mentally Ill Loved Ones

  1. Excellent post. The Tapout comment/picture made me laugh and cringe so much.

    Only addendums: it’s super hard and super important to remember that not all mental health professionals are good, or a good fit. If they are not working for you, you get to fire them. Supporting someone going through having to stop seeing a therapist due to not meshing, or worse, outright unacceptable behaviour, is very important. It is indescribably hard to do this. Especially in the US, where you may have a very limited selection with your insurance.

    Also, if the person you care for is choosing not to see a dr, that’s OK too. People choose not to go for many reasons: they can’t afford it is a big one. They may have had traumatic experiences in the past. Even if they are making a poor decision, telling them what they should do is not going to help. Just make it clear you support them, and that there is no shame in seeing a psychiatrist/psychologist/counsellor.

    Note: I have never been to a psychiatrist. I get SSRIs from my GP, because your family dr can do that here. We don’t go to specialists so often here – we get our pelvic exams from our GPs too. I am A-OK with psychologists and counsellors, but psychiatrists freak me out.

    Finally, re: praying, please make sure you know the person you’re talking to would be OK with that. With an atheist, even saying you’ll pray for them can be super uncomfortable (that is individual to your relationship) and offering to pray with them will likely result in Dramatic Hamster eyes. It would with me, anyway. 😛

    I have read a lot of similar articles, and I really enjoy how you write: I think it is more relateable and easy to read than many.

    P.S. I am super impressed at two articles in two days. 😉

    1. You make some damn good points (ones that have certainly been true for me, such as seeing psychiatrists who were… simply terrible), and I’m gonna have to add a disclaimer somewhere 🙂

      While I agree with the idea of not pushing someone who either can’t or won’t seek medical help for their problem, this can leave relationships in an unpleasant stalemate. One is miserable, the other becomes miserable, and both find themselves slipping into new roles in the relationship. Been there, suffered through that. I definitely want psychiatry to remain a suggestion… until it becomes too much. I’m considering an article on how to stage an intervention. Sometimes the person’s illness leaves you in fear for their life, or it’s made them so insufferable that you want to push the earth into the sun. I have been that insufferable person 🙂

      All of that said, it would be much easier and much less intimidating if GPs were willing to take on some mental health duties here. Most refer out as a rule, which can be a real kick in the head for the same reasons you cite, including the fact that our uninsured rate here in the states is still just… unconscionable. Even with insurance, god help you if you’re “out of network.” Oh man, this is getting my blood pressure up.

      And yeah, I’m gonna tweak that prayer section. Offering to pray together is very specific to one’s particular relationship, and could just be a fucking nuisance from the wrong person.

      Thanks for the great comments as always, Hrovitnir!

      1. When it was recommended that my son take anti-anxiety meds, our therapist (who is a clincal social worker) was going to send us to our GP. At that time, I didn’t trust that our GP would know enough of what kind or dosage etc. So I sought out the psychiatrist in my belief that he would be the expert and more in-tuned to my son’s needs. And while it was helpful after the initial session in which it was suggested that we were dealing with a pretty mild level of Asperger’s (which upon further research became such a huge Aha! moment for me and my son), after that it only became about adding prescriptions and the frustrations I described in my other post. It just became a hugely micromanaging stressful mess. My son and I both realizing was beginning to snowball and only making matters worse. He quit cold turkey…which was scary for me and hard on him..and really NOT recommended. But, he also claimed a certain amount of self-actualized dignity that helped him find his own way through a lot of his issues. Like I said, big balancing act for the caregiver…giving them space to navigate on their own terms but also knowing when to seek help. I’ve been there and done both.

        And the prayer topic…yeah, it can be enormously patronizing for some people. No matter where a person is on the belief/faith spectrum….it can come across as suggesting that your problems will all resolve if you would only pray correctly. As if you’ve done something to deserve this and need only ask for help and forgiveness.

        Oh..and there is the other topic about being in a relationship with someone who’s mental illness is becoming so damaging to your own mental and physical well-being that you have to leave in order save yourself. No matter how much it makes you feel like an insensitive and selfish person. That is the toughest thing.

        Keep up the good work, Ian. Sure are giving food for thought this week.

      2. I absolutely agree about taking care of yourself in a relationship (of any kind) with someone who is not dealing with their mental illness. You can and should create more space, take a break from contact, whatever you need. Even though you feel like an awful person. And in a romantic relationship, eventually you may have to leave. No matter how much you love them. Even if they’re getting their shit together -sometimes it’s too late.

        I may have already linked this but Captain Awkward is amazing for stuff like this. There is now a forum as well, Great people for support of friends or caregivers without judging mental illness.

        I have to say, working with vets has solidified my distrust of doctors. I work with cool people, but they’re people, and they can get dismissive/not listen/all the shit that can make it an ordeal to find a dr who is helpful.

        The other comments on here are great. My heart really goes out to parents having to deal with the system to help their kids.

  2. This is a tough one for a parent. We are compelled to rise to the needs of our children to help them. It’s our job and obligation as parents. But, we are so emotionally tied that perspective can get skewed with wanting to “fix” our kids who are suffering in a way we are powerless to stop. It’s not the easiest balancing act. Seeking help from therapists can end up being just another tedious rat race running all over town to different appointments for each of the specialists that only cover a portion of the help that is needed. That, in of itself, becomes a burden to both parent and child…which can magnify the mental health problem.

    I believe one of the biggest obstacles in psychiatric care today is the very way the system is set up. It has us running from therapist/counselor for talk therapy to the psychiatrist who prescribes the meds but spends no more than 15 minutes with the patient every couple of months (sometimes more). Not to mention the insurance headache. Visits to the psychiatrist become long drives across town, an hour in waiting room, 15 minute assesments that only end in recommendation of the next med to add to the cocktail already being prescribed. It’s exhausting and tedious for the caregiver (me) to keep educated with researching what each med is for, side-effects etc. You become the gatekeeper, screening everything in order to provide the help your loved-one needs without being them being overtreated in our pharmaceutical dependent culture. Meanwhile, said loved one, is feeling better because meds are taking the edge off the anxiety. So becomes impatient with talk therapy and doesn’t see the value in it, even begins to get a chip on his shoulder about it….but me, as the caregiver, know that some form of counseling or therapy is needed but what kind and with whom? This is just the tip of the iceburg. I could go on and on…

    I’m no stranger to the challenges of mental illnesses…both from familial experience (my mother, my ex-husband, 2 of my children, and my own in the form of child-of, wife-of, mother-of…all which spawns it’s own set of depressiveness ). Then there is my own education. I had planned to become a marriage and family therapist when I was an undergrad at Texas Tech. So, I’m inclined to value therapy. But my most recent experiences in helping 2 of my own children has left me pretty dissillusioned, if not down right angry. Something has got to give where pyschiatrists are not just pill pushers while social worker, pyschologists, mental health counselors etc are doing all the direct counseling with very little clear meeting in the middle by both parties. In retrospect, in regards to one of my sons, we should have simply gone to our GP for the prescription instead of traveling an hour across town just to be given a new prescription. One might be inclined to say that we had an unfortunate experience…but…it is pretty much the norm.

    Eventually, with the child that I’m referring to (I say child, but he was over 16 during this time), it became something we basically threw up our hands about and said F*** it! Focused on diet, exercise, music, and nature. And my roll? …just being available as much as I could, trying not to say the wrong things as I allow him to work through it on his own terms (and seeking counseling myself in an effort to help me navigate and cope).

    1. Sandra, you have no idea how much I identify with your story… from the other side. I was that kid. My dear mother, who only wanted me to finally be happy, did everything in her power to make sure that I got the proper care. My first counselor was a big hit, which I now know makes me pretty lucky. My first two psychiatrists, however? I don’t mean to sound overly flippant when I say that they were crazier than me.

      It was a constant struggle of scheduling, travel, referrals, and insurance garbage. I don’t know how she put up with it, to be honest. And, as that kid, it was stressful as all hell. Forcing someone to sit in a sterile, unpleasant waiting room for an hour when they already have anxiety problems should be prosecutable as a war crime.

      Anyway, I want you to know how much I appreciate what you’ve done for your family. A lot of people either live in denial, or they can’t deal with the chaos. “[A] big balancing act for the caregiver…giving them space to navigate on their own terms but also knowing when to seek help”: couldn’t have said it better myself 🙂 You’ve done right by them, and that will mean a lot for years to come.

      Good call with the exercise and diet interventions, by the way!

      1. I really do think the whole system of psychiatric care is broken. It’s my belief that it is in large part because of the huge influence of both the pharmaceutical and insurance industries. Yes, I call them industries. And I say that even as I do not dismiss the very effective medications that are available and really do help a person struggling with mental/emotional health issues. But…the process of send to psychiatrist who prescribes but spends almost no time at all with that patient, then go to another professional who will talk to you and but will then send you to another professional who can do specific behavior modification counseling, who then sends you to a local support group, and so on and on it goes. While the patient and the caregivers are becoming increasing tired, financially strained, emotionally drained, and eventually just jaded and cynical.

        Diet works. So does exercise. Sun light. Sleep. Yet, I do know that when one is in the depths of depression, being told to get outside, exercise, get enough sleep and eat well can seem patronizing at best. Especially if part of their depression is a loss in interest in those kinds of things or inability to want to do those things. So..Fake it till you make it? Or take medication? Guess it depends on the person.

        Such a complex topic.

  3. This was a very useful article, for me. My son is schizophrenic and for a long time I was at my wits’ end about how to talk to him and not leave him feeling like he was being humoured, or that he was a basket case and being patronised, or that I wasn’t listening. These comments help a lot. But I do have a question, what if he simply does not want to talk at all, as is often the case. My instinct is just to sit quietly with him. What do you think? I feel so dumb and so inadequate to do right by him without making a doormat of myself. That I won’t do.

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