How to Help a Loved One With the 'Uglier' Parts of Their Mental Illness

Lately in the news I’ve seen lots of support for mental illness.

Well, two mental illnesses: anxiety and depression.

• What is PTSD?

People seem eager to help someone who’s afraid to answer the phone, or to take a person with depression out to the movies. But what if that person with depression hasn’t showered for a week and refuses to leave their home? What if instead of anxiety, their loved one has post-traumatic stress disorder (PTSD), causing them to become numb to relationships, alienate their loved ones and react with aggression when someone approaches to help?

Would the would-be helper respond compassionately, or be offended and write the person off as a lost cause? What if someone’s psychosis caused them to neglect personal hygiene and yell or act out? Supporting mental illness means supporting loved ones even when they offend, confuse or upset you. And realistically, this is going to be the case more often than not. Nobody cares if you draw a butterfly on your arm. They care if you’ll answer the phone after they screamed at you and told you to get out of their life because there’s no way you could ever help them.

You can help them. Here’s how.

1. Learn about and embrace all their symptoms.

It can be more intuitive to comfort someone who is fearful or sad. It’s harder to address someone who is so emotionally numb or dissociated, it’s like they don’t even know you’re there, much less care about you. It’s hard to stay calm when someone is lashing out because of directionless aggression and uncontrolled irritability.

Embracing your loved one’s symptoms doesn’t mean subjecting yourself to maltreatment. One of the best things that ever happened to me was when my partner asked, “When you get that way, what should I do?” Wait until your loved one is clear, and ask them in a way that is nonjudgmental and genuinely oriented toward help.

In my case, I said, “Just leave me alone.” My PTSD causes aggression and irritability, and after an episode, incredible guilt at the way I have treated those around me. However, if I’ve already told someone how I’d like them to support me, it’s easy to feel resentful if they don’t respect my wishes. I felt angry when my former partner used to try to force me into phone conversations and threaten me if I wanted to hang up. There’s often nothing worse you can do to someone with PTSD than make them feel cornered. Listen to your loved one. Often, if they have an illness that presents with irritability or aggression, they are trying to protect you as much as themselves. Usually giving the person space and time alone will dissipate the problem before longer lasting relationship problems are created. If they prefer interaction during an episode, set guidelines beforehand to avoid either party getting inadvertently hurt or overwhelmed.

2. Understand that substance abuse can be a symptom.

I’ve noticed forward-thinking mental healthcare providers now incorporate substance abuse issues into their standard of care. It’s not uncommon for people with mental illness to try illicit substances as a form of self-medication. Even after treatment, in times of stress, people with mental health issues might regress to substance abuse.

You can support someone struggling with an addiction without supporting the addiction. You can even consider setting boundaries, such as banning substance use from your home, but make it clear you do not judge them as a person and that you will support them anytime they seek help. This puts the agency back in your loved one’s hands, and makes them feel like they have an ally, not a watchdog. If and when they do seek sobriety, they will feel comfortable sharing their process with you, and they won’t be afraid to confide in you should they relapse.

3. Understand that hygiene may be an issue.

Many of the people I work with have issues completing personal hygiene. This is one of the main mental health symptoms I find alienates people. In depressive phases, I have spent days or even weeks in pajamas without cleaning my room and neglecting personal hygiene. For some people, it can become such an issue that it prevents them from forming relationships.

Encourage your loved one to take a shower “to relax.” Offer to help them clean their room or kitchen, or help them do their laundry. Tell them how it helps you to relax and feel calmer to have your body and home in order. Most importantly, if they’re not open to it, don’t cut them out of your life for it. Talk to them on the phone or via email, if it becomes too much of a problem to go out in public. You don’t need to tell them the reason. It’s likely they already know, or if they are further advanced in their illness, they probably have a treatment team addressing the issue. Just don’t abandon them. If it’s come up multiple times, set ground rules, such as showering and changing clothes before meeting relatives at outings.

4. Educate yourself.

This really should be the first step for anyone whose loved one has a mental illness. Learn everything you can about their illness. Don’t confine yourself to academic articles. Read forum postings on websites for those with the illness. Always introduce yourself as a family member or friend trying to understand. They will often reach out to you with personal insights or websites for further education. Ask your family member or friend if it’s OK for them to get some resources from their psychiatrist or case worker for you. Once you understand the illness, it will become much easier for you to interact with your family member. You will understand that if they seem distant, angry, inactive or just not even here, that it is a symptom of their illness. You will be able to provide the support they need, even if that support means staying out of their way until symptoms have passed. You will have diminished feelings of judgment and increased feelings of compassion. Most importantly, you will have conveyed to your loved one that you care how they feel, and that accommodating their issues is your primary concern, not your own comfort or “keeping up appearances.”

Whenever someone with a mental illness confides in you, pay attention and encourage them to talk to you more in the future. Don’t try to wedge your own experiences into an analogy. It’s likely you’ve never felt what they are feeling. Just say, “I love you, and I’m sorry you’re hurting. What can I do to help?” If you have dealt with a similar illness, you can share, but be aware that your depression (for example) is not everyone’s depression. If you’re feeling overwhelmed and lost, just remember that “I care about you” and “can I do anything to help?” are always welcome statements, and to never abandon someone with a mental illness, no matter how ugly the symptoms may get.

The best thing you can do is keep faith in your friend, partner or relative. Never “write them off,” no matter how bad their illness may get. Make it clear you are always available for support and assistance. Seek out resources in your town or city for when they ask for help. Most of all, never condescend or blame. Their illness may make things difficult at times, but learn along with them how best to address their main issues. And above all, treat them as a person, not an illness, a symptom or a problem. Treat them as the person you’ve always loved.

Getty image via eggeeggjiew