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Mental Illness

Caregiving: Breaking The News And Handling The News

Some time ago, during A Quickie, the interest was expressed as to how to break the news of mental illness and also how to handle the news of finding out someone has a mental illness.

I think I may, at last, have managed to acquire some coherency on the topic.

Caregiving: A Quickie

I dunno if you’ve covered this already because I haven’t had a chance to read all the articles yet, but I’d be interested in a “˜how to break it to your SO/family/friends’ article, or maybe “˜how to handle it when your so/family member/friend tells you they’re mentally ill’. One of the biggest problems I’ve run into so far is with people not knowing how to handle me after finding out. And I never really know how to bring it up except to basically go “˜Hey, so I’m crazy’ which just makes matters worse, and I can’t really empathize with the person I’m telling because, y’know. I’m not and will never be in their position of being told that someone I love is mentally ill while I’m not. – thelefthandedwife

So, to be clear, I’ll try and break this down into two sections: How to break it to your SO/family/friends and How to handle it when your SO/family member/friend tells you they’re mentally ill.

How to break it to your SO/family/friends.

Right. Okay. I’ll admit something here: my family are several shades of awesome when it comes to mental illness. So when it came to telling my family about Mr. Juniper’s mental health issues, it was something of a non-event. There was concern, of course, but there was no need to explain what mental illness was, what a psychiatrist did, or really, anything that goes with mental illness. Mr. Juniper’s family, on the other hand, are of a sort where it was simpler for Mr. Juniper to say nothing.

So, onwards? I guess that brief point about our families is to suggest that every situation is going to be different when it comes to talking about mental illness and is likely going to need an individual approach. That said, I’m going to, albeit with some hesitance, offer some suggestions for talking about mental illness.

Does the person need to be told?

My rather gentle suggestion would be that telling a SO qualifies as being important. However, there is still the point of when and how. With Mr. Juniper, he didn’t particularly have a choice about telling me. He was recovering from an incident when we met and had no opportunity to do anything but be honest from the very beginning, unless he became very creative, very quickly.

Talking of a significant other suggests that the “other half” has progressed beyond the point of a fledgling relationship. In which case, that horrid old cliché comes into play: honesty is the best policy. At least, I think it does. But every relationship is different.

The other reason to think carefully about telling a SO of being mentally ill, is that they may, depending on where you are in the world, have legal powers if your mental illness was to deteriorate to the point of needing inpatient care. They may – again, depending where in world this is happening – also have the power to talk to your doctors. This was something significant for Mr. Juniper and I. As his girlfriend, I didn’t have a huge amount of “power” but as his wife, if it came to him becoming incapable of making decisions, it is me that the authorities would have to come to first.

With family, again, I think it’s worth bearing in mind the legal side of mental illness, in which case, it can be incredibly important to have at least one family member familiar with your condition and needs. From what I remember, here in the UK, the priority goes spouse, parents, siblings, and so on. That isn’t to strike fear into people, but it’s something to be aware of.

As for friends, my suggestion would be to consider whether or not they need to be told. Close friends, sure. Acquaintances? Perhaps not. Bear in mind, there isn’t usually an obligation to tell the world.

Consider what to tell them.

This is an important point, I think. It does also, I feel, go hand in hand with who to tell and therefore, how much to tell them. With a SO, my suggestion would be to talk about all the important facts. They’re the one who is (most likely) spending a considerable amount of time around you. By giving them all the information (within reason), it allows them to do their own research, to find support, and generally become more informed. However, it can still be done gently. One step at a time. Let the discussion develop over time, or indeed, write a bullet point list of facts you consider significant and do it that way. Every relationship is different, and generally has its own method for talking about potentially difficult topics.

With family and friends, again, the degree of openness has to be an entirely personal decision. My suggestion, however, would be to start by simply talking about having a “mental health issue” or a “mental health problem.” It’s simple and gets the point across. It can also be a helpful starting point.

My other suggestion would be not to mention diagnosis in the beginning particularly when it comes to family and friends that aren’t particularly “close.” My experience of this is that with a diagnosis, a person will then relate the experience of their sister’s brother-in-law’s hairdresser’s poodle’s veterinarian’s dentist’s accountant’s aunt’s son’s experience after getting that diagnosis. The other reason for possibly withholding a diagnosis in the beginning is that a lot of people have their own perceptions of a diagnosis, and all too often, those perceptions aren’t accurate reflections of the diagnosis. This can come through personal or second-hand experience of misdiagnosis, through personal or second-hand experience of that as a correct diagnosis, through stigma, or through general ignorance. There can often be a lot of “feelings” held and harboured by those who either disagree with a diagnosis (even if it’s the correct one) or from the difficulties that arise from a misdiagnosis. By talking about a “mental health issue” there’s not a lot to argue with, but there’s a good starting place for discussion.

Leaving out the specifics of a diagnosis also means there can be a focus on needs instead of a label. This doesn’t mean it’s important to go into every aspect of a particular mental health issue, but to perhaps give a vague overview of what this impact of the mental health issue is. It isn’t necessarily important to hear a person has X diagnosis, but it can be helpful to share that the mental health issue in question means there is, for instance, a struggle with anxiety, or fluctuating moods. This gives something to work with, and also can be a better path to lead towards disclosing a diagnosis. It also gives the person you’re talking to a chance to make sense of what they may have previously perceived as unusual behaviour (though by no means does every mental illness make itself physically obvious).

Unless the person is familiar with mental health, it’s also worth bearing in mind that they may not be familiar with the specifics of living with a mental health issue. So whilst you may be well acquainted with the purpose of a different therapies, medications, professionals, etc, the person you’re talking to may not be so well informed.

Another point would be that if you’re aware of good resources that may help the person you’re talking to, to inform themselves further, it could be very worth your while to share that information.

Take care of when and where to tell them. And how.

This is for everyone’s sake. There are instances where difficult conversations end up being held over dinner, or in the midst of rushing somewhere, but if possible, it’s worth considering the place and timing of a discussion that may prove difficult. This is something we have to do constantly, and sometimes it does require saying, “Look, I need to talk to you about something, when’s good?” Remember too, that having discussions like this can be incredibly draining. This is why it can also be, depending on what’s most appropriate and comfortable, an occasion to talk about an issue via email (or letter, of course, nothing wrong with writing a letter to someone who’s in the next room). Emails and letters can be helpful because they allow everyone space and time to acknowledge and get to grips with the discussion that’s going on.

Reactions.

People, for some reason, don’t always react with compassion and kindness when they hear news of someone being mentally ill. Sometimes this can come in the form of “It’s all big pharma!” Or they make assumptions about the person’s past, usually an assumption regarding childhood abuse or the mental state of the person’s parents. Sometimes it will be a declaration that X diagnosis doesn’t actually exist. At other times they’ll try and thrust R.D. Laing and Thomas Szasz at you.

My suggestion, other than thinking of whichever expletives happen to be favourites, is to say, “Well, I don’t believe that, but if you want to, then that’s up to you.” Or perhaps those views are ones you share, but I’d suggest that a discussion of those points would most likely be better placed at a different time, when the original focus of the discussion was not the disclosure of very personal information.

And remember, you’re allowed to react, too. Assuming that the discussion about your mental health issues has some planning to it, I’d suggest making sure that there is support in place for after the discussion, whether this is in the form of being able to call a professional who’s involved with your care to talk things over with, or simply the knowledge of some quiet time following the discussion.

How to handle it when your SO/family member/friend tells you they’re mentally ill.

Reactions.

If, per chance, someone tells you they’re mentally ill, and your initial reaction is to do one of the following:

  • Yell, “It’s big pharma!”
  • Decide that the person you’re talking to must have been abused as a child or had a parent with an addiction.
  • Cry out, “That diagnosis doesn’t exist! It’s a complete fabrication!”
  • Do anything that involves thrusting books at the person unless it’s a copy of Guess How Much I Love You.

Then stop, please, if you can, stop for a moment and remember: this isn’t about you and what you believe. This is about the person who is trying to talk to you about their health in a way that they are currently comfortable doing. When it comes to the anti-psychiatry movement and the basis of mental illness, then those are valid points, but this is neither the time nor the place. You’ve been faced with someone trying to talk about something very personal, the debates around mental illness are to be had in a public arena. Please, just try and listen.

If those don’t happen to be your reactions, then the person you’re talking to will, I would suspect, be eternally grateful. If those are your reactions, I can only echo what I said earlier: this is neither the time nor the place. It may even be that the person you’re talking to shares some of those views and would like to have a proper discussion about those points, but the discussion of the moment – of disclosing health problems – is not a platform for those views. If the person you’re talking to wants to talk about those things, maybe wait until there is a time when the discussion can be approached from a fresh angle. Remember too, that the person you’re talking to may not feel able to say no to that discussion if you decide to pursue those avenues of thought while they’re disclosing personal information. Though of course every situation is different.

As for other reactions, it’s okay to feel whatever you feel. But do bear in mind that the person you’re talking to has just disclosed that they have a mental health issue. Right now, this discussion has to be about them. It may feel as though there is no “right thing” to say, that there is indeed, a fear of saying completely the wrong thing. And so, it is okay to say, “I don’t know what to say.” Or to simply say, “Okay.” Then of course, it’s okay to feel and say, “I need to think about this.” I would hope this doesn’t need to be said, but I would suggest thanking the person you’re talking to for feeling that they could share. You may not feel particularly thankful that they’ve shared this information, but consider what it’s taken for them to do this. And whilst there is every possibility that you have your own issues, issues that may in the grand scheme of things be more significant than a person disclosing they have a mental illness, bear in mind that disclosing this information may be significant for them.

My other suggestion would be to actually take time to think about what’s been said. I’ve had to say it many times to Mr. Juniper that, you know, I need some time to myself to consider what’s been said. Especially as being his significant other, his mental illness does have a significant impact on my life, too.

The aftermath of finding out that someone has a mental illness can often lead to searching for answers. This is a good thing, but has to be done with a little thought. Go to reputable sources. This would be leading mental health charities, for instance, and government related organisations that deal with mental health issues. These sources of information should also then link to other reliable resources. Information that comes from unreliable sources is going to be unhelpful. It can be incredibly helpful to read about another person’s experience with X diagnosis, but that doesn’t mean their experience is what your SO/family member/friend’s experience will become or should become. Diagnoses often arise out of meeting Y number of Z criteria. This can mean there are potentially hundreds of possible manifestations for one diagnosis. Concentrate on your significant person, not someone else’s significant person. If all else fails, go to Wikipedia. I’ll admit, it has its uses.

Offering support.

I’d suggest there are some exceptions to the following feelings, but otherwise: you’re not responsible for your significant person. If you’re a SO then I’d suggest reading The Selfish Pig’s Guide To Caring. If you’re a family member or friend, I’d suggest reading that book, too. The point is that for a SO (and potentially a family member), being a caregiver is hard. And if you’re going to take on that role, it’s important to do so in an informed manner. I’d suggest that being mentally ill is hard, too, but I’d like to think that is already widely acknowledged.

Also, when it comes to offering support, remember that, in most cases, a person with a mental illness should ideally have professional support (bear in mind, this is coming from someone who lives in a country with good healthcare). This also is a good reason to become familiar with the basics of professional help for someone with mental health issues. Find a good FAQ (most likely through a charity site) that explains the basics of psychiatrists, treatment, medication, therapists, etc.

There’s another very important point to make here, when someone learns of another person’s mental illness, there can be a fear of what to do if that person may become (or already is) suicidal. Get informed. Don’t immediately think that getting rid of the kitchen knives is the answer. Call a charity – there are many that excel in giving advice in this realm – and ask for help. These charities aren’t just for helping the person who is suicidal, they’re there to help people who are trying to help someone who is suicidal.

Another facet of offering support: remember that the person with mental health problems is still human. As I’ve said before in the Caregiving series: it isn’t mental illness with a case of being human, it’s a human with a mental illness. Remember the basics: respect for fellow humans. Mental illness can in some circumstances cause people to want to kill themselves, or to struggle to separate fantasy and reality, but it rarely stops people from being able to swear. In short: be nice.

There is also a point to remember on difficult behaviour. Offering support can be incredibly important. Allowing the disclosure of a mental health problem to excuse difficult behaviour is not okay, and is not beneficial to anyone.

Getting support.

This is an aspect of becoming aware of another person’s mental health issues that can seem a little odd, but it is not unreasonable that when there is someone in your life with a mental health issue, that in fact, you may need support, too. I’m aware of some schools of thought that believe caregivers (and to a lesser extent, people who aren’t quite in the position of being a caregiver but are close enough) should automatically be in therapy. I am inclined to disagree. Support is important and therapy can be support, but support is by no means limited to therapy.

With regards to support, I’d also suggest looking over Caregiving: Support.

A conclusion. Of sorts.

I’m not usually inclined to “give advice” and try, simply, to share our experiences of living with mental illness. But here, I fear I have veered quite spectacularly into giving advice. What is so incredibly important to remember is that every situation is different and needs to be handled differently. So here, I guess I would like to reiterate that I’m offering suggestions rather than advice, as it were. I can only add, too, that talking about mental illness can be incredibly hard. I hope in time that the discussion of mental illness can become more acceptable. In the mean time, to all that are preparing to talk to someone about their issues or  who are having to cope with a less than desirable outcome to talking about issues, I hope good things come.

N.B. I’m aware that it may come across through my points on Laing and Szasz that I disagree with anti-psychiatry, and so I wanted to clarify that I feel the points of anti-psychiatry are actually very important and worthy of discussion, but when it comes to someone disclosing personal information, then it is, most likely, neither the time nor the place.

By Juniper

Rarely to be found without herbal tea nearby. Team Unicorn. Often in pyjamas. Also: TEAM KATNISS!

One reply on “Caregiving: Breaking The News And Handling The News”

I generally don’t have a choice about disclosing, because my main interactions with the public is as a disability rights  activist, and part of how I approach it is talking about things frankly. Most people I meet know ahead of time about my mental health stuff, and those that don’t are usually new doctors.

On the other hand, the fact that I’m pretty open means that I get a LOT of people who disclose to me- some of them it’s the first time that they’ve said aloud to another person (other than an SO if they have one) their diagnosis. It’s kind of powerful to be able to share that experience with them. It’s a big deal, a huge step in how they are handling things, and it’s a huge honor every time it’s happened to me. You get to be a part of something important in someone’s life when they do that, and how you react when you are one of the early disclosures can help shape the way that they feel about having a diagnosis.

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