Graduation Season: Celebrating and Respecting Alternate Paths

During this time of year, social media posts abound with photos A sea of graduates this season.of unfathomably beautiful young men and women in glossy gowns, beaming beside one or two relieved parents, above congratulatory post after post. So Proud! What a future this kid has!

As it happens, this year, our extended family is blessed to celebrate the graduations of two young women of remarkable talents (if we do say so ourselves), one of whom is headed off to college and another who earned a graduate degree. I suspect, when all the ceremonies are done and dusted, there will be no less than two-dozen images posted, multiples of that in genuine congratulations.

But as it’s been said, participating in social media is a double-edged sword. Because for some parents, seeing their nephew, niece or even the neighbor’s kid positioned in that quintessential shot, though well earned, can be incredibly painful. Because not all parents get to watch their child make that customary journey, that straight line from Kindergarten to high school graduation, much less through college.

Many of the Behind the Wall parents talk of their struggle to accept the derailment of their child’s path as a result of mental illness. In many cases, their children had been good students, a few outstanding, and others were also musicians, artists and/or athletes. Until their middle grades, these parents had no reason to believe their child wouldn’t graduate high school and go off to college… like every other kid they knew. It had been assumed before even one page of Goodnight Moon was ever turned. As these parents witness the same cohort of men and women to which their child had once belonged and progressed with, grade-by-grade, now arrive at their graduation, they are confronted by the staggering challenges their own child faces. The graduation ceremony that should have included their child is a brutal reminder of an abandoned path. There is a sense of loss.

To cope with this reality, while still honoring the rightful celebrants, we turn to the wise Behind the Wall parents we interviewed. These parents are strong, their advice informed.

Esme’s daughter, Jennifer, became increasingly ill during her middle grades and into high school as she struggled with what was diagnosed as borderline then later bipolar disorder and complicated with substance use. Jennifer had always been a good student and yet, her brain disorder impeded her ability to finish all her coursework. As Esme put it, she couldn’t even finish a small assignment in English, what had previously been her favorite class.

Sadly, when teens struggle to finish simple coursework or cannot even attend school due to an encroaching mental illness, parents and their children are judged. During her high school years Jennifer also had a few public raging episodes. Talk of it traveled throughout her community. Esme knows that other parents blamed her for Jennifer’s behaviors. Esme says that for those who don’t know what it’s like to live with a person with emerging mental illness, it’s easy for others to judge; other parents assume, those parents let their child run wild, no discipline in that house.

One of the most painful experiences for Esme occurred the day that would have been her daughter’s high school graduation. That day, she drove her younger daughter to the ceremony to cheer on her older, graduating friends. Esme recalls how long that drive to the school felt for her, how excruciating the approach, thinking about what that day could have been for their family.

But Esme then corrects this thinking. It’s not her path. Not yet. What she now understands is that Jennifer will have to chart a different route for herself. There is hope; she can begin recovery and rebuild her life. When she’s ready.

Bianca, whose son became very ill early into his college years and has a diagnosis of schizophrenia, reminds parents to look at the progress of their child not in weeks or months, but over the course of a year. Where was he last year? Is it better? She’s referring to what recovery looks like for a person who is learning to manage their own mental health, particularly after a significant health crisis. What she’s saying is that parents can’t set the timetable for their children. Everyone has to set their own path and timetable.

One young man we know has become a successful tradesperson and is still, one of the kindest persons I’ve ever known. Another, Stella, had been an outstanding student throughout her life. In high school, she had to relearn how to learn during her recovery from a profound episode of psychosis. But she did learn to work with her own challenges and graduated with an engineering degree in a highly specialized field of study from a highly ranked university. For Esme, she is grateful for now that her daughter is working toward recovery, which is progress.

It is worth noting that a young person walking at graduation following an accident or hospitalization that derailed studies is often celebrated at graduation ceremonies. “Look! He’s back after that illness!” We’ve all seen the social media postings—standing ovations. Tears.

Not so much when a person takes leave of absence to address mental illness. That return is quiet. But for that too, we can hold out hope.

As I prepare to write the card and prepare the sentiments to the graduates in our family, I know I will remark on their accomplishments, that they have such promise in their future. These things are all true. I am deliriously happy for them. And this is the distinction that I have come to learn through the wisdom of Behind the Wall parents: That the success of my loved ones is not my own. That their failures aren’t either. What is to be celebrated is their achievement of their goals that they set out to accomplish on their own.

Amongst the pictures and postings of the young people and the less young ones, I will be celebrating goals met, futures open, whatever that looks like for the loved ones in our lives. Even if the accomplishments aren’t marked by graduation gowns.


We welcome your thoughts and comments!

On The Road: Learning More As We Go

Suitcase-2Our Behind the Wall blog and book explores the emotional journey of parents who advocate for their now adult children diagnosed with serious mental illness. The primary criteria we set for this project from the beginning was that the finished work remains worthy of the parents who contributed, contain useful information, effectively convey that parents are not alone in their journey and offer hope that recovery is achievable. Our intent is to provide truth and solace.

Our interviews with parents yielded valuable information and hope. Parents needed to tell stories and we were grateful and honored to be there to listen. Throughout the interviews, consistent themes bubbled up in the stories including chaos, feelings of isolation and grief, coping, hope and recovery.

As we travel around the country for book signings and other speaking engagements, we continue to meet inspiring parents and hear stories. We consistently hear that we are not alone. There are many who live in recovery or have a loved one who does.

Because we feel a responsibility to speak on behalf of parents who share stories with us, below are a few things we’ve learned on the road we’d like to share.

What we learned on the road by talking about mental illness:

We are not alone. We cannot say this enough.
Families are yearning for a voice that recognizes and understands the grief, chaos, confusion and frustration associated with living with a person who has untreated mental illness and is trying to navigate the mental healthcare system.

Hearing stories from others and telling one’s own story has shown to be informative and healing. We all need to be heard. We all need to know there is hope for the difficulties we are experiencing. Knowing what has helped others shines light into the darkness and unknowing of a mental illness diagnosis.

It often seems as if there is constant talk about mental illness in the media and the assumption is that there are resources. Yet at speaking engagements, we are reminded that when a parent or loved one begins the journey of advocating for another, feelings of isolation and grief are new, raw and overwhelming; it’s difficult to see past the roiling emotions to find resources and most importantly, hope. And that’s why we tackled this project in the first place—to address the emotional journey of parents. To help others see the long view.

In order to make a difference for families, we continue to talk about mental illness using factual, clear, non-judgmental language.

After a hospital stay, mental health professionals don’t always provide critical follow-up protocols or advice.
Recently, a parent told us that upon her son’s release from a two-week hospital stay following a mental health crisis, there was no discussion from the mental health professionals (doctors, nurses, hospital administrators) about support or follow-up. “Not one social worker or nurse recommended NAMI (National Alliance on Mental Illness) as a resource or outpatient treatment, nor referred us to a doctor to renew my son’s prescription,” she said. “We had no idea what to do. There was especially no discussion on what we, as parents, should do or even what we could read to learn more…We had no idea how to help him reintegrate into the community and go back to school.”

This may not be the case in every hospital but it certainly was the case for this family and many others. We were disappointed to learn this but were not surprised. We are aware of countless stories (some our own) in which a healthcare provider did not fully understand the larger picture of managing mental illness, nor was the important historical perspective of the parent respected or considered in the treatment, which usually resulted in problematic or even tragic outcomes. Further, after a patient’s first mental health crisis, medical professionals often fail to convey that mental illness requires long-term management.

As family members and healthcare advocates, we can continue to talk about the reality of serious mental illness and that there is support. We can also work with—and on the behalf of—our own NAMI chapters to get information about resources into the hands of mental healthcare providers, especially after a psychiatric hospitalization.

Families and those diagnosed need to hear from health care providers that there is HOPE and RECOVERY. 
We have learned that mental healthcare providers don’t always understand that the parent or the loved one who serves as advocate is crucial to one’s recovery. The parent or person serving as advocate needs to be included in treatment. Period.

Studies show that a person recovering from any health trauma has a much better rate of recovery when well supported by loved ones and community. Who knows a person’s health history better than a parent who watched the illness unfold?

While Elin was speaking at a university hospital to mental healthcare providers in October, a young man who lives with schizophrenia told the group that one psychiatrist told him he would find recovery and that there is hope. The young man said, “That is what gave me hope and today I am in recovery.”

Early diagnosis is beneficial… if it’s possible.
Research shows that early intervention makes a significant difference in treating mental health issues, yet finding treatment for a person under eighteen is thwarted by a lack of available pediatric psychiatrists, a pervasive myth that individuals under eighteen cannot be diagnosed and by HIPAA laws that restrict the communication flow between parent (advocate) and medical professional. Almost every parent laments, “If only my adolescent had been diagnosed earlier…” And, “I knew my son/daughter’s behaviors were more than ‘adolescent angst but no one listened.’”

As John G. Looney, MD, MBA, Professor Emeritus of Psychiatry and Behavioral Sciences and Professor of Pediatrics at Duke University advises, therapists can treat the symptoms that are seen. There is no need for a label as long as the symptoms are being addressed. It is critical for parents, healthcare providers, and the adolescent to work as a team to address presenting symptoms.

Parents and loved ones are hurting.
Unless one has lived a similar experience, the chaos and grief are unimaginable. At book signings, we often meet parents who are deeply emotional, feeling raw from the experience. Fortunately, everyone in the room understands. And that’s what we learned: there are deeply compassionate people in the world ready to hold others upright and walk with them through difficult times. Which leads to…

We can teach others how to support us by asking for what we need; by asking for help the way a parent of any sick kid does it. Yes, I’ll take the casserole and errand running, please.


The best way for parents to get support is to reach out, ask for help.
It’s hard to ask for help, but when dealing with a family member’s health crisis—let’s say it’s cancer— it’s perfectly acceptable to request help. Even commonplace to create a whole website about a person’s struggle.

Recently, my friend’s child was hospitalized for a series of procedures and surgery. They set up a web page so that friends and family could provide support—meals, errands, caring for the sibling— and could follow medical progress through the daily blog written by the child’s mother. Friends and family were thus able to provide support without feeling we were being intrusive.

Why wouldn’t we do this for a family supporting a person in a mental health crisis? Families whose loved one is hospitalized for a mental health crisis need support too. Most friends want to help but may not know how. Maybe they don’t understand mental illness. Chalk it up to stigma.

Because of stigma, mental illness is awkward. We can teach others how to support us by asking for what we need; by asking for help the way a parent of any sick kid does it. Yes, I’ll take the casserole and errand running, please.

Resources are available in most communities; accessing resources can seem elusive.
Families need to learn about evidence-based treatments and where to find them in their community. We are always surprised to learn how challenging it can be to obtain services for the ill person and support for the caregiver. NAMI is a great place to start in most communities, though there are many others.

Anosognosia, or the inability to recognize one’s own mental illness, is the most vexing challenge.
Anosognosia affects about 40 percent of people who live with serious mental illness. At almost every event, we get a question about how to encourage a loved one experiencing anosognosia into treatment. Anosognosia is the root of many challenges in advocating and treating a person with serious mental illness, especially those who are over eighteen. A person cannot move forward in his treatment without acknowledging the diagnosis. We always recommend Xavier Amador’s book, I AM NOT SICK! I Do Not Need Help!* Amador developed the LEAP system of dialogue to gently guide an ill person toward insight and ultimately toward recovery on his own volition.

An important note: a person is more likely to address his illness when his loved ones and others close to him are in agreement about the illness, diagnosis and treatment.

“Letting go” and self-care are difficult concepts for parents.
It goes against a parent’s instincts to think of oneself But taking care of oneself provides the sustenance to care for others. All the parents we interviewed and we meet stress the importance of taking care of oneself.

Let’s keep getting the word out about coping strategies, hope and recovery. Please introduce yourself if you attend one of our events. To find out where we will be speaking next, keep checking our event schedule at:

* We recommend Dr. Amador’s website at:

As always, we welcome your comments:

Eight things NOT to say to a parent whose child lives with serious mental illness and how to respond if you’re THAT parent.

ConversationBubbles2Plus, how to express genuine support.


“What parent doesn’t feel their child’s pain?”

This is what Esme, a contributor / parent to Behind The Wall asks. As the saying goes, “We are only as happy as our most unhappy child.” Parents take on their child’s pain and usually wish they could take it all in their stead. Our parental vigilance is heightened when our child is sick; we fiercely monitor how he is treated physically and psychologically.

This is the agonizing reality for parents of chronically sick children: witnessing the suffering that accompanies an illness. In the case of mental illness, much of this pain derives from societal judgment. With that in mind, imagine saying to the parent of a child who lives with developmental disabilities, “Boy, your son is really, really dumb! Ha!” No one would ever say such a thing. But Annie, a contributor to our Behind The Wall project, tells us that the parent of a boy who went through school with her son once said, “I saw your son on the street downtown. Boy! What a wacko he is!”

As if Annie didn’t know her son has some challenges. Thank you, but yes, she knows his behaviors are sometimes a little odd.

Now, you may be thinking that the person who said such a thing is a clueless person who, if you were to meet, anyone would recognize her as misguided. But in fact, she is a respected body/mind health instructor.

As horrific as this comment may seem, sadly it is not an uncommon experience for parents of adults living with serious mental illness (SMI). But parents like Annie and Esme become accustomed to a society that really doesn’t understand. Esme’s daughter lives with bipolar disorder and borderline personality disorder. Even after being told her daughter was no longer welcome at a friend’s home, Esme is circumspect. Regarding how others perceive her daughter and judge her parenting Esme says, “I’m a private person and also the type of person who doesn’t really care what other people think. It’s not their life and good for them they don’t have these problems. That’s the way it is.”

Here’s a guideline  one may find helpful: many parents describe the grief associated with having a child with persistent mental illness as similar to experiencing a death. But without the casseroles and flowers. 

It is difficult to understand the reality of SMI. Those of us who have a loved one who lives with chronic mental illness all agree that others should be grateful not to know about the challenges brain disorders inflict on both the ill person and his immediate advocates and caregivers. Even non-nuclear family members who don’t live with the ill person don’t really get it. Showing understanding to a parent of a child with SMI does require some degree of delicacy, the same goes for addressing a parent whose child has died or has any other challenging disease. Here’s a guideline  one may find helpful: many parents describe the grief associated with having a child with persistent mental illness as similar to experiencing a death. But without the casseroles and flowers. There is nothing you or anyone can say to make it better, so don’t try. But expressing compassion without judgment, is the gesture of support that is always valued.

Here are some common misguided comments similar to those parents often hear, and how to respond. Even in the tender place that parents reside, responding with honesty can assert one not as victim, but as caregiver and advocate as well as messenger.

1. Be glad it’s only bipolar and not schizophrenia

Response:  Both bipolar disorder and schizophrenia are serious brain disorders and both are difficult for the person living with the illness.

2. She’s just a drunk!

Response:  Yes, she has a dual diagnosis, which means she has a diagnosed mental illness and uses substances. She tends to medicate her depression with alcohol and it has become alcohol abuse, for which she is getting help. 

3. Aren’t you afraid that he’ll hurt you? Aren’t you afraid to live with him?

Response:  Not all people who live with mental illness are violent. I am not afraid of my son. He has never been violent. Actually, people with serious mental illness are eleven times more likely to be victimized by a violent crime than the general population.*

4. Isn’t mental illness just an excuse for bad behavior?

Response: Sometimes mental illness looks like ‘bad behavior’ to others. For instance, when police try to reason with a psychotic person who is hearing voices or experiencing delusions, the person’s behavior may seem odd or defiant. A person experiencing an altered reality may also be very frightened. The person cannot understand or respond to what is said because his inner process is altered, which makes him unable to hear the real world around him or process what is happening. Often, his response times become delayed also. He does not choose to have these experiences.

5. She’s really out of it.

Response:  Yes, she has psychosis. Because of her brain disorder she sometimes hears voices, and her reality is different from ours at this time. She does not choose to have these experiences. What is most helpful to her is kindness and understanding.

6. You poor thing, having a child like that. How do you do it?

Response:  It is challenging to advocate for an adult child with mental illness. There are no outward signs to indicate she needs to be treated with kindness. But there are stigma and myths that perpetuate misunderstanding about mental illness. The person who suffers most is the person with the brain disorder because she remembers herself as she was, and knows what she has lost. What’s painful for parents is that we cannot always help our child and sometimes others falsely judge us for our child’s illness.

7. How did this happen?

Response:  Mental illness is a confluence of genetics, environment, and possibly drug use. It is a brain disorder that we parents didn’t cause.

8. Why won’t he just take his meds and stay in school?

Response: Some people who live with mental illness also have anosognosia, a common feature of brain disorders that affects the self-awareness of one’s own illness. This is the reason many who live with mental illness don’t believe they are ill and therefore, don’t think they need medications. Some professionals and advocates believe that if mental illness was not stigmatized, those who need treatment would be more likely to embrace it.

Here are ways to communicate your support for a parent who cares for a child with a brain disorder:

If you want to learn more

You can say:

  • I don’t know much about brain disorders but explain her illness to me and tell me what I can say to her or how to act toward your daughter.

 After learning about their child’s hospitalization

You can say:

  • I’m sorry. Can I help your family while he is in the hospital? Can I walk your dog, or pick up food for you?
  • Would it be ok to send your child a card in the hospital?

Show general concern

You can say:

  • I’ve heard that it sometimes feels as though you have lost the child you once knew.
  • What would be helpful to you at this time?

You can and want to offer your time or perform a helpful task

You can say:

  • Any time you need to talk, I can listen.
  • Any time you need a distraction, call me and we’ll go to a movie, for a walk, out for coffee…
  • I am happy to offer my _______expertise.

Examples: cook meal, help navigate insurance, find a psychiatrist, research medications, walk the family dog, drive other children to school/ sports/ activities, help the family locate a Family- to -Family NAMI class or find other support.

And one more thought:  If you’re a parent who’d like others— friends or other family members— to understand your difficult parenting journey, or you have a family member whose child lives with SMI, we recommend this blog. Yes, a shameless plug. But we don’t sugar coat anything here and it has helped our own family. Maybe we can help yours.

* Mr. Insel’s blog entry that we have cited can be found at: Thomas Insel, NIMH Director, January 11, 2011.

We welcome your thoughts: