Mental Illness: When It’s a Family Affair (15 Observations and/or Best Practices)

For years, I had no idea what was wrong with my mother.

That she’d been diagnosed with a mental illness: manic-depression (Known today as Bipolar Disorder.).

Ashamed of her condition, Mom told no one. My father stayed silent on the topic as well, not clueing my brothers and me in on her condition. No doubt he thought he was protecting us.

But I wanted to know why Mom was different than other mothers. Why was she so often sad? Why were there so many days when she didn’t get dressed or budge from her spot on the sofa?

50 years later, I’ve learned a lot about life with a mentally ill family member.

If you’re in the same situation, here are my observations and tips. Hopefully, you’ll find them helpful.

#15 Keep your loved ones in the loop.

Don’t assume your (trusted) family and friends, or your children, won’t be able to handle the fact that your family member has a mental health diagnosis. More often than not, the unknown is worse than the known.

As soon as your kids are old enough to notice things are “off” with someone they interact with regularly, explain to them in simple, clear language that this individual has some challenges.

#14 Same goes for medical personnel.

My mother was so secretive about her mental illness, she often wouldn’t even mention it during doctor appointments. Consequently, I had to be creative about how to notify doctors of her mental illness and/or associated symptoms.

• One time I followed Mom’s primary care physician into the hall. To inform him that my mother was hearing voices. This was not a regular occurrence, but it happened that particular week and I thought he should know.
• On another occasion, I called the office of Mom’s psychiatrist and asked for a note to be put in her file.
• During visits with new medical care providers, Mom often omitted her psychiatric meds when asked to list her current medicines. Wanting to be 100% transparent, I always added the missing meds. How else could they help her?

#13 Have reasonable expectations.

About the future.

There was one week when my mother was doing so well, I was positively euphoric. I had the thought, the hope, that this improved behavior was Mom’s new normal.

A physician friend cautioned me. “She may get better, but she will never be well.” By “well,” he meant, “cured.”

He was right. My mother’s mental illness involved a chemical imbalance that required pharmaceutical treatment. For life.

Through the years, Mom’s behavior moved backward and forward and backward again. Good days and bad days. And very, very, bad days. Her meds would be adjusted and things would improve until…

With that said, some mental health problems are temporary. “Moderate” or “situational” depression, for example.

When our children were small, my doctor diagnosed me with moderate depression and prescribed an antidepressant which I took for a year or two. I sought help because I recognized my hair-trigger anger as a problem. In time, with counseling, my anger and listlessness diminished and I was able to stop taking the drug.

#12 Listen up.

One time my mother complained at length about a situation in her life. As she spoke, my mind galloped hither and yon, trying to construct possible solutions.

At a loss, I finally said, “Mom, I have no idea how to help you. I don’t know what we can do about this.”

Her answer? “I don’t need you to fix this. I just wanted you to listen.”

Oh…

#11 Especially if they …

One morning my mom called. “When I woke up today I had the thought that I might be better off dead.” Alarmed, I quickly dressed, picked Mom up, and took her to the local emergency room.

When your loved one says something like this, get them help. Dial 911 or drive them to your local hospital.

Or, if you feel up to the task, you can ask them a couple of questions:

• “Are you feeling suicidal right now?”
• “Do you have a plan in mind?” If they say yes to these two questions, it is important to stay with them until they get connected to their own counselor or to medical or mental health care providers.

I know from my work with Libera that text messages that include things like, KMS (Kill Myself), Advil or Ibuprofen (drugs commonly used in suicide attempts), or a crying emoji, can mean a person is contemplating taking their own life.

Thankfully, Mom’s mood lifted as that particular day wore on.

#10 Less is more.

Frequently transporting your loved one to their psychiatrist or family physician can do more harm than good.

A few years back my mother got into the habit of going to see her psychiatrist a lot. As in, almost weekly. To mollify her, the man tweaked her psych meds slightly. Nearly every single visit. The frequent attention didn’t improve her mental health. Instead, she seemed to regularly be in panic mode.

Finally, at wit’s end, I reached out to an aquaintance, a psychiatrist who practices elsewhere in West Virginia. “She needs a geriatric psychiatrist,” the doctor told me. And he told me where to find one.

Mom’s new geriatric psychiatrist booked her appointments every eight weeks. I fully expected another psychotic break, but Mom did fine! Midway through, she called the clinic with an emotional crisis, but instead of telling her to come in ASAP, the staff talked her through it. In time, her appointments moved to three months apart. I was amazed.

#9 Pray.

This tip is for the folks who consider themselves believers. When your loved one experiences an emotional crisis, be sure to pray:

• For them.
• With them (if they are open to prayer)
• Before interacting with them. I always prayed for a positive experience for me and Mom.

#8 Change is hard.

Good or bad, a change in circumstance always brought on anxiety for my mother. I saw it when Mom moved from her house to an independent apartment in a nearby senior living community. Even though the move was her idea, she felt “nervous” until she’d been there two full weeks.

Then, when the time came to move her to the assisted living section of her senior community, anxiety hit again. Despite the orders of her geriatric psychiatrist, Mom refused to move. Read about that here.

She also experienced major stress when we switched her mental health care provider: digestive problems, disturbed sleep, and a sudden decrease in cognitive function.

Anxiety is hard!

#7 Learn sign language.

My father always took care of my mother. And her mental health crises. Until he began to fail with dementia. Then it was up to me.

In time I began to recognize and respond to the signs that Mom was headed for a downward spiral. Her signs included:

• Trouble sleeping
• Paranoia
• Lack of logic
• Click here for a more extensive list of signs.

For years, the best way to head off a psychotic break was for me to say, “Mom, why don’t we call your psychiatrist?”

Immediately, she’d calm down. And even more so, after her appointment. But this perpetuated the unhealthy cycle she was operating in (see above).

In time, I learned an even better way to prevent a psychotic break. See below.

#6 Have mercy!

Or rather, empathy.

What you have to remember is that your loved one is being affected by things beyond their control. They may not have any idea what they’re saying or doing.

Early last year my mother asked me to fill her in on a few of her difficult episodes. She had absolutely no recollection of why she went into the hospital — specifically, the psychiatric ward — on multiple occasions.

#5 Expect holidays to be rough.

When a family member is dealing with a mental health problem, sometimes there is no telling what might come out of their mouth. At Thanksgiving or Christmas dinner, or during the family Easter egg hunt.

You may even find yourself needing to exclude them from a holiday celebration, for the sake of your children. Or your sanity. I experienced this firsthand.

#4 Don’t argue with them. Just don’t.

Especially before or during a psychotic break. Because they are not thinking rationally, chances are they will not see your point of view. Inevitably both of you will end up honked off.

It’s kind of like when people try to change your political opinions via Facebook.

#3 Read the book, “Boundaries.”

I cannot recommend this book enough. Everyone should read it, not just people dealing with a loved one with mental illness.

Setting boundaries was a huge help before, during, and after my mother’s mental health crises.

• Boundary #1: For a period of time, I told my mother I would not visit her by myself. Having someone with me hopefully guaranteed: She would be civil to me. I would be kind to her. There would be a witness a) that the visit happened and b) in case anything unusual occurred.
• Boundary #2: For a solid month, I only communicated with my mother in writing. This was during a time when she was accusatory and hateful to me whenever we spoke on the phone. In addition, letters let her see (and not forget) important details I wanted her to know.
• Boundary #3: For one week during a “rough patch,” my husband Tony played mediator between Mom and me. Because I really really needed a break from caregiving.

#2 “Don’t take it personally.”

Thank you, Dr. D — Mom’s first ever geriatric psychiatrist — for pulling me out in the hall to tell me this.

“It is not you. It’s her condition. You’re doing all you can. Don’t let her get to you.”

#1 My favorite mental illness tip of all.

Thanks again, Dr. D, for changing Mom’s life and mine for the better when you said:

“Your mother can no longer manage her medications. I insist she be moved to a facility with a supervised med pass as soon as possible.”

Mom fought the move. Fought me. Fought my oldest brother, her medical power of attorney at the time. But in the end, she moved. Because of my husband Tony. He told her, “If necessary, Mom, I will put you in a head-lock and carry you through the building, past all your girlfriends. Do you really want that?”

All about appearances, the vision Tony cast horrified Mom.

And Mom lived happily ever after.

How I wish we’d done the supervised med pass sooner! Once she began to take her medications as prescribed, Mom became “normal.” Our constant conflicts stopped. Pretty much forever.

Finally, my mother made several friends, something she’d always struggled to do. Mom and her gal-pals formed a “Rummy Club” and played cards every afternoon without exception.

Not only that, Mom’s anxiety disappeared. Which had an unexpected but wonderful benefit. I’ll never forget the time her second geriatric psychiatrist came into the room, his expression, serious.

“I have to tell you, ma’am, this is not something we see every day. At 86, your cognitive function has actually improved since the last time we tested you. This is remarkable.”

The news thrilled Mom. She brought it up at least three times on the way home. And she kept urging me to drive faster. I knew why. She wanted to tell the Rummy Club her geriatric doctor found her remarkable.

Bonus Content Regarding Mental Illness

• For more tips on helping a loved one experiencing mental health issues, click here.
• To find a peer-led support group for people with family members with mental illness, click here.
• To read a beautiful blog post about being a supportive caregiver, click here.

Like what you read here? Click here to read more of my “Lessons from a Life Half Lived.